title: Rotigotine transdermal patch enables rapid titration to effective doses in advanced-stage idiopathic Parkinson disease: subanalysis of a parallel group, open-label, dose-escalation study.
abstract: OBJECTIVE
  Rotigotine (Neupro) is formulated as a transdermal delivery system designed to provide a selective, non-ergot D3/D2/D1 agonist to the systemic blood flow over a 24-hour period. In clinical trials, patches were applied once daily and uptitrated to the individual effective dose in increments of 2 mg/24 h every week. The aim of this analysis was to determine the safety of a more rapid titration of rotigotine by assessing the tolerability of escalating transdermal doses of rotigotine given in 2 different titration schemes.
  
  
  METHODS
  We analyzed the safety of rotigotine in 2 groups of patients with advanced stage Parkinson Disease. The starting dose of 4 mg/24 h was increased every week by 2 mg/24 h in the slow-titration group and 4 mg/24 h in the fast-titration group. The primary focus of this subanalysis was the separate tolerability of rotigotine in each randomized treatment arm, during the dose-escalation period. However, the 2 titration schemes were also compared with each other.
  
  
  RESULTS
  The dose of first reported nausea and/or vomiting was 8 mg/24 h for the fast-titration group and 4 mg/ 24 h for the slow-titration group. There were no remarkable differences concerning the side-effect profile between the 2 different titration schemes.
  
  
  CONCLUSIONS
  The fast-titration regimen had a similar adverse event profile to slower titration, and allowed rotigotine to be introduced quickly. This subanalysis suggests that rotigotine may be uptitrated more rapidly.
authors.affiliation: *CNS International, I3 Research, Maidenhead, Berks, SL6 8AD, United Kingdom. tomislav.babic@i3research.com
authors.forename: Tomislav
authors.initials: T
authors.lastname: Babic
authors.forename: Bernard
authors.initials: B
authors.lastname: Boothmann
authors.forename: Jiri
authors.initials: J
authors.lastname: Polivka
authors.forename: Ivan
authors.initials: I
authors.lastname: Rektor
authors.forename: Babak
authors.initials: B
authors.lastname: Boroojerdi
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Häck
authors.forename: Olaf
authors.initials: O
authors.lastname: Randerath
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy*; D013764:Tetrahydronaphthalenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*
chemical_list: D018491:Dopamine Agonists; D013764:Tetrahydronaphthalenes; D013876:Thiophenes; C047508:rotigotine