Rotigotine

How it works

It stimulates dopamine receptors, principally D3, D2 and D1 subtypes, providing continuous dopaminergic stimulation through steady transdermal delivery.

Prescribing in practice

• Dopamine agonists can cause impulse-control disorders and sudden-onset sleep, which patients and carers must be warned about and monitored for throughout treatment.
• The patch backing of some formulations contains aluminium and should be removed before MRI or cardioversion to avoid burns.
• Application-site reactions are common; the application site should be rotated and the patch not applied to the same area on consecutive days.

Monitoring

Monitor for impulse-control behaviours, excessive daytime somnolence, blood pressure (including postural drops) and local skin reactions.

Counselling the patient

• Rotate the patch site each day and apply to clean, dry, intact skin to reduce skin reactions.
• Report any new compulsive behaviours such as gambling or compulsive shopping to your clinician.
• Be cautious with driving because of the risk of drowsiness and sudden sleep onset.

Evidence & guidelines

Rotigotine transdermal patches have demonstrated efficacy in randomised trials in both Parkinson's disease and restless legs syndrome and are recommended treatment options in NICE guidance.