Rotigotine - Uses, Dosage, and Warnings

Overview

Rotigotine was first approved in 2012 by the Food and Drug Administration for treating signs and symptoms of Parkinson’s disease. It is useful to treat patients suffering from mild to moderate disease symptoms. The drug provides continuous delivery for patients with Parkinsonism and restless leg syndrome. The drug is mainly classified under anti-Parkinson agents and dopamine agonists.

How Does Rotigotine Work?

Rotigotine is only available as a transdermal patch. A transdermal patch is an adhesive tape placed on the skin and is used to deliver doses of the drug at periodic intervals. The drug acts on the nervous system and improves the symptoms caused by Parkinson’s disease.

Uses

• Parkinson’s Disease - A disorder that targets the nervous system and gradually affects the body parts controlled by the nerve is called Parkinson’s disease. It usually occurs as a result of genetic and environmental factors.

• Restless Leg Syndrome - The condition is characterized by an uncontrolled urge to move one’s leg due to an uncontrolled sensation. It usually occurs in the evening and is especially high at night. Moving the legs helps to reduce the unpleasant feeling and gives a soothing effect.

Dosage

The drug comes in different doses to accommodate the requirements of each individual. The different doses are mentioned below.

• 2.25 mg.

• 4.5 mg.

• 6.75 mg.

• 9 mg.

• 13.5 mg.

• 18 mg.

These doses are delivered in smaller units, like 1 mg or 2 mg, over a period of 24 hours.

Warnings

The drug can cause side effects in individuals with pre-existing medical conditions. Hence, they should be carefully evaluated before drug administration. Special precautions should be followed in pregnant mothers and renal impairment patients.

For Patients

What Is Parkinson’s Disease?

Parkinson’s disease specifically affects the nerves and the muscles controlled by the nerves. As a result, the affected individual may have impaired movements. The early stages of the disease may have little or no visible effects on the health. The patient may express little or no expression. The disease cannot be completely cured. However, the intake of proper medications at the right time prevents the progression of the disease and contributes to a better life.

Some of the common symptoms of Parkinson’s disease include the following.

• Tremor.

• Rigid muscles.

• Impaired posture.

• Loss of movement.

• Speech problems.

• Difficulty in writing.

The disease occurs as a result of impaired genes. In some cases, environmental factors act as a trigger in exaggerating the disease condition. This occurs due to exposure to certain toxins that have mild ill effects on health.

Learn More About Rotigotine

When and How Often to Take Rotigotine?

The drug is applied as a transdermal patch once every day. The transdermal patch dissipates the medication over a span of 24 hours continuously for solid effects. Once the patch is removed, the efficiency of the drug is reduced. Do not remove the patch without the doctor’s advice, as the treatment may be unsuccessful or the duration may prolong for a better recovery.

How Effective Is Rotigotine?

Rotigotine is extremely effective in patients with Parkinson's disease. Almost 70 % of patients have shown better improvement, including patients above 80. Many studies have successfully proven the drug's efficiency in young and elderly patients.

Things to Inform the Doctor

Before starting any treatment or visiting the doctor, it is essential to carry the list of current medications and previous blood reports. Also, informing the doctor about any previous history of allergic reactions is crucial. This benefits the doctor to prescribe the medications accordingly. The doctor may recommend a few tests before starting the treatment to avoid any adverse effects caused by the drug.

Starting Rotigotine

How to Take Rotigotine?

Unlike other drugs available in various forms like oral, intravenous, and parenteral routes, Rotigotine is only available as a transdermal patch. There is no specific antidote for the drug in case of overdosing. Applying excess transdermal patches should be avoided. The amount of drug circulating usually decreases once the patch is removed. The half-life of the drug is usually between 5 to 7 hours. The patient's heart rate, blood pressure, and heart rhythm should be carefully monitored during the initial dosage of the drug.

Things to Do After Starting Rotigotine

It is better to apply the patch daily as the health care professional recommends. Do not consume certain drugs that may interact with the drug and cause adverse effects. In case of any allergic reactions, report to the doctor immediately.

Look Out for Side Effects:

• Nausea.

• Vomiting.

• Loss of appetite.

• Fainting.

• Weight gain.

• Drowsiness.

• Weight gain.

• Dry mouth.

• Abnormal vision.

• Fainting.

• Loss of energy.

• Joint pain.

• Restless leg syndrome.

• Irregular heartbeat.

• Increased sweating.

• Constipation.

• Abnormal dreams.

• Swelling in hands, feet, and legs.

Some serious side effects have also been reported. In such cases, it is important to visit the doctor immediately.

The symptoms are mentioned below.

• Hives.

• Itching.

• Rashes.

• Hallucinations (hearing abnormal sounds or voices).

• Feeling unusually suspicious.

• Agitation.

• Abnormally excited.

Dietary Alterations:

No specific diet is to be followed while applying Rotigotine. Sometimes, the doctor may recommend specific diets for patients with renal impairment.

What Should Be Done When a Dose Is Missed?

If you miss the dose, kindly contact the health care professional and follow the steps they have mentioned. Do not apply multiple patches in case of missing a dose. A patch of Rotigotine usually dispenses the drug over a period of 24 hours.

What Should Be Done to Treat Rotigotine Overdose?

There is no specific antidote for Rotigotine overdosage. Hence, it is safe to avoid extra patches to prevent unwanted side effects. Some of the side effects caused by the drug are extremely serious as it affects an individual's mental health. Hence, it must be carefully applied per the doctor’s suggestions to avoid complications.

How to Store Rotigotine?

Rotigotine should be stored in the original pouch and kept away from children and pets. Preserve the medication at room temperature for more and better efficiency. Avoid direct exposure to sunlight as it may harm the medicine.

How to Handle Rotigotine?

The transdermal patch of Rotigotine comes in separate pouches. It consists of 30 transdermal patches in a single-carton box. So after using a patch, it should be disposed of safely. The rest should be stored safely in the carton box. Do not reuse it after 24 hours.

How to Dispose of Rotigotine?

It is better to inform the local biohazard waste to collect any medical waste as it can be discarded more safely. It is important to avoid discarding home waste, as there are high chances of other people or pets consuming the medication accidentally. Do not flush it down the toilet. It is better to thoroughly understand the Food Drug Administration's safe disposal methodologies before disposing of the drug.

Avoid Self-Medication:

Rotigotine has to be exactly administered in the doses prescribed by the doctor. Since it is available as a transdermal patch, do not exceed the dosage limit as it may have more side effects. Also, regular visits to the doctor can help understand the disease progression and alter the dose effectively.

For Doctors

Indication:

The FDA has approved the drug to be useful in patients with Parkinson’s disease and restless leg syndrome. However, other specifications of the drug are still under research and yet to be approved by the FDA.

Mechanism of Action:

Rotigotine is continuously delivered through the skin via a silicone-based patch. The patch is replaced once in 24 hours. The drug activates the dopamine receptors in the body. It mimics dopamine's effects, which helps treat Parkinson’s disease.

Pharmacodynamics:

Rotigotine binds to all dopamine receptors but specifically to the D3 receptor, because it has the highest affinity. It is also an agonist at the 5 HT1A receptor as it inhibits dopamine intake and prolactin secretion.

Drug Interactions:

Rotigotine should not be used with specific drugs as it may interact with them, resulting in adverse effects. The doctor may prescribe a dose depending on the medicine consumed and other health issues of the individual. The doctor may also advise following a few precautions before consuming the medicines.

The following interactions are selected based on their potential significance.

• Sulpiride.

• Haloperidol.

• Olanzapine.

• Metoclopramide.

Other Specifications

Rotigotine in Pregnant Women:

Rotigotine should be administered with precaution in pregnant women as there are no specific studies supporting the side effects caused by the drug.

Rotigotine in Lactating Women:

The drug's effect on breastfeeding mothers is yet to be known. Hence it is safe to avoid the drug in feeding mothers as it may affect the child and cause congenital disabilities like developing abnormalities.

Rotigotine in Pediatric Patients:

Many studies are still under research to identify the effects of the drug on pediatric patients. Since children are more sensitive to medicines, it is better to take a proper history of the allergic reactions experienced by the patient before drug administration.

Rotigotine in Geriatric Patients:

Rotigotine is effective in geriatric patients. However, it is not safe for patients taking medications for kidney disorders. Therefore, a thorough examination of the medical history of elderly patients and their current medication history must be done before administering the patch.

Rotigotine in Renal Impairment Patients:

The drug is unsafe in patients with renal impairment. This is because the route of elimination of the drug is via the kidneys. In patients with renal impairment, there may be existing kidney damage. In addition, excessive Rotogotine can cause serious side effects in the kidney. Hence, it is essential to administer the drug as per the doses recommended by the doctor to avoid complications.

Rotigotine in Hepatic Impairment Patients:

The drug has a few effects on hepatic impairment patients. However, the effects are not as severe in patients with renal impairment.

What Are the Clinical Trials Conducted in Rotigotine?

The following trial was conducted on Rotigotine to understand the drug's efficacy.

Objective -The study compared the safety and efficacy of administering Rotigotine as a once-daily, continuous transdermal patch versus the placebo effect in early Parkinson's disease.

Methods - Patients had been randomized to receive Rotigotine at 2 mg/ 24 hrs or the placebo with a weekly titration of 6 mg/ 24 hrs which was maintained for six months.

Outcome - Patients receiving Rotigotine had lower efficacy than those receiving the placebo effect. Also, some adverse reactions at the administration site had been reported, along with symptoms like nausea and dizziness.

Results - The study concludes that Rotigone, when administered at 6 mg/ 24 hours, had been proven effective in early-stage Parkinson's disease.