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Rotigotine is a dopamine agonist delivered through the skin via an adhesive patch. This transdermal system delivers a steady supply of the medication for 24 hours. Rotigotine’s brand name is Neupro®.
The U.S. Food and Drug Administration (FDA) first approved rotigotine in 2007 to treat Parkinson’s symptoms. The drug is approved for use as a monotherapy in early Parkinson’s and concurrently with other treatments for advanced Parkinson’s. In 2008, the FDA approved the drug for treatment of Restless Legs Syndrome (RLS).
Like other dopamine agonists, rotigotine is designed to connect to the same receptors as dopamine. When you take this class of drug, the goal is to provide a synthetic replacement for the natural dopamine lost due to Parkinson’s.
One way to think about how this works is to think of dopamine and other neurotransmitters as keys. Just as each key has a corresponding lock, each neurotransmitter has a corresponding receptor. Dopamine agonists are chemical “keys” designed to fit the same “lock” as dopamine.
Because it is approved to treat both early and advanced Parkinson’s, rotigotine is available in multiple doses. The higher doses do not require more frequent application of a patch. Instead, the higher doses are delivered via a larger patch.
While there are risks to rotigotine, there are many reasons to consider the drug to manage your Parkinson’s symptoms.
Ease of use is a considerable benefit of rotigotine: A single patch supplies 24 hours of medication. Moreover, because rotigotine is not taken orally, digestive issues do not influence the treatment’s efficacy. For example, you do not need to time your doses around meals, as is often necessary with oral medications like levodopa.
Because rotigotine is not an oral medication, it provides a treatment option for people who have difficulty swallowing.
Many people with Parkinson’s spend part of their morning waiting for medication to take effect. The RECOVER study found rotigotine use corresponded with improvements in early morning motor function over a four-week period.
In 2016, Ikeda et al. found rotigotine helped treat freezing of gait and reduced fall risk. The authors observed that the steady, 24-hour supply of medication may be a factor in this effect.
In 2018, Valldeoriola et al. wrote that rotigotine reduced non-motor symptoms by 14.6%. Improvements were observed in rates of urinary, sleep, and mood/cognition-related symptoms.
In 2020, Castrioto et al. wrote that rotigotine was associated with improvements in levels of anxiety.
Evaluating the RECOVER study, Kassubek et al. observed that rotigotine was associated with decreased pain.
In 2007, Jankovic et al. wrote, “Rotigotine consistently demonstrated statistically significant and clinically relevant efficacy over placebo in patients with early PD, as assessed by significantly greater improvement with time in the UPDRS subtotal scores (parts II and III) and UPDRS parts II and III individual scores.” The authors also wrote that once-daily use of transdermal system provided stable levels of medication in participants’ blood samples over a six-month period.
In 2013, Zhou et al. published a meta-analysis of research about rotigotine. The report’s core findings include that rotigotine significantly reduced the symptoms of Parkinson’s compared to placebo. The report says application-site skin irritation, nausea, and sleepiness were the most common side effects.
Other findings from the 2013 meta-analysis include:
In 2021, Ruan et al. compared the efficacy of multiple dopamine agonists in people with Parkinson’s experiencing motor fluctuations. Their core findings include:
Regarding gastrointestinial side effects, the FDA’s prescribing information notes that in clinical trials rotigotine was associated with increased rates of vomiting and nausea compared to placebo.
In a trial for people with early Parkinson’s:
In a trial for people with advanced Parkinson’s:
In a trial for people with early Parkinson’s:
In a trial for people with advanced Parkinson’s:
Importantly, in discussing an early trial for rotigotine as a monotherapy, authors from the Parkinson’s Study Group write, “Nausea and vomiting occurred primarily during the dosage titration phase, with a trend toward symptom onset at the time of initiation of active drug.” This suggests these side effects may be temporary. Moreover, when analyzing data about adverse events associated with rotigotine, in 2013 LeWitt et al. found most occurrences of nausea were considered mild.
Like other dopamine agonists, rotigotine is more likely than some other Parkinson’s medications to cause or worsen impulse control disorders (ICDs). In 2016, Antonini et al. wrote that 9% of participants in long-term use trials of rotigotine experienced an ICD.
In their 2013 article, LeWitt et al. examined research about long-term rotigotine use by people living with advanced Parkinson’s. The authors evaluated data about adverse events (AEs) from two open-label studies. The table below highlights some of their findings:
| Adverse Event (AE) | Participants in Trial One Experiencing AE | Participants in Trial Two Experiencing AE | Average % of AEs Considered “Mild” |
| Application Site Reaction | 26% | 33% | 71% |
| Fall | 16% | 40% | 50% |
| Hallucination | 9% | 23% | 50% |
| Sleepiness | 34% | 58% | 72% |
| Decreased Weight | 11% | 9% | 62% |
The authors mention other side effects as well, and summarize the AE profile of rotigotine by saying, “With the exception of application site reactions, a known side-effect of the rotigotine patch, the adverse event profiles were similar to those observed in previous long-term studies of other dopaminergic agonists.”
The FDA’s prescribing information also references other risks, including:
While it will not be the best option for everyone, rotigotine is worth discussing with your care team to see if it might be right for you. The medication is approved for use as a monotherapy and as an add-on therapy. Therefore, rotigotine can be a part of your long-term treatment plan and help you remain active and live well for many years.
Despite the possible side effects, rotigotine’s ease of use and unique, transdermal delivery system make it a valuable treatment option. Because rotigotine supplies a steady supply of medication, it can help treat multiple complicated Parkinson’s symptoms—including gait disturbances and sleep related issues—with a single dose, all day long.
2007 Rotigotine Study Report in Jama Neurology
Press Release About Availability in Europe
Canadian Drug Expert Committee Report
Davis Phinney Foundation Medication Guide
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