Neupro Patch Treatment for Restless Legs Syndrome (RLS) Symptoms

Skin Patch Works as a Dopamine Agonist, May Cause Rashes

The Neupro transdermal patch is a prescription medication used to treat restless legs syndrome (RLS) and Parkinson's disease with some common side effects like rash
The Neupro transdermal patch is a prescription medication used to treat restless legs syndrome (RLS) and Parkinson's disease with some common side effects like rash. Tetra Images/Getty Images

The Neupro patch is a prescription medication, sold under the generic name of rotigotine transdermal, that is applied to the skin and may be used to treat the symptoms of Parkinson’s disease and restless legs syndrome (RLS) or Willis-Ekbom disease. How does the Neupro patch work? What are some of the common and serious side effects? Learn about the use of Neupro to treat these neurological and sleep conditions, including the cost, site placement, and cautions.

Using the Neupro Patch to Treat Restless Legs Syndrome

Neupro is a prescription patch that can be used to treat Parkinson’s disease and moderate to severe restless legs syndrome (RLS). Parkinson’s disease is characterized by resting tremor, stiffness or rigidity, slowness of movement, and postural instability leading to falls. RLS consists of an uncomfortable or disagreeable sensation associated with an urge to move that occurs most often when lying down in the evenings. Movement characteristically relieves this uncomfortable sensation. Each of these distinct conditions is caused by abnormalities related to dopamine.

How Does a Neupro Patch Work?

The Neupro patch works by stimulating dopamine receptors within the body. It is known as a non-ergot dopamine agonist. Dopamine is one of the neurotransmitters, or chemical messengers, within nerve cells in the brain and peripheral nervous system. As a so-called dopamine agonist, Neupro improves the function of these important cells.

Who Should Not Use a Neupro Patch?

There are certain conditions where Neupro patches should be used with caution or not at all. It should not be used in the setting of psychosis. It should only be used cautiously if you are allergic to sulfites. Neupro has the potential to interact with other medications, especially those that may depress levels of consciousness.

You should discuss its use and the potential of interaction with your other medications with your doctor. Alcohol use should be avoided with the use of Neupro. Further caution is needed in the setting of cardiovascular disease and some other sleep disorders that increase the risk of excessive daytime sleepiness. As it may cause swelling in the feet or legs as a side effect, Neupro should not be used by those who may be at risk of fluid retention. The safety of Neupro in pregnancy and breastfeeding is unknown.

What Are Common Side Effects Associated with the Neupro Patch?

As with any drug, there is the potential for harmful side effects with the use of the Neupro patch. Although you would not be expected to experience most side effects - and would likely not experience any of them - some of the more common that can occur with the use of Neupro include:

  • Skin reaction at the site of patch application (affecting 37% in 1 year)
  • Sleepiness or fatigue
  • Swelling (Peripheral edema)
  • Nausea or vomiting
  • Upset stomach
  • Loss of appetite
  • Dizziness
  • Headache
  • Insomnia or sleep disturbance
  • Sweating
  • Sensory changes
  • Redness (Erythema)
  • Joint pain or muscle spasms
  • Constipation
  • High blood pressure (Hypertension)
  • Abnormal dreams
  • Upper respiratory infection (like the common cold)
  • Compulsive behaviors (such as uncontrolled shopping or gambling)
  • Risk of symptom rebound or augmentation (affecting 13%)

In a 5-year trial of 295 patients who used Neupro, 57% discontinued treatment. In this study, 30% stopped use due to side effects and 11% stopped using the patch because of a lack of benefit. If you are concerned about a potential side effect, it is recommended that you contact your prescribing doctor immediately.

What Are Potential Serious Reactions with Neupro Patch Use?

Severe reactions to the medication may also occur. Though these occur infrequently, some of the potential serious reactions include:

  • Sudden sleep episodes
  • Lightheadedness or fainting
  • Hallucinations
  • Psychosis
  • Sensory changes
  • Fibrosis (thickening or scarring of tissues) tic complications
  • Retinal degeneration (in animal studies)
  • Neuroleptic malignant syndrome (in abrupt withdrawal)

If you are concerned about any of these serious reactions, consider urgent evaluation and discontinue the use of the medication under doctor supervision.

Additional Information About Neupro Use: Cost, Placement, and Cautions

For the treatment of restless legs syndrome, doses of 1 mg to 3 mg are used for treatment. Generally, a lower dose is started and only increased as needed. The doses should be increased after 1 week of use. If the medication is stopped, the doses should be reduced by 1 mg every other day and then stopped. The costs vary with insurance coverage and pharmacy pricing, but the average monthly expense is $575 to $675 without insurance, depending on the dose.

The Neupro patch is placed on the skin and the site of placement should be rotated. It should be applied once per day in the morning. Each site of application should be used once in 2 weeks to avoid developing a rash.

There are some who should use Neupro with caution or not at all, as described above. The safety of the medication in pregnancy and breastfeeding is not well established. It is important to monitor your blood pressure when starting or increasing the dose of the medication to avoid fainting. Routine skin examination should be performed to identify any reactions. As the backing of the patch contains aluminum, it must be removed with cardioversion procedures as well as during an MRI to avoid burns. As described above, the medication should be tapered if being discontinued to avoid side effects from abrupt withdrawal.

If you have any difficulties with the use of Neupro, you should be in close contact with your prescribing health provider or a board-certified sleep specialist.

Sources:

“Neupro.” Epocrates Rx Pro. Version 5.1.2, 2013. Epocrates, Inc. San Mateo, California.

Oertel W, et al. "Long-term safety and efficacy of rotigotine transdermal patch for moderate-to-severe idiopathic restless legs syndrome: a 5-year open-label extension study." Lancet Neurol 2011;10:710-720.

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