Rotigotine

NEUPRO

What it isNon-ergot dopamine agonist delivered transdermally; Parkinson disease and restless legs.

Why this oneContinuous delivery avoids the pulsatile stimulation of oral agonists and works when swallowing fails.

What limits itApplication-site reactions are common. Impulse-control disorders and sudden sleep onset; heat increases absorption.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Parkinson's disease, early-stage	Adults	2 mg/24h patch QD	4 mg/24h (lowest effective)	6 mg/24h
Parkinson's disease, advanced-stage	Adults	4 mg/24h patch QD	—	8 mg/24h
Restless legs syndrome	Adults	1 mg/24h patch QD	1 mg/24h (lowest effective)	3 mg/24h

Titration Increase at weekly intervals (by 2 mg/24h for PD, 1 mg/24h for RLS).

Renal Undefined

Hepatic Undefined

Apply one patch once daily to clean, dry, intact skin (abdomen, thigh, hip, flank, shoulder, or upper arm)
Press firmly for 30 seconds; rotate sites and do not reuse a site within 14 days
Do not apply to oily, irritated, or damaged skin
Discontinue by gradually reducing the dose

Contains sodium metabisulfite — allergic reactions in sulfite-sensitive patients
Falling asleep during activities of daily living / somnolence
Hallucinations / psychosis; dyskinesia
Postural hypotension and syncope, esp. during titration
Impulse control / compulsive behaviors
Elevation of blood pressure and heart rate
Application site reactions (may be severe)
Withdrawal-emergent hyperpyrexia and confusion

Pregnancy No adequate human data; animal studies show adverse embryofetal development.

Lactation No human data; may inhibit lactation (decreases prolactin secretion).

NO BOXED WARNINGS

Principal riskApplication-site reactions; impulse-control disorders

Cost, est. cash$300–$5,000/month

Generic entry2032 est.

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityOrthostasis, hallucinations, dyskinesia and impulse-control symptoms; abrupt withdrawal can be hazardous.

no kinetic interactions