Rotigotine skin patch (Neupro)

Rotigotine (Neupro) can be used at any stage of Parkinson’s. It is used on its own, with levodopa medication or with other Parkinson’s medication. If it is used with levodopa, this will usually happen later on in the condition when levodopa can be less effective and more doses are needed.

The patient information leaflet that comes with your medication will give you full details about how to use each patch correctly. We have included some key information here.

You need to apply a new patch every day. This should be done at the same time each day. A good time to put on a new patch is in the morning after your bath or shower.

The patient information leaflet that comes with your rotigotine skin patch (Neupro) will list all the areas where you can apply it safely but these include your:

• thighs
• hips
• tummy and waist
• shoulder area
• upper arms

Rotigotine can cause skin irritation so if you use the patch on a specific area of skin, do not reapply the patch to the same spot for at least 14 days. Placing the patch on an area of skin nearby should not create any problems. See the section on Risks and side effects of rotigotine (Neupro).

The patches come in individual packets like plasters. So you can take out the patch, peel off the backing and stick it to you skin. Avoid touching the sticky side of the patch.

Hold the patch in place for 30 seconds to make sure it is firmly attached to your skin and to allow the drug to start working. After this it can stay in place for 24 hours before you remove it and apply a new one. Your Parkinson’s nurse or pharmacist can show you how to apply the patch if you are unsure.

If you forget to apply the patch at your usual time or if it falls off, put a new one on as soon as you remember and keep it on for the rest of the 24 hours. Do not change the time of your next dose. Put a new patch on at your usual time.

Download diagrams that show you how to apply your Neupro patch.
The diagrams were supplied by UCB, the pharmaceutical company that make Neupro.

Dosage

Neupro skin patches come in different strengths. The strength of patch that you use at the beginning will be low. Over time this can be increased to make sure that your symptoms are well controlled.  

Your healthcare professional will decide the right dose for you. Check your prescription each time to make sure that it’s correct.

If you use a rotigotine skin patch (Neupro) you can have a bath or shower, and you can exercise. So there shouldn’t be any day-to-day need to remove it. Just make sure that the patch doesn’t get too hot. For example, take care on a hot day, do not expose the specific area of skin to direct heat such as a sauna and avoid having a bath that is too hot. See the section below on skin irritation to find out more.

If you apply your rotigotine skin patch to an area of your body which moves, such as your arm, you may find it difficult to keep it in place for 24 hours. If this happens, try using medical tape to stick it in place. This is sometimes called Micropore tape and you can buy it at a pharmacy.

Medical procedures

The material on the back of each skin patch contains aluminium. This means that you should remove your skin patch if you are having certain medical investigations such as a magnetic resonance imaging (MRI) scan.

You should also remove it if for certain heart procedures.

It is best to talk to your healthcare professional before you have any medical procedure to find out whether you need to remove your skin patch.

Using a rotigotine (Neupro) skin patch means that rotigotine is released at a constant rate throughout the day.

But it’s important to remember that rotigotine (Neupro) may have been given to you as an extra medication on top of your other Parkinson’s treatment. This means you will have to continue taking these medications and they will also be released into your body.

Sometimes rotigotine is used when you have trouble with swallowing or can’t eat (known in hospitals as Nil by Mouth).

A rotigotine skin patch (Neupro) may also be useful if you:

• want your treatment regime to contain fewer tablets. This could be useful if swallowing medication is tricky for example.
• experience restless legs syndrome, which causes an overwhelming urge to move your legs
• continue to experience poorly controlled Parkinson’s symptoms despite using levodopa medication or other treatment for Parkinson’s
• experience motor fluctuations from your levodopa drugs wearing off – the dose of rotigotine can be adjusted to reduce ‘off’ periods and increase the times when you are ‘on’

‘On/off’ refers to movement fluctuations, usually caused by levodopa medication wearing off before the next dose is due. ‘On’ is when your symptoms are controlled and when you feel at your most capable. Being ‘off’ is when your Parkinson’s symptoms come back and affect you the most. Some people have described this as like a light switch being turned on and off, or going up and down like a yo-yo.

The patient information leaflet that comes with your rotigotine skin patch (Neupro) will tell you the full range of side effects you may experience. This does not mean you will experience all of them.

Most people won’t experience any problems with rotigotine skin patches (Neupro) but speak to your healthcare professional if you experience any of the things listed below.

Skin irritation

A Neupro skin patch may cause a skin reaction on the area of skin where you place the patch. This can include red or itchy skin, but this is usually mild and will normally disappear a few hours after you remove the patch. Moving the skin patch to a different part of your body every day will help to avoid irritation.

If an area of your skin gets sore and itchy after having the patch on it, try using a cold compress to cool it down. You can buy one from the pharmacy or make your own using ice or something else frozen wrapped in a cloth. Hold this over the area of skin to soothe it.

If you are allergic to plasters or if your skin shows any reaction to the skin patch that doesn’t go away then you should inform your healthcare professional.

Sleep issues

Rotigotine is a dopamine agonist medication, so can make you feel very sleepy, faint or dizzy. This is most likely to happen when you start using it. Once a stable dose is reached, this effect often wears off.

Increased sleepiness or a sudden onset of sleep, without any warning, has been reported. If this happens, it’s important that you tell your specialist or Parkinson’s nurse.

Impulsive and compulsive behaviours

Impulsive and compulsive behaviours are side effects of Parkinson’s medication that can cause particular disruption to your everyday life. Behaviours can include gambling, becoming a ‘shopaholic’, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on people’s lives including family and friends.

Remember that not everyone taking Parkinson’s medication will experience this behaviour so it should not put you off taking your medication to control your symptoms. But it’s important to be aware of what these side effects are.

If you have a history of behaving impulsively you should mention this to your GP, specialist or Parkinson’s nurse. 

Asking your specialist team to make changes to your medication regime or adjusting the doses that you take is the easiest way to control impulsive and compulsive behaviours if you begin to experience these side effect. So, tell your healthcare professional as soon as possible before they create large problems.

If you are not able to get through to your healthcare professional straight away, you can call our Parkinson’s UK helpline on 0808 800 0303.

We have a range of advice that can help you manage impulsive and compulsive behaviours as well as information on what unusual behaviour to look out for.