Dopamine Agonist — Transdermal Patch (Parkinson's / RLS) Pregnancy: Avoid — limited data

Rotigotine

Brand names: Neupro

Adult dose

Dose: Parkinson's (early): start 2 mg/24h, titrate weekly by 2 mg/24h to max 8 mg/24h; Parkinson's (advanced): max 16 mg/24h; RLS: 1–3 mg/24h

Route: Transdermal patch (apply once daily, rotate sites)

Frequency: Once daily (change patch every 24 hours)

Max: 16 mg/24h (Parkinson's); 3 mg/24h (RLS)

Only transdermal dopamine agonist — provides continuous drug delivery avoiding peaks and troughs associated with oral agents. Particularly useful when oral route unavailable (nil by mouth, dysphagia). Rotate patch sites — abdomen, thigh, hip, flank, upper arm, shoulder.

Paediatric dose

Route:

Seek specialist opinion — not licensed in children.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Caution in severe hepatic impairment.

Clinical pearls

CRITICAL: remove patch before MRI — aluminium backing causes burns. The patient must be reminded at every MRI appointment.
ICD screening at every visit — same risks as oral dopamine agonists (QUIP questionnaire)
Continuous delivery advantage: avoids pulsatile dopamine stimulation — theoretically reduces dyskinesia development. Useful in patients with significant wearing-off on oral regimens.

Contraindications

MRI or cardioversion — remove patch before procedure (contains aluminium in backing layer)
Hypersensitivity to rotigotine

Side effects

Application site reactions (erythema, pruritus, oedema)
Impulse control disorders (ICD — gambling, hypersexuality)
Somnolence and sudden sleep onset
Nausea
Hallucinations
Peripheral oedema

Interactions

Antipsychotics (dopamine antagonism)
Metoclopramide (dopamine antagonism)
Other dopaminergic agents (additive effects)

Monitoring

ICD screening (QUIP)
Application site rotation and skin reactions
Blood pressure (postural)
Sleep assessment

Reference: BNFc; BNF 90; NICE NG71 (Parkinson's Disease); MHRA ICD Warning. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways