Rotigotine for the Treatment of Advanced Parkinson's Disease

Abstract

Background: Rotigotine, a non-ergot dopamine agonist, has been developed as a novel transdermal formulation. The rotigotine transdermal patch is approved by the regulatory authorities for use in all stages of Parkinson’s disease (PD) in Europe and for early-stage PD in the US. For patients with advanced-stage PD and motor fluctuations, approved doses range from 4mg/24 hours to 16mg/24 hours. The rotigotine patch offers a certain number of potential advantages, including faster onset as intestinal absorption is not needed, continuous drug delivery and ease of use via application of a once-daily adhesive patch. An interesting element of this profile is continuous drug delivery, which may avoid the pulsatile dopaminergic stimulation that has been postulated to be related to the development of motor complications.Objective: The aim of this article is to review the pharmacokinetics, pharmacodynamics and clinical efficacy and tolerability of the rotigotine transdermal patch.Methods: Source material was identified using a PubMed search for the term ‘rotigotine’ in articles published up to October 2009 and a review of published congress abstracts. The review focused primarily on publications related to the rotigotine indication for advanced PD.Results and conclusions: The rotigotine transdermal patch demonstrates clinical efficacy and a tolerability profile that appears to be well within the range of that observed with other non-ergot dopamine agonists, except for local skin reactions, which are common with the rotigotine patch. The once-daily patch formulation may encourage compliance; however, as is the case for other theoretical advantages of continuous drug delivery, such as reduced emergence of motor complications and improved tolerance of peripheral adverse events, this requires further detailed study.