Neupro Special Precautions

Patients should seek medical advice before using Neupro or in case of symptoms after beginning treatment with Neupro.
Blood pressure should be regularly checked while using Neupro, especially at the start of the treatment. Neupro may affect the blood pressure.
Eyes should be regularly checked while using Neupro. Patients should seek medical advice straight away if they notice any problems with their eyesight between checks.
The dose may need to be changed in patients with serious liver problems. Patients should seek medical advice straight away if their liver problems worsen during treatment.
The patch may cause skin problems (see Skin problems caused by the patch under Side Effects).
The patient may feel very sleepy or fall asleep suddenly (see Driving and using machines as follows).
Dopamine agonist withdrawal syndrome (DAWS): Medicines used to treat Parkinson's disease should be reduced or stopped gradually. After stopping or reducing Neupro treatment, patients should tell their doctor if they experience symptoms such as depression, anxiety, fatigue, sweating or pain.
A drug withdrawal syndrome has been reported during tapering or after discontinuation of dopamine agonists including rotigotine. Limited data suggest that patients with impulse control disorders and those receiving high daily dose and/or high cumulative doses of a dopamine agonist (DA) may be at higher risk for developing DAWS. Withdrawal symptoms do not respond to levodopa, and may include apathy, anxiety, depression, fatigue, sweating, panic attacks, insomnia, irritability and pain. Prior to discontinuation, patients should be informed about potential withdrawal symptoms, and closely monitored during tapering and after discontinuation. In case of severe withdrawal symptoms, temporary re-administration of Neupro at the lowest effective dose to manage these symptoms may be considered.
Loss of consciousness: Neupro can cause loss of consciousness. This can happen especially when Neupro is started or when the dose is increased. Patients should tell their doctor if they lose consciousness or feel dizzy.
Changes in behaviour and abnormal thinking: Neupro can cause side effects that change behaviour. It may be helpful to tell a family member or carer that this medicine is being used and to ask them to read the leaflet. This is so that the patient's family or carer can tell the patient or the doctor, if they are worried about any changes in behaviour.
These include: craving for large doses of Neupro or other medicines used to treat Parkinson's disease; unusual urges or cravings which cannot be resisted and that could harm the patient or others; abnormal thinking or behaviour (see Changes in behaviour and abnormal thinking under Side Effects for more information).
Sodium metabisulphite (E223): Neupro contains sodium metabisulphite (E223). Sodium metabisulphite (E223) may rarely cause severe hypersensitivity (allergic) reactions and bronchospasm.
Driving and using machines: Neupro may make the patient feel very sleepy, and the patient may fall asleep very suddenly. If this happens, the patient should not drive. In isolated cases, people have fallen asleep while driving and this has caused accidents.
Also patients should not use tools or machines if they feel very sleepy, or do anything else which may put others or themselves at risk of serious injury.
Use in Children: Do not give this medicine to children below 18 years of age because it is not known if it is safe or effective in this age group.