Neupro

Generic name: rotigotine (transdermal)
Drug class: Dopaminergic antiparkinsonism agents

Medically reviewed by A Ras MD.

What is Neupro?

Neupro is a prescription medicine used to treat Parkinson’s disease and moderate-to-severe primary Restless Legs Syndrome (RLS). Neupro is a patch worn on the skin.

It is not known if Neupro is safe and effective in children.

Description

NEUPRO is a transdermal system that provides continuous delivery of rotigotine, a non-ergoline dopamine agonist, for 24 hours following application to intact skin.

NEUPRO is available in six strengths as shown in Table 4.

Table 4 Nominal Dose, Drug Content, and Transdermal System Size
NEUPRO Nominal Dose	Rotigotine Content per System	NEUPRO System Size
1 mg/24 hours	2.25 mg	5 cm2
2 mg/24 hours	4.5 mg	10 cm2
3 mg/24 hours	6.75 mg	15 cm2
4 mg/24 hours	9 mg	20 cm2
6 mg/24 hours	13.5 mg	30 cm2
8 mg/24 hours	18 mg	40 cm2

The chemical name of rotigotine is (6S)-6-{propyl[2-(2-thienyl)ethyl]amino}-5,6,7,8-tetrahydro-1-naphthalenol. The empirical formula is C19H25NOS. The molecular weight is 315.48. The structural formula for rotigotine is:

The asterisk designates the chiral center.

Neupro

System Components and Structure

NEUPRO is a thin, matrix-type transdermal system composed of three layers as shown in Figure 1:

Backing film

Drug matrix

Protective liner

Figure 1: System Schematic

A flexible, tan-colored backing film, consisting of an aluminized polyester film coated with a pigment-layer on the outer side. The backing provides structural support and protection of the drug-loaded adhesive layer from the environment.
A self-adhesive drug matrix layer, consisting of the active component rotigotine and the following inactive components: ascorbyl palmitate, povidone, silicone adhesive, sodium metabisulfite, and dl-alpha-tocopherol.
A protective liner, consisting of a transparent fluoropolymer-coated polyester film. This liner protects the adhesive layer during storage and is removed just prior to application.

Mechanism of Action

Rotigotine is a non-ergoline dopamine agonist. The precise mechanism of action of rotigotine as a treatment for Parkinson’s disease is unknown, although it is thought to be related to its ability to stimulate dopamine receptors within the caudate-putamen in the brain. The precise mechanism of action of rotigotine as a treatment for Restless Legs Syndrome is unknown but is thought to be related to its ability to stimulate dopamine receptors.

What is the most important information I should know about Neupro?

Neupro is for use on the skin only.

Who should not use Neupro?

Do not use Neupro if you are allergic to rotigotine or any of the ingredients in Neupro. See the end of this leaflet for a complete list of ingredients in Neupro.

What should I tell my healthcare provider before using Neupro?

Before you start using Neupro, tell your doctor if you:

have breathing problems including asthma.
have daytime sleepiness from a sleep disorder or have unexpected or unpredictable sleepiness or periods of sleep.
have mental problems such as schizophrenia, bipolar disorder, or psychosis.
feel dizzy, nauseated, sweaty, or faint when you stand up from sitting or lying down.
drink alcoholic beverages. This may increase your chances of becoming drowsy or sleepy while using Neupro.
have high or low blood pressure.
have or have had heart problems.
are pregnant or plan to become pregnant. It is not known if Neupro will harm your unborn baby.
are breastfeeding or plan to breastfeed. It is not known if Neupro passes into your breastmilk. The amount of breast milk you make may be decreased while taking Neupro. Talk to your doctor about the best way to feed your baby if you take Neupro.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Neupro and other medicines may affect each other causing side effects. Neupro may affect the way other medicines work, and other medicines may affect how Neupro works.

Especially tell your doctor if you take other medicines that can make you sleepy such as sleep medicines, antidepressants, or antipsychotics.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

How should I use Neupro?

How should I use Neupro for Restless Legs Syndrome?

Read the Instructions for Use that come with Neupro for specific information about the right way to apply the Neupro patch.
Use Neupro exactly as your doctor tells you to use it.
Neupro comes in 3 different size (dose) patches for RLS. Your doctor should start you on the lowest dose of Neupro. Your doctor may change the dose weekly until you are taking the right amount of medicine to control your symptoms. It may take several weeks before you reach the dose that controls your symptoms best.
Apply Neupro 1 time each day at the same time each day.
You may bathe, shower, or swim while wearing a Neupro patch. Water may loosen your Neupro patch.
If the edges of the patch lift, you may tape them down with bandaging tape.
If your Neupro patch falls off, apply a new Neupro patch for the rest of the day. The next day, apply a new patch at your regular time.
If you miss a dose or forget to change your Neupro patch, apply a new Neupro patch as soon as you remember. Replace the Neupro patch at your normal time the next day.
Talk to your doctor often about your condition. Do not stop or change your treatment with Neupro without talking to your doctor.

How should I use Neupro for Parkinson’s disease?

Read the Instructions for Use that come with Neupro for specific information about the right way to apply the Neupro patch.
Use Neupro exactly as your doctor tells you to use it.
Neupro comes in 4 different size (dose) patches for Parkinson’s disease. Your doctor should start you on a low dose of Neupro. Your doctor will change the dose weekly until you are taking the right amount of medicine to control your symptoms. It may take several weeks before you reach the dose that controls your symptoms best.
Apply Neupro 1 time each day at the same time each day.
You may bathe, shower, or swim while wearing a Neupro patch. Water may loosen your Neupro patch.
If the edges of the patch lift, you may tape them down with bandaging tape.
If your Neupro patch falls off, apply a new Neupro patch for the rest of the day. The next day, apply a new patch at your regular time.
If you miss a dose or forget to change your Neupro patch, apply a new Neupro patch as soon as you remember. Replace the Neupro patch at your normal time the next day.
Talk to your doctor often about your condition. Do not stop or change your treatment with Neupro without talking to your doctor.

What should I avoid while taking Neupro?

Do not drive, operate machinery, or do other dangerous activities until you know how Neupro affects you.
Avoid exposing the site where you have applied your Neupro patch to heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds, and direct sunlight. Too much medicine could be absorbed into your body.
Do not use Neupro during certain medical procedures called magnetic resonance imaging (MRI) or cardioversion. Using Neupro during these procedures could cause a burn to the site where you applied your Neupro patch.
Avoid direct sunlight if you get a skin rash or irritation from Neupro until your skin heals. Sun exposure could lead to skin color changes.

What are the possible side effects of Neupro?

Neupro can cause serious side effects, including:

severe allergic reactions. Neupro contains a sulfite called sodium metabisulfite. Sulfites can cause severe allergic reactions that are life threatening to some people who are sensitive to sulfites. An allergy to sulfites is not the same as an allergy to sulfa. People with asthma are more likely to be allergic to sulfites. Remove your Neupro patch right away and call your doctor if you have swelling of the lips or tongue, chest pain, trouble breathing or swallowing.
falling asleep during normal activities. You may fall asleep while doing normal activities such as driving a car, doing physical tasks, or using hazardous machinery while taking Neupro. You may suddenly fall asleep without being drowsy or without warning. This may result in having accidents. Your chances of falling asleep while doing normal activities while using Neupro are greater if you take other medicines that cause drowsiness. Tell your doctor right away if this happens. Before starting Neupro, be sure to tell your doctor if you take any medicines that make you drowsy.
hallucinations and other psychosis. Neupro can cause psychotic symptoms including hallucinations (seeing or hearing things that are not real), confusion, excessive suspicion, aggressive behavior, agitation, delusional beliefs (believing things that are not real), and disorganized thinking. If you have hallucinations or any of these other psychotic-like changes, talk with your doctor right away.
changes in blood pressure. Neupro can decrease or increase your blood pressure. Lowering of your blood pressure is of special concern. If you faint or feel dizzy, nauseated, or sweaty when you stand up from sitting or lying down, this may mean that your blood pressure is decreased. If you notice this, you should contact your doctor. Also, when changing position from lying down or sitting to standing up, you should do it carefully and slowly. Lowering of your blood pressure can happen, especially when you start taking Neupro or when your dose is increased.
fainting. Fainting can occur, and sometimes your heart rate may be decreased. This can happen especially when you start using Neupro or your dose is increased. Tell your doctor if you faint or feel dizzy.
unusual urges. Some patients using Neupro get urges to behave in a way unusual for them. Examples of this are an unusual urge to gamble, strong urges to spend money, binge eating, or increased sexual urges and behaviors. If you notice or your family notices that you are developing any unusual behaviors, talk to your doctor.
changes in heart rate. Neupro can increase your heart rate.
skin site reactions. Skin reactions may occur at the site where you apply Neupro. Tell your doctor if you get a rash, redness, swelling, or itching that will not go away at the skin site where you have applied Neupro.
For patients with Parkinson’s disease
- increased weight and fluid retention can occur in patients using Neupro. Neupro can cause your body to keep extra fluid which leads to swelling and weight gain. Tell your doctor if you have swelling or fluid retention, especially in the ankles or legs, or have an unusually fast increase in weight.
- uncontrolled, sudden movements. Neupro may cause uncontrolled, sudden movements or make such movements you already have worse or more frequent. Tell your doctor if this happens. The doses of your anti-Parkinson’s medicine may need to be changed.
For patients with Restless Legs Syndrome
- changes in Restless Legs Syndrome symptoms. Neupro may cause Restless Legs Syndrome symptoms to come back (rebound), or become worse or start earlier in the day.

The most common side effects of Neupro for Parkinson’s disease are nausea, vomiting, sleepiness, application site reactions, dizziness, loss of appetite, difficulty falling asleep and staying asleep, increased sweating, vision problems, leg swelling, and uncontrolled, sudden movements of arms or legs.

The most common side effects of Neupro for Restless Legs Syndrome (RLS) are application site reactions, nausea, difficulty falling asleep and staying asleep, sleepiness, and headache.

Tell your doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Neupro. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Neupro

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Neupro for a condition for which it was not prescribed. Do not give Neupro to other people even if they have the same symptoms you have. It may harm them.

This Patient Information leaflet summarizes the most important information about Neupro. If you would like more information, talk with your doctor. You can ask your pharmacist or doctor for information about Neupro that was written for health professionals.

For more information, go to www.neupro.com or call 1-844-599-2273.