ROTIGOTINE

ROTIGOTINE
(ro-ti'go-teen)
Neupro
Classifications: dopamine receptor agonist; antiparkinson agent;
Therapeutic: antiparkinson agent

Prototype: Levodopa
Pregnancy Category: C

Availability

2 mg/24 h, 4 mg/24 h, 6 mg/24 h transdermal patches

Action

Rotigotine has central dopamine receptor agonist properties. Its mechanism of action in treatment of Parkinson's is thought to be related to its stimulation of centrally located postsynaptic dopamine D2-type receptors.

Therapeutic Effect

Diminishes hypomobility associated with "off" episodes ("end-of-dose wearing off" and unpredictable "on/off" episodes) in persons with advanced Parkinson's disease.

Uses

Treatment of the signs and symptoms of early-stage idiopathic Parkinson's disease

Unlabeled Uses

Treatment of restless legs syndrome (RLS)

Contraindications

Concurrent administration of sedatives; concurrent administration with MRI or cardioversion; rapid withdrawal of rotigotine; pregnancy (category C); lactation. Safe use in children has not been established.

Cautious Use

History or risk factors of hypotension; cardiovascular disease; CHF; renal function impairment; pre-existing dyskinesia.

Route & Dosage

Parkinson's Disease
Adult: Transdermal Initially 2 mg for 24 h; may increase by 2 mg/24 h/wk if tolerated. Max recommended dose is 6 mg/24 h.

Administration

  • Apply immediately after opening pouch to clean, dry undamaged skin on abdomen, lower back, thigh, hip, shoulder, upper arm. Press firmly into place for 20–30 sec. Do not apply to same site more than once every 14 d.
  • Do not apply to shaved skin area within 3 d of shaving.
  • Wash site from which old patch is removed with soap and water to eliminate residual drug.
  • Wash hands after application to remove any residual drug.
  • Always taper dose by 2 mg/d when discontinuing therapy.
  • Store at 20°–25°C (68°–77°F) in sealed pouch until use.

Adverse Effects (≥1%)

Body as a Whole: Accidental injury. CNS: Abnormal dreams, dizziness, fatigue, hallucination, headache, insomnia, somnolence, vertigo. CV: Edema, hypertension. GI: Anorexia, constipation, dry mouth, dyspepsia, nausea, vomiting. Musculoskeletal: Arthralgia, back pain. Skin: Application-site reactions, erythematous rash, sweating. Special Senses: Abnormal vision, sinusitis. Urogenital: Urinary tract infection.

Interactions

Drug: Concurrent use with cns depressents (e.g., alcohol, antidepressants, antipsychotics, benzodiazepines) can potentiate the sedative effects of rotigotine. dopamine agonists (e.g., antipsychotics, metoclopramide) may decrease the efficacy of rotigotine.

Pharmacokinetics

Absorption: 1–64% depending upon application site. Onset: 1–8 h. Distribution: 89.5% Bound to plasma proteins. Metabolism: In liver. Elimination: Urine (71%) with minor stool elimination. Half-Life: 5–7 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor BP, especially during dose escalation when postural hypotension is most likely to occur.
  • Monitor CV status especially in those with CHF.
  • Lab tests: Periodic LTFs and platelet count.
  • Weigh patient periodically and report weight gain associated with peripheral edema.
  • Monitor diabetics for hypoglycemia.

Patient & Family Education

  • Do not apply lotions, ointment, or powder to skin area where patch will be placed.
  • Do not remove patch during the 24 h period between applications.
  • Do not apply heating pads or other sources of heat over the patch.
  • Avoid alcohol or other CNS depressants when using rotigotine.
  • Rotigotine can be very sedating. Do not engage in hazardous activities until response to drug is known.
  • Rise slowly from lying or sitting to a standing positing to minimize risk of postural hypotension.
  • Report any of the following: persistent or severe skin site reactions; nausea, vomiting or general GI distress; excessive daytime sleepiness and interference with activities of daily living; hallucinations, compulsive behavior.
  • Periodic dermatology follow-up is recommended to monitor for melanomas.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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