Rotigotine
Drug Profile
Rotigotine is a non-ergot dopamine D2-agonist with similar actions to those of bromocriptine, but in contrast to bromocriptine (a dopamine D2-agonist) it also has agonist properties at D1 and D3 receptors. It is used as monotherapy in the management of Parkinson's disease, mainly in the early stage. Rotigotine is given as transdermal patches delivering amounts ranging from 2 to 8 mg per 24 hours. The initial dose is 2 mg daily, increased in weekly steps of 2 mg if necessary, to a maximum of 8 mg daily. Patches are applied once daily and should be replaced every 24 hours with the new patch being applied to a different site. Treatment with rotigotine should be withdrawn gradually; the daily dose should be reduced in steps of 2 mg every other day until complete withdrawal is achieved. Rotigotine should be used with caution in patients with severe hepatic impairment and reduced doses may be necessary in cases of worsening impairment.
Rotigotine is also being studied as a transdermal preparation in the treatment of restless legs syndrome.
Indications
monotherapy for early-stage Parkinson's disease, used alone or as an adjunct to levodopa with dopa-decarboxylase inhibitor
Cautions
avoid abrupt withdrawal; ophthalmic testing recommended; avoid exposure of patch to heat; hepatic impairment
Interactions:
Rotigotine has the following interaction information:
Antipsychotics: manufacturer of rotigotine advises avoid concomitant use of antipsychotics (antagonism of effect)
Increased risk of toxicity with myelosuppressive drugs
Metoclopramide: manufacturer of rotigotine advises avoid concomitant use of metoclopramide (antagonism of effect)
Rotigotine belongs to Dopaminergics and will have the following interactions:
Memantine: effects of dopaminergics possibly enhanced by memantine
Methyldopa: antiparkinsonian effect of dopaminergics antagonised by methyldopa
Hypotensive reactions : Hypotensive reactions may be disturbing in some patients during first few days-monitor blood pressure
Contra-indications
pregnancy; breast-feeding; remove patch (aluminium-containing) before magnetic resonance imaging or cardioversion
Side-effects
nausea, vomiting, constipation, dry mouth, diarrhoea, dyspepsia, weight changes; postural hypotension, peripheral oedema; confusion, drowsiness (including sudden onset of sleep), sleep disorders, dizziness, headache, dyskinesia, asthenia, hallucinations; hyperhydrosis, rash (including local reactions to patch), and pruritus; less commonly abdominal pain, anorexia, taste disturbance, palpitation, tachycardia, hypotension, hypertension, atrial fibrillation, syncope, dyspnoea, cough, hiccup, tremor, psychosis, pathological gambling, anxiety, impaired attention, dystonia, paraesthesia, impaired memory, erectile dysfunction, increased libido, arthralgia, and visual disturbances; rarely convulsions and loss of consciousness