Neupro (rotigotine transdermal system) for Parkinson’s disease
Fact-checked by What is Neupro for Parkinson’s disease?
Neupro (rotigotine transdermal system) is a therapeutic skin patch that’s approved for easing the symptoms of Parkinson’s disease. It can be used in both early and advanced stages of the neurodegenerative disease, alone or in combination with treatments such as levodopa.
The motor and nonmotor symptoms of Parkinson’s are caused by the death of nerve cells that produce dopamine, an important brain signaling molecule.
Neupro patches contain rotigotine, which is believed to be a dopamine agonist — a molecule that binds to the same receptors as dopamine to mimic its functions in the brain. This can help compensate for dopamine loss to ease Parkinson’s symptoms. The medication is continuously absorbed into the bloodstream via an adhesive skin patch, called a transdermal delivery system.
UCB markets Neupro in most regions. The medication is also approved for the treatment of moderate to severe restless leg syndrome. There is no Neupro patch generic available.
Therapy snapshot
| Brand name | Neupro |
| Chemical name | Rotigotine transdermal system |
| Usage | Used to treat the symptoms of Parkinson’s |
| Administration | Skin patch |
Who with Parkinson’s can take Neupro?
In the U.S., Neupro is approved as a Parkinson’s treatment. It has similar approvals in other regions, specifically the European Union and Canada.
Neupro is contraindicated, or should not be used, in people with allergies to the medication or any of its ingredients, including the known allergen sodium metabisulfite.
It is also not usually recommended for people with major psychotic disorders, as it may exacerbate symptoms.
How is Neupro administered in Parkinson’s?
Neupro is available as transdermal patches with an adhesive backing. The patches should be worn continuously for 24 hours and replaced each day at approximately the same time.
The patches are available in various sizes, corresponding to different dose strengths. The recommended dose depends on the stage of Parkinson’s and how symptoms respond to treatment. Typically, doctors prescribe a lower starting dose and gradually increase it as needed — up to 6 mg per day for early Parkinson’s and 8 mg/day for advanced Parkinson’s.
A healthcare provider can provide specific instructions about how to use Neupro patches. Typically, the patches are pressed firmly onto an area of skin that is clean, dry, not irritated or damaged, and not likely to be rubbed by clothing. Neupro patch application sites can be the front of the abdomen, thigh, hip, flank, shoulder, or upper arm. The sites should be rotated so the same one isn’t used more than once within a two-week period.
Neupro patches should be removed before MRI scans, and patients should avoid exposing the patches directly to external heat sources.
Neupro in Parkinson’s clinical trials
Five clinical trials supported the approval of Neupro for Parkinson’s.
Three of these collectively involved more than 1,000 people with early Parkinson’s. The trials focused on how Neupro affected combined scores on the Unified Parkinson’s Disease Rating Scale (UPDRS) parts 2 and 3, which evaluate the severity of motor symptoms and their impact on daily functioning.
- In one trial, Neupro given at 4-8 mg/day led to significant improvements in UPDRS scores relative to the placebo group; there was no added benefit of doses higher than 6 mg.
- Another trial found that Neupro, at at dose of up to 6 mg/day, improved UPDRS scores by a mean of 4 points — a significant difference from the placebo, where a mean 1.3-point worsening was observed.
- In the third trial, called SURE-PD, Neupro led to a significant, 4.5-point improvement in UPDRS scores relative to the placebo. The therapy was as effective as lower doses of ropinirole, an oral dopamine agonist, though ropinirole overall appeared to have greater effects.
The remaining two trials involved 857 participants with advanced Parkinson’s who were taking levodopa but experiencing off episodes, or periods where motor symptoms return in between levodopa doses. In these trials, Neupro was used as an add-on to levodopa.
- The PREFER study showed that Neupro led to significant reductions in daily off time compared with a placebo — by a mean of 1.8 hours with a low dose (8 mg/day) and 1.2 hours with a higher dose (12 mg/day) — over about six months of treatment.
- CLEOPATRA-PD (NCT00244387) demonstrated that Neupro, given at a dose of up to 16 mg daily, significantly decreased daily off time by a mean of 1.6 hours compared with a placebo over six months. The medication showed effectiveness similar to that seen with the oral dopamine agonist pramipexole hydrochloride (sold as Mirapex and others).
Neupro side effects
The most common Neupro patch side effects are:
- nausea
- vomiting
- sleepiness and sleep disturbances
- application site reactions
- dizziness
- loss of appetite
- increased sweating
- vision disturbances
- swelling of the arms and legs
- dyskinesia, or uncontrolled, sudden movements
Neupro may cause new dyskinesia or exacerbate existing dyskinesia related to ongoing levodopa treatment. Adjusting the levodopa dosage can sometimes help resolve or ease these problems.
Other potential safety considerations for Neupro include:
- serious systemic allergic reactions, especially for people with sensitivity to sulfites
- local reactions where the skin patch is applied, such as swelling, redness, or itching
- excessive drowsiness or falling asleep during everyday activities
- new or worsening hallucinations and psychotic-like behavior, especially with advanced Parkinson’s
- problems with impulse control or strong compulsions
- low blood pressure and fainting, especially when increasing the dose
- high blood pressure and heart rate changes
- fluid retention and weight gain
Patients will be monitored for these complications; if any occur, treatment with Neupro may need to be discontinued or the dose adjusted. Suddenly stopping Neupro can trigger potentially serious withdrawal symptoms, including high fever and confusion. If discontinuation is required, the dose should be gradually reduced under medical supervision.
Parkinson's News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
