Neupro (Rotigotine) Patch Dosing Recommendations
The recommended dosing for Neupro (rotigotine) transdermal patch varies by indication, with early Parkinson's disease requiring up to 8 mg/24 hours and advanced Parkinson's disease requiring up to 16 mg/24 hours, while restless legs syndrome typically requires 1-3 mg/24 hours. 1, 2
Dosing by Indication
Parkinson's Disease
- For early Parkinson's disease (monotherapy): Start at 2 mg/24 hours and titrate up to a maximum of 8 mg/24 hours 1, 2
- For advanced Parkinson's disease (with levodopa): Start at 4 mg/24 hours and titrate up to a maximum of 16 mg/24 hours 1, 2
Restless Legs Syndrome
- Starting dose: 1 mg/24 hours 3
- Maintenance dose: 1-3 mg/24 hours based on symptom control 3
- Maximum dose: 3 mg/24 hours 3
Titration Schedule
Standard Titration
- Increase by 2 mg/24 hours weekly until reaching the effective dose 4, 2
- This allows gradual adjustment to minimize side effects while achieving therapeutic effect 2
Rapid Titration (When Clinically Indicated)
- Can increase by 4 mg/24 hours weekly in advanced Parkinson's disease 4
- Rapid titration has shown similar adverse event profiles to slower titration in studies 4
Administration Guidelines
- Apply patch once daily to clean, dry, intact skin 2, 5
- Rotate application sites daily to minimize skin reactions 2, 5
- Apply to abdomen, thigh, hip, flank, shoulder, or upper arm 2
- Each patch delivers stable drug levels over 24 hours, providing continuous dopaminergic stimulation 1, 5
Special Considerations
- No dose adjustment required based on gender, ethnicity, or for patients with impaired liver or kidney function 5
- The transdermal delivery system is particularly useful when oral administration is problematic (e.g., perioperative period, gastrointestinal disturbances) 2, 5
- The 24-hour continuous, non-fluctuating drug levels can improve early morning and nocturnal symptoms 1
Common Side Effects
- Application site reactions (most common) 1, 2
- Dizziness, nausea, and somnolence 1, 2
- Side effects are generally mild to moderate in intensity 5
Clinical Pearls
- The patch matrix provides continuous, non-fluctuating plasma drug levels at steady state 1
- Rotigotine has high affinity for dopamine D2 and D3 receptors 1
- The transdermal system allows for rapid discontinuation if needed by simply removing the patch 5
- For Parkinson's disease, efficacy is comparable to oral dopamine agonists like ropinirole and pramipexole at appropriate doses 1, 2