Rotigotine: Effects, Uses & Risks

The drug rotigotine belongs to the group of non-ergoline dopamine agonists and is used in the therapy of restless legs syndrome or Parkinson’s disease.

What is rotigotine?

Rotigotine is a so-called aminotetroline and tiophene derivative that is very similar to dopamine. It is liptophilic and has an extremely low molecular weight, so it is well suited for patch administration.

Pharmacological action

The drug rotigotine belongs to the group of non-ergoline dopamine agonists and is used in the therapy of restless legs syndrome or Parkinson’s disease. At certain receptors for the neurotransmitter dopamine, rotigotine mimics the effect of this substance, with this beneficial effect being caused by the D3, D2 and D1 receptors, which are activated in the caudate nucleus. The caudate nucleus is found in the end brain (cerebrum) and is partly responsible for the control of voluntary movements.

Medical application and use

Rotigotine is used in the early stages of Parkinson’s disease; in later stages, it may also be combined with levopoda. In addition, the drug is also used in restless legs syndrome. It is applied in the form of a so-called transdermal patch, from which the active ingredient is released. Rotigotine is thus supplied continuously for 24 hours, which leads to an improvement in mobility as well as a reduction in dyskinesia (walking disorders). The dose ranges from 1 to 16mg per 24 hours, and the patch works regardless of absorption disorders, gastroparesis and meals. The drug comes in four different patch sizes that release either 2, 4, 6, or 8mg of rotigotine within 24 hours. Typically, the drug is used over a longer period of time. It is started at a low dose, then increased weekly until the patient reaches the dose that is right for them. Many patients reach a dosage of 6 to 8mg per day within four weeks, with 8mg being the maximum dosage. Patients who have advanced Parkinson’s disease reach the maximum dose of 16mg per day after about seven weeks. Rotigotine is applied at the same time each day, and the skin should be dry, clean and unbroken. In addition, the site must be changed every day. Common application sites include the upper arm, hip, thigh or abdomen. Patients should not use lotions, oils, creams or other skin care products near the patch. If the patch is applied to a hairy area of the skin, the area should be shaved three days before the patch is applied. In low doses, rotigotine is also used for restless legs syndrome, which involves twitching of the legs that cannot be kept under control by the patient.

Risks and side effects

Side effects such as drowsiness, dizziness, vomiting, or nausea may occur during therapy with rotigotine. Very rarely, patients also suffer from chronic cough. If neuroleptics are taken at the same time, the effect of the drug may be reduced. No data are yet available on the safety of the drug during pregnancy, but it can be expected that milk production may be suppressed by the drug. Therefore, it is recommended that rotigotine not be used during pregnancy and lactation. In combination with levodopa, some side effects such as movement disorders, water retention in the legs or delusions may occur more frequently, which should also be taken into account by the physician. In addition, the active substance should be discontinued before cardioversion or MRI. Careful consideration must also be given to the risk in patients whose liver function is severely restricted, as rotigotine can only be broken down very slowly in this case. Patients who suffer from drowsiness or sleep attacks as a result of taking rotigotine must not drive vehicles or perform any activity that could endanger themselves or others. Rotigotine skin patches may also cause skin irritation, although these are not severe reactions, but ulceration or blistering may occur. Regular eye examinations are also recommended during rotigotine use.If vision problems occur, it is recommended to consult a physician.