Neupro

The recommended starting dose for early-stage Parkinson's disease is a 2 mg/24 hour patch applied daily. Depending on the effectiveness and the side effects that you experience, your doctor may gradually increase the dose.

For advanced-stage Parkinson's disease, the starting dose is a 4 mg/24 hour patch applied daily. The daily dose should not be more than 16 mg/24 hour.

To treat the symptoms of restless legs syndrome, the starting dose is a 1 mg/24 hour patch applied daily. It may be gradually increased to a maximum of 3 mg/24 hours.

Neupro (Rotigotine) transdermal patches are to be changed every day at approximately the same time each day. The patch may be applied to the shoulder, upper arm, lower abdomen (belly), flank (the area of your side between your ribs and hip), thigh, or hip. Do not apply heat directly to the patch or to the area of skin close to the patch. This may cause an increased amount of medication to be absorbed into the body, possibly causing an increase in side effects.

To apply the patch:

• Choose a clean and dry area of intact skin that is not oily, damaged, irritated, or exposed to the sun. Avoid areas where it may be rubbed by tight clothing and do not apply lotions or creams to the area where you are applying the patch. This helps prevent the patch from falling off. To avoid irritation, apply the patch to a different area of skin each day. Do not use the same area of skin twice within 14 days.
• Peel apart the foil pouch containing the patch. Remove the patch from the pouch.
• A protective layer covers the sticky side of the patch. Remove the protective layer by holding the patch in both hands with the sticky side facing you. Bend the patch in half to break the protective layer.
• Avoid touching the adhesive. Peel off one side of the release liner. Put the sticky surface of the patch on your skin and press the sticky side of the patch in place.
• Fold back the other half of the patch to remove the other side of the liner and press the patch down firmly with the palm of your hand. Hold the patch in place for about 30 seconds and make sure that the patch is affixed to your skin, especially around its edges.
• Wash your hands with soap and water.

When changing the patch, remove the old one carefully, fold it in half so that the adhesive sides stick together, and throw it away or bring it to the pharmacy for proper disposal. The patch still contains medication that can harm people who do not need the medication. Keep it out of the reach of children or pets. If adhesive remains on your skin, rub it off gently.

Bathing, showering, swimming, or other contact with water does not affect the patch. However, external heat such as hot water, steam, saunas, excessive sunlight, heating pads, or hot water bottles on the area of the patch may cause too much medication to be absorbed into your body. If your patch falls off, apply a new patch.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important that Neupro (Rotigotine) be used exactly as prescribed by your doctor. If Neupro (Rotigotine) is stopped suddenly, there is a risk of developing Neuroleptic Malignant Syndrome which can be fatal. If it becomes necessary to stop the medication, it should be done gradually under your doctor's supervision.

If you forget to apply or change your patch, change it as soon as you remember. If it is close to the time when you normally change your patch, still apply it but change the patch again at your usual time and continue with your regular schedule. Do not wear 2 patches at once. If you are not sure what to do after forgetting to apply or change the patch, contact your doctor or pharmacist for advice.

Store Neupro (Rotigotine) at room temperature in the original pouches until you are ready to apply the patch. Keep this an all other medication out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause drowsiness or dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause nausea and vomiting; it may cause a reaction at the application site. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

1 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 1 mg/24h" contains 2.25 mg of Neupro (Rotigotine) which provides 1 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

2 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 2 mg/24h" contains 4.5 mg of Neupro (Rotigotine) which provides 2 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients: polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

3 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 3 mg/24h" contains 6.75 mg of Neupro (Rotigotine) which provides 3 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients:polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

4 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 4 mg/24h" contains 9 mg of Neupro (Rotigotine) which provides 4 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients:polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

6 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 6 mg/24h" contains 13.5 mg of Neupro (Rotigotine) which provides 6 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients:polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

8 mg/24h
Each flexible beige-to-light-brown, square-shaped transdermal system with rounded edges, imprinted with "Neupro 8 mg/24h" contains 18 mg of Neupro (Rotigotine) which provides 8 mg of Neupro (Rotigotine) over a 24 hour period. Nonmedicinal ingredients:polyester film, siliconized, aluminized, colour-coated with a pigment (titanium dioxide (E171), pigment yellow 95, pigment red 166) layer and imprinted (pigment red 144, pigment yellow 95, pigment black 7), poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerisate, Povidone K90, sodium metabisulphite (E223), ascorbyl palmitate (E304) and DL α tocopherol (E307), transparent fluoropolymer coated polyester film.

Do not use Neupro (Rotigotine) if you are allergic to Neupro (Rotigotine) or any ingredients of the medication.

There may be an interaction between Neupro (Rotigotine) and any of the following:

• alcohol
• Aldesleukin
• Aliskiren
• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• amifostine
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• antihistamines (e.g., cetirizine, doxylamine, Diphenhydramine, Hydroxyzine, Loratadine)
• antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• barbiturates (e.g., butalbital, Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• brimonidine
• Bupropion
• Buspirone
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Carbamazepine
• chloral hydrate
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• efavirenz
• Gabapentin
• kava kava
• Lamotrigine
• Levetiracetam
• levodopa
• Methadone
• Methylphenidate
• Metoclopramide
• Mirtazapine
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Phenelzine, Rasagiline, Selegiline, Tranylcypromine)
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine)
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• Obinutuzumab
• Pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pregabalin
• Phenytoin
• primidone
• Prochlorperazine
• scopolamine
• Tapentadol
• Topiramate
• Tramadol
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Neupro (Rotigotine). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Neupro (Rotigotine).

Allergy: People who are allergic to sulfites may experience a similar reaction to Neupro (Rotigotine). Before you take Neupro (Rotigotine), inform your doctor about any previous adverse reactions you have had to medications or foods, especially pickled foods, beer and wine. Contact your doctor at once if you experience signs of an allergic reaction, such as skin rash, itching, difficulty breathing or swelling of the face and throat.

Behaviour changes: Neupro (Rotigotine) has been known to cause changes in behaviour. You may notice compulsive behaviour, such as gambling, increased sexual activity or inappropriate spending. If you experience symptoms of Depression such as poor concentration, changes in weight, changes in sleep, decreased interest in activities, contact your doctor as soon as possible. If you notice compulsive behaviour or signs of depression in a family member, ensure that they see their doctor.

Drowsiness/reduced alertness: Neupro (Rotigotine) may cause drowsiness, low blood pressure or dizziness and lightheadedness when rising from a lying or sitting position. Avoid driving or operating machinery that requires alertness until you known how Neupro (Rotigotine) affects you.

Heart disease: Neupro (Rotigotine) may cause increases in blood pressure or heart rate, or for your body to retain fluid. If you have a history of high blood pressure or heart disease, this may make the heart problems worse. If you have heart problems or a history of heart problems, discuss with your doctor how Neupro (Rotigotine) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Neupro (Rotigotine), and whether any special monitoring is needed.

Melanoma: People with Parkinson's disease may be at increased risk of developing melanoma (a type of Skin Cancer). It is not known if this increased risk is due to Parkinson's disease or to the medications used to treat Parkinson's disease. Your doctor will monitor you for skin cancer while you are taking Neupro (Rotigotine). Talk to your doctor if you have any concerns.

Movement difficulty: When used in addition to medications containing levodopa, Neupro (Rotigotine) increases the risk of experiencing difficulty starting voluntary movement and can increase the side effects of levodopa. If you experience worsening side effects of these medications, talk to your doctor or pharmacist.

MRI and cardioversion: The backing layer of these patches contains aluminum. If magnetic resonance imaging (MRI) or cardioversion is required, the patch should be removed to avoid skin Burns. Inform any medical professional involved in your care that you are using Neupro (Rotigotine).

Neuroleptic malignant syndrome (NMS): Rarely, Neupro (Rotigotine) can cause a potentially fatal syndrome known as neuroleptic malignant syndrome (NMS). If you notice the symptoms of NMS such as high Fever, muscle stiffness, confusion or loss of consciousness, sweating, racing or irregular heartbeat, or fainting, get immediate medical attention.

Stopping the medication: If Neupro (Rotigotine) needs to be stopped, it should be done gradually, under the supervision of your doctor. Suddenly stopping Neupro (Rotigotine) can cause neuroleptic malignant syndrome, which can be fatal. Discuss with your doctor, the safest way to stop using Neupro (Rotigotine).

Sudden onset of sleep: There are reports of people who take Neupro (Rotigotine) and other medications for Parkinson's disease falling asleep with no warning or drowsiness. If you have a sleep disorder, discuss this with your doctor. If you experience drowsiness while taking Neupro (Rotigotine), avoid driving or using machinery.

Worsening of symptoms: People who take Neupro (Rotigotine) for restless legs syndrome may experience an increase in the severity of symptoms or find that the onset of symptoms occurs earlier in the day, compared to before starting Neupro (Rotigotine). If you experience increased symptoms, talk to your doctor.

Pregnancy: The effect of Neupro (Rotigotine) on a developing baby has not been determined. Neupro (Rotigotine) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Neupro (Rotigotine), contact your doctor immediately.

Breast-feeding: Neupro (Rotigotine) is likely to reduce the quantity of breast milk produced. In addition, Neupro (Rotigotine) may pass into breast milk. If you are a breast-feeding mother and are taking Neupro (Rotigotine), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Neupro (Rotigotine) have not been established for children.

This medication is contained in a patch that is to be applied to your skin, such as the abdomen or the upper arm. Avoid areas where the skin is oily, broken or irritated. If you need to stick the patch to a hairy area of skin, you must shave the area at least three days before sticking the patch there.<br/><br/>Avoid touching the sticky side when handling the patch. To apply: thoroughly clean and dry the area, then apply the patch and press firmly for 30 seconds. When you change patches, apply the new one at a different location. Wait two weeks before applying a patch at the same location. Patches are waterproof; you may swim or take a shower. If your patch comes off during the day, a new patch should be applied for the rest of the day.<br/><br/>You should avoid external heat (for example saunas, hot baths, heating pads) on the area of the patch. The patch may cause itching or a rash where it has been applied. If such a reaction persists, consult your pharmacist. This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. Consuming alcohol may intensify the effect of this product. If you choose to drink alcohol, do so in moderation. Talk to your health care professional to find out exactly how much alcohol you can drink.