Rotigotine Transdermal System

INTRODUCTION

Indications

Symptomatic management of early-stage idiopathic Parkinson's disease.

Action

Acts as an agonist of dopamine in the CNS, primarily at D2 receptor sites. Therapeutic Effects: Improvement in symptoms of Parkinson's disease.

Adverse Reactions/Side Effects

CNS: DROWSINESS, insomnia, confusion, dizziness, hallucinations, headache, malaise, sudden sleep attacks. CV: peripheral edema, postural hypotension, syncope. GI: nausea, vomiting, anorexia, dry mouth, dyspepsia, ↑ liver enzymes. GU: urinary incontinence. Derm: application site reactions, ↑ risk of melanoma, ↑ sweating, pruritus, purpura. Metab: weight gain. MS: leg pain. Neuro: abnormal gait, ataxia, dyskinesia, hypertonia, hypoesthesia, neuralgia, paresthesia. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be aware that rotigotine can cause severe drowsiness and sudden, unexpected episodes of falling asleep (sleep attacks). Use caution during activities where patient might fall asleep suddenly.

• Assess gait and motor function to help determine antiparkinson effects, especially when starting drug therapy or during dosing changes or addition of other antiparkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 15–18 hr after applying the patch), as well as when drug effects are minimal (just before applying the next patch).

• Document increased side effects such as involuntary movements (dyskinesias) or fluctuations in response (on-off phenomenon, end-of-dose akinesia). Notify physician because increased side effects might require dose adjustment or a change in medication regimen.

• Monitor confusion, hallucinations, and other psychological problems. Repeated or excessive symptoms may require change in dose or medication.

• Assess blood pressure (BP) when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any nerve pain or signs of paresthesia (numbness, tingling). Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess dizziness and syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

• Monitor transdermal application site for skin reactions (rash, irritation, dermatitis). Report prolonged or excessive application site reactions to the physician.

• Report any suspicious skin lesions to the physician; this drug ...