Neupro
Neupro (rotigotine) is a dopamine agonist used to treat adults with Parkinson's disease (PD) and restless legs syndrome (RLS). It helps manage symptoms such as tremors, stiffness, and uncontrollable leg movements. The medication comes as a patch that you apply to your skin once a day. Neupro (rotigotine) is only available as a brand-name medication, with no generic version. Common side effects include nausea, vomiting, and sleepiness.
What is Neupro (rotigotine)?
What is Neupro (rotigotine) used for?
- Parkinson's disease (PD)
- Moderate-to-severe restless legs syndrome (RLS)
How Neupro (rotigotine) works
Neupro (rotigotine) is a dopamine agonist. It's not completely known how it works. But it's thought to turn on dopamine receptors in the brain to help improve movement problems such as tremors, stiffness, and uncontrollable leg movements.
Drug facts
Side effects of Neupro (rotigotine)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Parkinson's disease
- Nausea (28-48%)
- Application site reaction (19-46%)
- Sleepiness (12-32%)
- Dizziness (14-23%)
- Vomiting (8-20%)
- Tiredness (6-18%)
- Uncontrolled muscle movements (14-17%)
- Trouble sleeping (6-14%)
- Swelling in the arms and legs (2-14%)
- Hallucinations (0-13%)
- Joint pain (8-11%)
- Excessive sweating (1-11%)
- Headache (8-10%)
Restless leg syndrome
- Application site reactions (23–43%)
- Nausea (15–23%)
- Headache (15–21%)
- Fatigue and weakness (7-14%)
- Sleepiness (5-10%)
- Trouble sleeping (3-10%)
Less Common Side Effects
Parkinson's disease
- Visual problems
- Abnormal dreams
- Indigestion
- Constipation
- Muscle spasms
- Nasal and sinus congestion
- Flu infection
- Cough
- Redness
Restless leg syndrome
- Itching
- Dizziness
- Dry mouth
- Excessive sweating
- Vomiting
- Constipation
- Diarrhea
- Weight gain
Neupro (rotigotine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Excessive sleepiness: falling asleep during activities, falling asleep while driving, sudden sleep episodes, daytime sleepiness
- Mental health changes: hallucinations, confusion, delusions, aggression, agitation
- Impulsive behavior: strong urges to gamble, uncontrollable sexual urges, intense urges to spend money, binge eating
- Serious withdrawal symptoms: fever, sweating, stiff muscles, confusion, not aware of your surroundings, fast or irregular heartbeat
- Severe allergic reaction: hives, swelling in your face or tongue, trouble breathing
The following Neupro (rotigotine) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Burning, itching, redness, skin rash, swelling, or soreness at the application site
swelling of the hands, ankles, feet, or lower legs
Less common
Bladder pain
bloody or cloudy urine
blurred vision or other changes in vision
difficult, burning, or painful urination
dizziness
frequent urge to urinate
headache
lower back or side pain
nervousness
pounding in the ears
seeing, hearing, or feeling things that are not there
slow or fast heartbeat
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Confusion
convulsions
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
sweating
unusual tiredness or weakness
vomiting
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Sleepiness or unusual drowsiness
Less common
Acid or sour stomach
belching
difficulty having a bowel movement (stool)
difficulty with moving
dreaming abnormal
feeling of constant movement of self or surroundings
indigestion
loss of appetite
muscle pain or stiffness
pain in the joints
sensation of spinning
stomach discomfort, upset, or pain
trouble sleeping
unable to sleep
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Neupro (rotigotine)
Pros
- Approved to treat both PD and RLS
- Patch is applied to the skin once a day
- Good option for people who don't want to take pills
Cons
- Can't stop suddenly; must wean off the medication
- Not suitable for people with sulfite allergies
- Can cause serious side effects, like impulsive behavior and hallucinations
Pharmacist tips for Neupro (rotigotine)
- Neupro (rotigotine) contains a type of sulfite that can cause allergic reactions, including serious symptoms like trouble breathing, facial swelling, or asthma attacks, in some people. Talk to your prescriber if you’ve had an allergic reaction before.
- Let your prescriber know if you feel nauseous, are vomiting, or have stomach upset while taking Neupro (rotigotine). These symptoms are more common when you first start the medication and might mean your dose needs to be adjusted.
- The Neupro (rotigotine) patch can cause dizziness or tiredness, which can affect your ability to focus, think clearly, or react quickly. Avoid driving or using machinery until you know how this medication affects you. Tell your prescriber if you take other medications that make you sleepy.
- Don’t apply creams, lotions, or other skin products to the areas where you place the Neupro (rotigotine) patch. These products can affect how the medication is absorbed into your body, which can make it not work as well.
- Avoid exposing the area where you apply the Neupro (rotigotine) patch to direct sunlight or heat sources like heat lamps, hot tubs, heating pads, or electric blankets. Heat can cause your body to absorb too much medication, which might raise the risk of side effects.
- Don’t stop taking Neupro (rotigotine) without talking to your prescriber first. Stopping suddenly can cause withdrawal symptoms like fever and confusion.
- You can shower, bathe, or swim while wearing the Neupro (rotigotine) patch. If the edges of the patch start lifting, use bandage tape to hold them down.
- Remove the Neupro (rotigotine) patch before certain medical procedures, such as magnetic resonance imaging (MRI) or cardioversion, to avoid skin burns at the patch site.
- If your patch falls off before it's time to replace it: Put on a new Neupro (rotigotine) patch right away in a different spot. Then use a new patch the next day at your usual time.
- If you forget to change your patch: Apply a new patch as soon as you remember. Then, return to your regular schedule for changing patches. It’s fine if you wear the patch for less than 24 hours. Never apply two patches to make up for a missed dose.
How to use Neupro (rotigotine):
- Apply the patch to clean, dry skin and keep it on for 24 hours. Replace it with a new patch at the same time each day.
- To apply the patch: Remove the patch from its pouch. Peel off one side of the adhesive liner and stick the patch to the skin. Then, peel off the other side of the liner. Press down firmly on the patch for 30 seconds, making sure the edges are smooth. Save the pouch for when you need to remove the patch later.
- Place the patch to your stomach, thigh, hip, side, shoulder, or upper arm. Rotate application sites daily, and don't use the same spot more than once every 14 days.
- To remove the patch: Gently peel off one edge of the patch and remove it. Fold the patch in half with the sticky sides together and put it back in the saved pouch before throwing it in the trash.
- Wash your hands well with soap and water after applying or removing a patch, especially if you touched the sticky side since it contains medication. Avoid using hand sanitizer or alcohol-based cleansers, as they can irritate your skin.
Common questions about Neupro (rotigotine)
No, Neupro (rotigotine) isn't a controlled substance because it doesn't have a risk of dependence or addiction.
No. Don't cut Neupro (rotigotine) into smaller pieces. Cutting the patches could change how the medication is absorbed into your body, which could affect how well it works. If you're having problems with your dose, let your prescriber know. They can adjust your dose or recommend other treatments. Always use the patch exactly as directed and only wear one patch at a time.
You might start noticing improvement in your symptoms during the first week of treatment with Neupro (rotigotine). But studies show it can take several weeks for the full effects. Take the medication every day and follow up regularly with your prescriber. If you’ve been taking it for a while without improvement, talk to your prescriber.
Place the Neupro (rotigotine) patch on clean, dry, and hairless skin. You can apply it to your stomach, thigh, hip, side, shoulder, or upper arm. Avoid placing the patch on oily, irritated, or damaged skin, and steer clear of areas where it might rub off, like under tight clothing or belts. Rotate application sites to prevent skin irritation, and don’t use the same area again within 14 days. If you’re unsure where to place the patch, ask your pharmacist or prescriber for guidance.
No, Neupro (rotigotine) doesn't come in pill form. But there are other dopamine agonists that are available in pill form, such as pramipexole (Mirapex ER) and ropinirole. Speak to your prescriber about these other treatment options.
It's possible. Studies show that some people on the highest dose of Neupro (rotigotine) gained more than 10% of their starting weight. This weight gain is linked to fluid build-up (edema). Your prescriber will monitor you for weight gain and fluid build-up, especially if you have other health conditions like heart failure or kidney problems. Let your care team know if you notice any swelling or sudden weight changes.
Avoid alcohol while taking Neupro (rotigotine), as it can make side effects like sleepiness or dizziness worse. Talk to your prescriber if you have questions about drinking alcohol while taking this medication.
No, Neupro (rotigotine) isn't available as a generic.
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Risks and warnings for Neupro (rotigotine)
Neupro (rotigotine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious allergic reactions
- Risk factors: History of asthma | Allergy to sulfites
Neupro (rotigotine) contains a type of sulfite that can cause allergic reactions, including serious symptoms like anaphylaxis or asthma attacks, in some people. Talk to your prescriber if you’ve had an allergic reaction before. Remember, a sulfite allergy isn't the same as a sulfa allergy.
Extreme sleepiness
- Risk factors: Already feeling sleepy | History of sleep problems | Taking other medications that cause sleepiness | Drinking alcohol
Neupro (rotigotine) can make you very sleepy, and you might even fall asleep suddenly during daily activities. These sleep episodes can happen without warning, even if you think you're alert, and have been reported up to a year after starting the medication. Your risk is higher if you're also taking other medications that cause sleepiness, such as benzodiazepines, muscle relaxants, or sleep medications.
To avoid accidents, make sure you know how Neupro (rotigotine) affects you before driving or doing activities that need focus. Talk to your prescriber if you feel too sleepy or have fallen asleep suddenly while taking this medication.
Hallucinations and mental health changes
- *Risk factors: Older adults | History of mental health problems | Advanced Parkinson's disease | Taking higher doses of Neupro (rotigotine) *
Some people taking Neupro (rotigotine) had hallucinations (seeing or hearing things that aren't there), especially those with advanced Parkinson's disease. Others also felt distressed, confused, paranoid or showed aggressive behavior. People with a history of mental health problems are generally not recommended to take Neupro (rotigotine) because it might worsen their condition. These changes can happen after starting the medication or adjusting the dose. Contact your prescriber right away if you or your loved ones notice hallucinations or any changes in behavior while you're taking Neupro (rotigotine).
Low blood pressure and fainting
- *Risk factors: Starting a higher dose of Neupro (rotigotine) *
Neupro (rotigotine) can cause low blood pressure when you move from lying down to standing up (orthostatic hypotension). This might make you feel dizzy, lightheaded, or even faint. These drops in blood pressure are more likely when you're starting a higher dose and can happen when lying down, standing, or changing positions. Let your care team know if you feel dizzy, lightheaded, or faint, especially when standing up. To avoid falls, get up slowly and avoid sudden movements.
Impulsive behavior
Neupro (rotigotine) can cause strong, uncontrollable urges, like gambling, spending money, binge eating, or engaging in sexual activity. Let your prescriber know if you or your loved ones notice new or unusual behaviors when you're taking Neupro (rotigotine). They might recommend lowering your dose or stopping the medication altogether.
High blood pressure and heart rate
- Risk factors: Starting a higher dose of Neupro (rotigotine) | History of heart problems
Neupro (rotigotine) can raise your blood pressure while lying down or standing, particularly when starting a higher dose. Some people also experienced a faster heart rate with this medication. Let your care team know if you notice symptoms like dizziness, headaches, or a racing heart, especially if you have a history of heart problems.
Weight gain and swelling
- Risk factors: Taking a higher dose of Neupro (rotigotine)
Neupro (rotigotine) can cause weight gain and fluid build-up (edema), which are more likely at higher doses. This is especially important for people with heart failure or kidney problems. Let your care team know if you notice swelling, sudden weight changes, or discomfort while taking this medication.
Uncontrolled muscle movements
- Risk factors: Taking medications containing levodopa | Taking a higher dose of Neupro (rotigotine)
Neupro (rotigotine) can cause or worsen uncontrolled body movements, like eye-twitching, lip-smacking, or feet-tapping. The risk is higher if you're also taking other Parkinson's medications with levodopa, such as Sinemet or Rytary. Talk to your prescriber right away if you experience uncontrolled movements that you can't stop.
Skin reactions
Neupro (rotigotine) often causes application site reactions, such as redness, swelling, or itching at the patch area. To reduce the chance of a reaction, use a different area of your body each day and avoid applying the patch to the same spot more than once every 2 weeks. Contact your prescriber if a reaction lasts more than a few days, gets worse, or spreads beyond the patch area. If you develop a widespread skin reaction, your prescriber might recommend stopping the medication.
Worsening symptoms of RLS
Neupro (rotigotine) can worsen your restless leg syndrome (RLS) symptoms. This could mean your symptoms become more intense or start earlier in the day than before treatment. Symptoms might also worsen as the medication wears off at the end of its dose. Contact your prescriber if you notice any changes or worsening of your symptoms while taking this medication.
High fevers and confusion
Although rare, stopping or lowering your dose of Parkinson's disease medications like Neupro (rotigotine) too quickly can cause side effects similar to neuroleptic malignant syndrome (NMS), a serious and life-threatening condition. Symptoms of NMS include very high fevers, irregular heartbeat, sweating, muscle stiffness, confusion, and changes in blood pressure. It’s important to treat NMS as soon as possible. Don’t stop taking Neupro (rotigotine) or change your dose without talking to your prescriber since they can help you do it safely.
Withdrawal symptoms
Some people have reported symptoms like anxiety, depression, fatigue, trouble sleeping, sweating, and pain during or after stopping Neupro (rotigotine). If severe withdrawal symptoms occur, your prescriber might suggest restarting a dopamine agonist at the lowest dose to help manage the symptoms.
Neupro (rotigotine) dosage
Patch| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 1mg | 30 patches | $857.21 | $28.57 |
| 2mg | 30 patches | $844.90 | $28.16 |
| 3mg | 30 patches | $855.84 | $28.53 |
| 4mg | 30 patches | $830.47 | $27.68 |
| 6mg | 30 patches | $835.18 | $27.84 |
| 8mg | 30 patches | $836.57 | $27.89 |
Typical dosage for Neupro (rotigotine)
Neupro (rotigotine) is a patch that you apply to the skin on your stomach, thigh, hip, side of your body, shoulder, or upper arm.
The dose usually starts low, and your prescriber will adjust it based on how well it works to treat your symptoms and if you tolerate it without side effects.
- Early-stage Parkinson's disease: The typical starting dose is 2 mg once a day. The maximum dose is 6 mg per day.
- Advanced-stage Parkinson's disease: The typical starting dose is 4 mg once a day. The maximum dose is 8 mg per day.
- Restless legs syndrome: The typical starting dose is 1 mg once a day. The maximum dose is 3 mg per day.
Interactions between Neupro (rotigotine) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Sulpiride
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Neupro (rotigotine) cost?
$830.47
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