Neupro (Rotigotine)

Neupro is a dopamine agonist indicated for movement‑disorder conditions.

• Parkinson's disease: improves motor symptoms and reduces OFF periods in patients with idiopathic Parkinson's disease.
• Restless legs syndrome: lessens the urge to move the legs and improves sleep quality in adults with moderate to severe RLS.

• Rotigotine is absorbed continuously through the skin from the transdermal patch, delivering steady plasma concentrations. It stimulates dopamine D1, D2, and D3 receptors in the central nervous system, providing dopaminergic activity that compensates for the deficient endogenous dopamine seen in Parkinson's disease and restless legs syndrome.

Common Side Effects

• Application site reactions: erythema, pruritus, or edema at the patch site.
• Nausea or vomiting.
• Dizziness or light‑headedness.
• Somnolence or fatigue.
• Dry mouth.
• Increased sweating.

Serious or Rare Side Effects

• Hallucinations or psychotic symptoms.
• Impulse control disorders such as compulsive gambling or hypersexuality.
• Severe hypotension or syncope.
• Allergic reactions including skin necrosis or anaphylaxis.

Before initiating therapy, clinicians should evaluate patient‑specific risk factors.

• Cardiovascular assessment: monitor for orthostatic hypotension, especially in elderly patients.
• Psychiatric history: watch for hallucinations, confusion, or impulse control disorders.
• Hepatic function: consider dose adjustment in moderate hepatic impairment.
• Concomitant dopamine antagonists: avoid or use with caution due to antagonistic effects.
• Hypersensitivity: discontinue if allergic reaction to rotigotine or patch excipients occurs.
• Store at room temperature: keep in the original pouch, protect from moisture and direct sunlight.

Rotigotine may interact with several drug classes.

Major Interactions (Avoid)

• MAO‑B inhibitors (e.g., selegiline, rasagiline): risk of hypertensive crisis.
• Strong CYP1A2 inhibitors (e.g., fluvoxamine): may increase rotigotine exposure.
• Potent CYP2C19 inhibitors (e.g., omeprazole): can raise plasma levels.
• Antipsychotics with dopamine antagonism (e.g., haloperidol): reduce therapeutic effect.
• Other dopamine agonists: additive dopaminergic effects.

Moderate Interactions (Monitor Closely)

• Antihypertensives: enhanced hypotensive effect.
• CYP3A4 inducers (e.g., carbamazepine, rifampicin): may lower rotigotine concentrations.
• Alcohol: may increase central nervous system depression.
• SSRIs or SNRIs: potential for increased nausea.
• Nicotine replacement therapy: may affect patch adhesion and absorption.