From the Guidelines
Rotigotine is the primary transdermal medication used for Parkinson's disease, available as a patch (Neupro) that delivers medication continuously through the skin over 24 hours. The typical starting dose is 2 mg/24 hours, which can be gradually increased to a maximum of 8 mg/24 hours based on response and tolerability 1. The patch should be applied once daily to clean, dry, intact skin, rotating application sites to prevent skin irritation. Other transdermal options include the rotigotine-ethosomal gel, though it's less widely available. Transdermal delivery offers several advantages for Parkinson's patients, including steady medication levels that help reduce motor fluctuations, avoidance of first-pass metabolism, and easier administration for patients with swallowing difficulties. Common side effects include skin reactions at the application site, nausea, somnolence, and dizziness. These medications work by stimulating dopamine receptors in the brain, helping to compensate for the dopamine deficiency that characterizes Parkinson's disease.
Some key points to consider when using transdermal rotigotine for Parkinson's disease include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Rotating application sites to minimize skin irritation
- Monitoring for common side effects such as nausea, somnolence, and dizziness
- Considering the potential benefits of transdermal delivery, including reduced motor fluctuations and easier administration
It's also important to note that while rotigotine is a commonly used transdermal medication for Parkinson's disease, other options such as rivastigmine may be considered in certain cases, particularly for patients with mild cognitive impairment or REM sleep behavior disorder 1. However, rotigotine remains the primary transdermal medication used for Parkinson's disease, and its use should be guided by the most recent and highest-quality evidence available.
From the Research
Transdermal Medication for Parkinson's Disease
- Transdermal rotigotine patch is a well-established treatment option for Parkinson's disease (PD), offering a convenient alternative to oral medication 2, 3, 4.
- The patch delivers the drug over a 24-hour period, providing continuous dopamine stimulation, which can help improve motor and non-motor symptoms of PD 2, 5, 3.
- Rotigotine transdermal patch has been shown to be effective in improving motor symptoms, such as tremors and rigidity, as well as non-motor symptoms, including sleep disturbances and health-related quality of life (HRQOL) 2, 3, 4.
Efficacy and Tolerability
- Clinical trials have demonstrated the efficacy and tolerability of rotigotine transdermal patch in patients with early and advanced PD, with treatment benefits maintained for up to 6 years 2.
- The patch has been shown to be generally well-tolerated, with an adverse event profile characterized by adverse events typical of dopaminergic stimulation and transdermal patch application 2, 3.
- Application-site reactions were the most frequent adverse event, but were considered mild to moderate in the majority of cases 3.
Use of Wearable Devices
- The use of wearable devices, such as Kinesia 360, can help assess motor function in PD patients and titrate medication, leading to improved motor symptom management 6.
- Continuous, objective, motor symptom monitoring using a wearable biosensor as an adjunct to standard care may enhance clinical decision-making and improve outcomes in PD patients starting rotigotine 6.
Clinical Experience and Recommendations
- Rotigotine transdermal patch has been used worldwide for over a decade, with a well-established safety and efficacy profile 2, 4.
- The patch offers a safe and efficacious alternative for the treatment of PD, and can be particularly useful in patients with gastrointestinal disturbances or other conditions that reduce the suitability of oral medication 2, 4.
- Recommendations for the use of rotigotine transdermal patch in PD include its use in selected cases, such as in acute medical emergencies or nil-by-mouth or pre/post-surgical scenarios, and in the context of personalized medicine 4.