Movement disorders
Henry J. Woodford in Essential Geriatrics, 2022
Swallowing disorders (see Chapter 2) are common and can develop even in the early stages of PD.91 These include abnormal tongue control or festination, delayed swallowing reflex and impaired pharyngeal peristalsis. Swallowing problems do not always respond to dopaminergic therapy and can be made worse by intercurrent illness. This may lead to an inability to take usual medications and further functional impairment. This is also an issue when people with PD are made ‘nil by mouth' in the peri-operative period.92 Options include giving medications in a dispersible form via a nasogastric tube, using a transdermal rotigotine patch or a subcutaneous infusion of apomorphine. Equivalent doses of drugs can be calculated – seeTable 9.2. However, initial rotigotine patch doses should not exceed 4 mg/day to reduce the risk of adverse events.
Dermal and Transdermal Drug Delivery Systems
Tapash K. Ghosh in Dermal Drug Delivery, 2020
A phase II clinical trial evaluated the effectiveness of various doses of transdermal rotigotine at replacing levodopa (Hutton et al., 2001). In this trial, 85 Parkinson’s disease patients were randomized to placebo or one of four doses of rotigotine for 21 days. Significantly greater reductions in levodopa dose were achieved compared to placebo for the two highest doses of rotigotine. The transdermal system was found to be safe and well tolerated. In a later clinical study the safety and efficacy of rotigotine in patients with early-stage Parkinson’s disease was evaluated. In the open-label study, 31 patients in the early stages of Parkinson’s disease received rotigotine up to a maximum of 18.0 mg/day. Significant improvements were seen for patients achieving the maximum dose. Overall, the data suggest that rotigotine is safe, well tolerated and effective treatment for early-stage Parkinson’s disease (Güldenpfennig et al., 2005). These data were confirmed in multicenter, randomized, double-blind studies (Watts et al., 2007; Jankovic et al., 2007), where it was concluded that transdermal rotigotine, titrated to a dosage of 6 mg/day, was effective for the treatment of early-stage Parkinson’s disease. The long-term effectiveness and safety of the rotigotine patch has been established (Lewitt et al., 2013; Giladi et al., 2013). The most common side effects were somnolence (18–25%), application site reactions (12–15%) and nausea (9%).
Medication effects on sleep
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
sleep and often leading to recurrent arousals from sleep.44 These associated disorders are quite common, occurring in up to 15% of the population and increasing in frequency with age. PLMD/RLS may develop in patients during pregnancy, OSA, renal failure, low serum ferritin levels, and in patients taking antidepressants, particularly the SSRIs. Both PLMD and RLS are most commonly treated with low dosages of dopamine precursors and dopamine receptor agonists at bedtime. Possible side effects of these medications, which include carbidopa/ levodopa (Sinemet), pramipexole (Mirapex), ropinirole (Requip), and rotigotine, are nausea, headache, tachyphylaxis and augmentation of symptoms.45
Pharmacotherapy for post-stroke aphasia: what are the options?
Published in Expert Opinion on Pharmacotherapy, 2023
Marcelo L. Berthier, Guadalupe Dávila
A new option for treating PSA is rotigotine (transdermal patches). Rotigotine is a non-ergoline dopamine agonist that binds all receptors (D1-D5) with a special affinity for D3, and it is approved for treating Parkinson’s disease and restless legs syndrome [82]. Rotigotine is safe in stroke patients and improves post-stroke neglect [82] and language function (spontaneous speech, comprehension, and naming) in a patient with severe mixed transcortical aphasia and linguistic anxiety [83] secondary to two extensive hemorrhages involving left frontal and parietal cortices [84]. Future trials can evaluate the role of rotigotine over more traditional ergoline dopaminergic agents, like bromocriptine, because it has good tolerance and adverse event profile [82]. PWA featuring reduced verbal output and motivation would be the best candidates for dopaminergic stimulation [76,85].
Randomized, double-blind, crossover study of the adhesiveness of two formulations of rotigotine transdermal patch in patients with Parkinson’s disease
Published in Current Medical Research and Opinion, 2018
Jan-Peer Elshoff, Lars Bauer, Nadine Goldammer, Marga Oortgiesen, Hanna Pesch, Lars Timmermann
Male or female patients of ≥18 years of age, with a diagnosis of idiopathic PD, were eligible for study participation. Patients were required to have been continuously treated with any dosage of commercially available rotigotine for at least 3 months, and to be on a stable dose of rotigotine including use of an 8 mg/24 hours (40 cm2) patch for at least 2 weeks prior to enrollment. Those who were on a rotigotine dose of >8 mg/24 hours prior to study entry were to take commercial rotigotine patches in addition to the study treatment to achieve their usual rotigotine dose. Patients were to take their usual medications and no concomitant treatments were prohibited; however, patients had to agree to refrain from swimming, bathing or using a sauna during the treatment period.
A noninterventional study evaluating the effectiveness of rotigotine and levodopa combination therapy in younger versus older patients with Parkinson’s disease
Published in Expert Opinion on Pharmacotherapy, 2018
Dirk Woitalla, Antoine Dunac, Ali Safavi, Maria-Gabriella Ceravolo, Juan Carlos Gomez Esteban, Nicola Pavese, Mahnaz Asgharnejad, Lars Joeres, Jan-Christof Schuller, K. Ray Chaudhuri
This was a multicenter, noninterventional study conducted in routine clinical practice comparing outcomes in patients with PD who were <70 years of age versus ≥70 years of age treated with levodopa and the rotigotine transdermal patch as combination therapy. The study evaluated the effectiveness and tolerability of rotigotine in 195 enrolled patients across 41 sites in France, Germany, Italy, Spain, and the UK. The recommended dosing for rotigotine is between 2 and 8 mg/day in early stages of PD, or between 4 and 16 mg/day in advanced stages of PD with motor fluctuations. In the current study, the mean daily dose prescribed was 5.5 mg (6.1 mg/day for younger patients and 4.9 mg/day for older patients), suggesting patients were generally treated with low rotigotine doses.
Related Knowledge Centers
- Dopamine Agonist
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- Transdermal Patch
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