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The following information highlights critical safety warnings and precautions for using Neupro (rotigotine). Patients and healthcare providers should review this information carefully to ensure safe use of the medication.

• Allergic Reactions: Neupro contains sulfites, which can trigger serious allergic reactions, including anaphylaxis or asthma attacks, particularly in individuals with asthma or a history of sulfite allergies. Note that a sulfite allergy is different from a sulfa allergy. Consult your prescriber if you have a history of allergies.

• Excessive Sleepiness: The medication may cause significant drowsiness, potentially leading to sudden sleep episodes during daily activities, even a year after starting treatment. Risks increase if combined with other sedatives or alcohol. Exercise caution if you have a history of sleep disorders or are already feeling drowsy.

• Mental Health Changes: Neupro may induce hallucinations or changes in mental state, such as confusion or paranoia, particularly in older adults, those with advanced Parkinson’s disease, or a history of mental health issues. Report any behavioral changes to your healthcare provider immediately.

• Orthostatic Hypotension: The drug can cause low blood pressure when standing up, leading to dizziness or fainting. This risk is higher when initiating a higher dose. Rise slowly from sitting or lying positions to minimize the risk of falls.

• Impulsive Behavior: Some users experience strong, uncontrollable urges such as gambling or overeating. Inform your doctor if you notice new compulsive behaviors.

• Cardiovascular Effects: Neupro may elevate blood pressure and heart rate, especially with higher doses, posing a risk for those with heart conditions. Monitor for symptoms like dizziness or a rapid heartbeat.

• Weight Gain and Edema: The medication can lead to weight gain and fluid retention, particularly in those with heart or kidney issues. Report any swelling or sudden weight changes to your care team.

• Uncontrolled Movements: The risk of involuntary movements, such as twitching or tapping, increases with higher doses or when combined with levodopa-containing medications. Contact your doctor if these occur.

• Skin Reactions: Application site reactions like redness or itching are common. Rotate patch sites daily and avoid reusing the same spot within two weeks. Consult your prescriber if reactions persist or worsen.

• Worsening Restless Leg Syndrome (RLS): Symptoms of RLS may intensify or occur earlier in the day. If symptoms worsen as the medication dose wears off, contact your prescriber.

• Neuroleptic Malignant Syndrome (NMS): Rapidly stopping or reducing Neupro can lead to NMS, a serious condition characterized by high fever, muscle stiffness, and confusion. Do not alter your dose without consulting your doctor.

• Withdrawal Symptoms: Discontinuing Neupro may lead to withdrawal symptoms like anxiety or depression. Severe symptoms may require restarting a dopamine agonist at a low dose.

Please discuss any concerns or side effects with your healthcare provider to ensure the safe use of Neupro (rotigotine).

When using this medication, you may encounter some common side effects such as nausea, dizziness, vomiting, tiredness, and headache. These are typically mild and often manageable, but if they persist or worsen, it is advisable to consult with your healthcare provider. You might also notice increased sweating, lightheadedness, or redness and itching at the application site. Additionally, some individuals experience trouble sleeping or drowsiness during the day.

More serious side effects are less common but require prompt medical attention. These include mental or mood changes like hallucinations or confusion, severe dizziness or fainting, and unusual strong urges such as increased gambling or sexual urges. Some people may experience uncontrolled muscle movements, swelling in the ankles or feet, or a rapid heartbeat. It's important to discuss any instances of severe dizziness or fainting with your doctor, as these could be related to sudden drops in blood pressure, especially when starting or adjusting the dose.

Rare side effects, which necessitate immediate medical help, include severe allergic reactions characterized by rash, itching/swelling, severe dizziness, or trouble breathing. In very uncommon cases, people have reported falling asleep suddenly during daily activities, sometimes without prior drowsiness. If you experience unexpected sleepiness, refrain from driving or engaging in potentially dangerous activities and consult your doctor.

Remember, while this list covers many potential side effects, it may not include all possibilities. If you notice any other unusual effects, it is essential to reach out to your healthcare provider for advice.

If you are taking Neupro (rotigotine), it's important to inform your doctor and pharmacist about all other medications and supplements you are using, including prescription, over-the-counter, vitamins, and herbal products. This is because Neupro (rotigotine) can interact with certain drugs, which may lead to serious effects.

Avoid using Neupro with sulpiride, as this combination is not recommended. Additionally, concurrent use of Neupro with medications such as haloperidol or metoclopramide is generally not advised unless necessary. In cases where these medicines must be used together, your doctor might adjust the dosage or frequency to minimize interaction risks.

Furthermore, be cautious if you are taking products that cause drowsiness, like alcohol, marijuana, certain antihistamines (like cetirizine, diphenhydramine), sleep or anxiety medications (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (e.g., codeine). These can enhance drowsiness, so check all your medications, including allergy or cough-and-cold products, for ingredients that might cause this effect. Consult your pharmacist to ensure safe usage of these products.