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Nguyen-Thi PT, Vo TK, Le HT, Nguyen NTT, Nguyen TT, Van Vo G. Translation from Preclinical Research to Clinical Trials: Transdermal Drug Delivery for Neurodegenerative and Mental Disorders. Pharm Res 2024; 41:1045-1092. [PMID: 38862719 DOI: 10.1007/s11095-024-03718-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/19/2024] [Indexed: 06/13/2024]
Abstract
Neurodegenerative diseases (NDs), particularly dementia, provide significant problems to worldwide healthcare systems. The development of therapeutic materials for various diseases has a severe challenge in the form of the blood-brain barrier (BBB). Transdermal treatment has recently garnered widespread favor as an alternative method of delivering active chemicals to the brain. This approach has several advantages, including low invasiveness, self-administration, avoidance of first-pass metabolism, preservation of steady plasma concentrations, regulated release, safety, efficacy, and better patient compliance. Topics include the transdermal method for therapeutic NDs, their classification, and the mechanisms that allow the medicine to enter the bloodstream through the skin. The paper also discusses the obstacles and potential outcomes of transdermal therapy, emphasizing the benefits and drawbacks of different approaches.
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Affiliation(s)
| | - Tuong Kha Vo
- Department of Sports Medicine, University of Medicine and Pharmacy (VNU-UMP), Vietnam National University Hanoi, Hanoi, 100000, Vietnam
| | - Huong Thuy Le
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, 700000, Vietnam
| | - Nhat Thang Thi Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam.
| | - Thuy Trang Nguyen
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 71420, Vietnam
| | - Giau Van Vo
- Degenerative Diseases Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, 92037, USA.
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Abstract
Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and CD-ROM forms and are available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The October 2007 monograph topics are maraviroc, etravirine, bifeprunox, regadenoson, and fesoterodine. The DUE is on maraviroc.
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Affiliation(s)
- Dennis J. Cada
- Drug Information Center, Washington State University Spokane, Wash
| | - Terri Levien
- Drug Information Center, Washington State University Spokane, Wash
| | - Danial E. Baker
- Drug Information Center and College of Pharmacy, Washington State University Spokane, PO Box 1495, Spokane, WA 99210-1495
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An update on pharmacological, pharmacokinetic properties and drug-drug interactions of rotigotine transdermal system in Parkinson's disease and restless legs syndrome. Drugs 2015; 75:487-501. [PMID: 25795100 PMCID: PMC4382528 DOI: 10.1007/s40265-015-0377-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This narrative review reports on the pharmacological and pharmacokinetic properties of rotigotine, a non-ergolinic D3/D2/D1 dopamine receptor agonist approved for the treatment of early- and advanced-stage Parkinson’s disease (PD) and moderate to severe restless legs syndrome (RLS). Rotigotine is formulated as a transdermal patch providing continuous drug delivery over 24 h, with a plasma concentration profile similar to that of administration via continuous intravenous infusion. Absolute bioavailability after 24 h transdermal delivery is 37 % of the applied rotigotine dose. Following a single administration of rotigotine transdermal system (24-h patch-on period), most of the absorbed drug is eliminated in urine and feces as sulphated and glucuronidated conjugates within 24 h of patch removal. The drug shows a high apparent volume of distribution (>2500 L) and a total body clearance of 300–600 L/h. Rotigotine transdermal system provides dose-proportional pharmacokinetics up to supratherapeutic dose rates of 24 mg/24 h, with steady-state plasma drug concentrations attained within 1–2 days of daily dosing. The pharmacokinetics of rotigotine transdermal patch are similar in healthy subjects, patients with early- or advanced-stage PD, and patients with RLS when comparing dose-normalized area under the plasma concentration–time curve (AUC) and maximum plasma drug concentration (Cmax), as well as half-life and other pharmacokinetic parameters. Also, it is not influenced in a relevant manner by age, sex, ethnicity, advanced renal insufficiency, or moderate hepatic impairment. No clinically relevant drug–drug interactions were observed following co-administration of rotigotine with levodopa/carbidopa, domperidone, or the CYP450 inhibitors cimetidine or omeprazole. Also, pharmacodynamics and pharmacokinetics of an oral hormonal contraceptive were not influenced by rotigotine co-administration. Rotigotine was generally well tolerated, with an adverse event profile consistent with dopaminergic stimulation and use of a transdermal patch. These observations, combined with the long-term efficacy demonstrated in clinical studies, support the use of rotigotine as a continuous non-ergot D3/D2/D1 dopamine receptor agonist in the treatment of PD and RLS.
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Jenner P. Wearing Off, Dyskinesia, and the Use of Continuous Drug Delivery in Parkinson's Disease. Neurol Clin 2013; 31:S17-35. [DOI: 10.1016/j.ncl.2013.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Kim HJ, Jeon BS, Lee WY, Lee MC, Kim JW, Kim JM, Ahn TB, Cho J, Chung SJ, Grieger F, Whitesides J, Boroojerdi B. Overnight switch from ropinirole to transdermal rotigotine patch in patients with Parkinson disease. BMC Neurol 2011; 11:100. [PMID: 21831297 PMCID: PMC3166898 DOI: 10.1186/1471-2377-11-100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background A recent trial involving predominantly Caucasian subjects with Parkinson Disease (PD) showed switching overnight from an oral dopaminergic agonist to the rotigotine patch was well tolerated without loss of efficacy. However, no such data have been generated for Korean patients. Methods This open-label multicenter trial investigated PD patients whose symptoms were not satisfactorily controlled by ropinirole, at a total daily dose of 3 mg to 12 mg, taken as monotherapy or as an adjunct to levodopa. Switching treatment from oral ropinirole to transdermal rotigotine was carried out overnight, with a dosage ratio of 1.5:1. After a 28-day treatment period, the safety and tolerability of switching was evaluated. Due to the exploratory nature of this trial, the effects of rotigotine on motor and nonmotor symptoms of PD were analyzed in a descriptive manner. Results Of the 116 subjects who received at least one treatment, 99 (85%) completed the 28-day trial period. Dose adjustments were required for 11 subjects who completed the treatment period. A total of 76 treatment-emergent adverse events (AEs) occurred in 45 subjects. No subject experienced a serious AE. Thirteen subjects discontinued rotigotine prematurely due to AEs. Efficacy results suggested improvements in both motor and nonmotor symptoms and quality of life after switching. Fifty-two subjects (46%) agreed that they preferred using the patch over oral medications, while 31 (28%) disagreed. Conclusions Switching treatment overnight from oral ropinirole to transdermal rotigotine patch, using a dosage ratio of 1.5:1, was well tolerated in Korean patients with no loss of efficacy. Trial registration This trial is registered with the ClincalTrails.gov Registry (NCT00593606).
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Parkinson Disease Study Group, and Neuroscience Research Institute, BK21, College of Medicine, Seoul National University Hospital, Seoul, Korea.
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Nishiyama K, Seyama H, Okano H, Yamada S, Kurita H, Chiba A, Yamaguchi Y, Shiokawa Y. Escalation regimen of cilostazol for acute brain infarction. Intern Med 2011; 50:1559-63. [PMID: 21804281 DOI: 10.2169/internalmedicine.50.4384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Several reports have indicated that cilostazol is effective in the prevention of recurrence after cerebral infarction. However, cilostazol is inferior in tolerability for the adverse events than other anti-platelet agents. The goal of this study was to determine whether cilostazol escalation oral administration affects its tolerability. METHODS One hundred sixty-eight patients hospitalized for brain infarction with cilostazol treatment in our stroke center from 2006 to 2008 were enrolled in this study. During this term, we had two teams in our center and used different regimens. One of which used 100 mg b.i.d. regimen of cilostazol (Standard group) and the other used 50 mg b.i.d. for the initial 4 days, followed by a dose of 100 mg b.i.d. of it (Escalation group). Patient's information such as baseline characteristics, adverse events, were collected and statistically analyzed retrospectively. RESULTS Seventy-nine patients were enrolled in Standard group and 87 patients in Escalation group. Comparison between these groups demonstrated that Escalation group had fewer patients who discontinued treatment (p=0.001) and a lower incidence of headache (p=0.004). CONCLUSION This type of dose escalation regimen of cilostazol may be superior to the standard regimen in tolerability.
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Chen JJ, Swope DM, Dashtipour K, Lyons KE. Transdermal Rotigotine: A Clinically Innovative Dopamine-Receptor Agonist for the Management of Parkinson's Disease. Pharmacotherapy 2009; 29:1452-67. [DOI: 10.1592/phco.29.12.1452] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rektor I, Babic T, Boothmann B, Polivka J, Boroojerdi B, Randerath O. High Doses of Rotigotine Transdermal Patch. Clin Neuropharmacol 2009; 32:193-8. [DOI: 10.1097/wnf.0b013e31819a689f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rascol O, Perez-Lloret S. Rotigotine transdermal delivery for the treatment of Parkinson's disease. Expert Opin Pharmacother 2009; 10:677-91. [PMID: 19239399 DOI: 10.1517/14656560902746041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Rotigotine is a non-ergot dopamine agonist that has been developed as a new transdermal formulation, and is indicated for use in early (USA and Europe) and advanced (Europe only) Parkinson's disease (PD). The potential advantages of the rotigotine patch include immediacy of effect onset as intestinal absorption in unneeded, constant drug delivery, and ease of use via application of a once-daily adhesive patch. An interesting element of this profile is constant drug delivery, which may avoid pulsatile dopaminergic stimulation, which has been postulated to be related to the development of motor complications. OBJECTIVE To consider the evidence surrounding the profile of rotigotine and, in particular, whether its constant delivery system offers significant benefits to the treatment of early and advanced PD. METHODS Source material was identified using a PubMed search for the term 'rotigotine' (up to March 2008). The review focuses only on publications related to the rotigotine indication for PD. RESULTS/CONCLUSION The rotigotine transdermal patch demonstrates clinical efficacy, alongside a tolerability profile that appears to be well within the range of that observed with other non-ergot dopamine agonists. The once-daily patch formulation may favour compliance but, in similarity with the other theoretical advantages of constant drug delivery (for example reduced emergence of motor complications, improved tolerance to peripheral AEs), requires further detailed study.
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Affiliation(s)
- Olivier Rascol
- Clinical Investigation Center and Neurosciences Institute, Department of Clinical Pharmacology, Faculty of Medicine, INSERM U 825, Toulouse, France.
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Di Stefano A, Sozio P, Iannitelli A, Cerasa LS. New drug delivery strategies for improved Parkinson's disease therapy. Expert Opin Drug Deliv 2009; 6:389-404. [DOI: 10.1517/17425240902870405] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Biperiden enhances L-DOPA methyl ester and dopamine Dl receptor agonist SKF-82958 but antagonizes D2/D3 receptor agonist rotigotine antihemiparkinsonian actions. Eur J Pharmacol 2008; 599:81-5. [DOI: 10.1016/j.ejphar.2008.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/29/2008] [Accepted: 09/16/2008] [Indexed: 11/19/2022]
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Pham DQ, Nogid A. Rotigotine transdermal system for the treatment of Parkinson's disease. Clin Ther 2008; 30:813-24. [PMID: 18555929 DOI: 10.1016/j.clinthera.2008.05.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Levodopa has been the cornerstone of the treatment of Parkinson's disease (PD) for >30 years, but long-term levodopa therapy is associated with development of such motor complications as motor fluctuations, dyskinesias, and drug-induced involuntary movements. Rotigotine is a dopamine agonist with high affinity for the D(2) receptor. Rotigotine transdermal system, the first such system approved by the US Food and Drug Administration for the management of PD, has been formulated to deliver a consistent concentration of drug to the bloodstream with the goal of minimizing the complications associated with pulsatile dosing. OBJECTIVE This article reviews the clinical pharmacology, pharmacokinetic and pharmacodynamic properties, tolerability, and efficacy of rotigotine transdermal system in the treatment of PD. METHODS MEDLINE (1966-April 2008) and International Pharmaceutical Abstracts (1971-April 2008) were searched using the term rotigotine. All prospective, randomized clinical efficacy trials in humans were included. The reference lists of the identified articles were reviewed for additional publications. RESULTS In clinical trials, rotigotine transdermal system at doses ranging from 4.5 to 67 mg/d was associated with significant clinical benefit in patients with early and advanced PD. In 4 randomized, doubleblind, placebo-controlled trials of 6 months' duration, patients receiving rotigotine transdermal system had significant improvements on the Unified Parkinson's Disease Rating Scale (UPDRS) part II (activities of daily living) that ranged from -0.3 to -4.2, compared with +0.92 to -2 for placebo (P < 0.001, rotigotine transdermal system vs placebo). In one trial that included pramipexole as an active comparator, the change in UPDRS II at 6 months was -4.2 in the rotigotine transdermal system group and -4.6 in the pramipexole group (P = NS, rotigotine transdermal system vs pramipexole). Changes on the UPDRS III (motor examination) at 6 months ranged from -3.58 to -8.7 with rotigotine transdermal system, compared with +0.38 to -4.3 in the placebo group and -10.3 in the pramipexole group (P < 0.001 vs placebo; P = NS vs pramipexole). The change in "off" time at 6 months ranged from -2.1 to -2.7 hours with rotigotine transdermal system, compared with -0.9 hour with placebo and -2.8 hours with pramipexole (P < 0.001 vs placebo; P = NS vs pramipexole). The proportion of patients achieving a >30% reduction in "off" time ranged from 55.1% to 59.7% of patients receiving rotigotine transdermal system, compared with 34.5% to 35.0% of patients receiving placebo and 67.0% of patients receiving pramipexole (P<0.001 vs placebo; P = NS vs pramipexole). The most commonly reported adverse event was application-site reaction, occurring in 9% to 46% of patients receiving rotigotine transdermal system, compared with 5% to 13% of patients receiving placebo. Other adverse events occurring in >20% of patients receiving rotigotine transdermal system were somnolence(8%\2-33%)and nausea(12%-49%). Less than 5% of patients assigned to rotigotine transdermal system discontinued study medication because of an adverse drug event. CONCLUSIONS The available evidence suggests that rotigotine transdermal system was effective compared with placebo in decreasing morbidity in patients with early and advanced PD. The most commonly reported adverse events associated with rotigotine transdermal system were application-site reaction, nausea, and somnolence. Additional clinical trials are needed to determine the long-term tolerability profile of rotigotine transdermal system and its clinical efficacy and tolerability compared with oral dopamine agonists.
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Affiliation(s)
- David Q Pham
- Western University of Health Sciences, College of Pharmacy, Pomona, California 91766-1854, USA.
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Abstract
Safe, effective drug therapy in older adults requires an understanding of drug disposition and response in this population. Evidence suggests that physiologic changes during aging, including hepatic or renal function changes, contribute to pharmacokinetic differences. A major issue surrounding the study of older adults relates to the ability to study a large number of people in a minimally invasive way. Population pharmacokinetics provides a potential means of addressing this issue and a tool to evaluate drug exposure's magnitude and consistency. This article highlights examples of pharmacokinetic studies in psychiatry, in particular those conducted in older adults. It also reviews new drugs approved for treatment in psychiatry or neurology, many of which were developed as novel formulations (eg, extended-release transdermal film) with improved pharmacokinetic profiles or developed with regard to the actions of a specific enantiomer or metabolite.
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Affiliation(s)
- Kristin L Bigos
- Department of Pharmaceutical Sciences, University of Pittsburgh, 3501 Terrace Street, 805 Salk Hall, Pittsburgh, PA 15261, USA
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Seeberger LC, Hauser RA. Optimizing bioavailability in the treatment of Parkinson's disease. Neuropharmacology 2007; 53:791-800. [DOI: 10.1016/j.neuropharm.2007.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 08/20/2007] [Accepted: 08/29/2007] [Indexed: 10/22/2022]
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LeWitt PA, Boroojerdi B, MacMahon D, Patton J, Jankovic J. Overnight Switch From Oral Dopaminergic Agonists to Transdermal Rotigotine Patch in Subjects With Parkinson Disease. Clin Neuropharmacol 2007; 30:256-65. [PMID: 17909303 DOI: 10.1097/wnf.0b013e318154c7c4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess safety, tolerability, and efficacy outcomes of an overnight switch from oral ropinirole, pramipexole, or cabergoline to rotigotine, a dopaminergic agonist with transdermal delivery over 24 hours in subjects with established Parkinson disease (PD). METHODS In this open-label multicenter study, we hypothesized that the selected doses of transdermal rotigotine would provide at least equivalent antiparkinsonian actions in subjects with idiopathic PD not adequately controlled with oral ropinirole (up to 9 mg/d), pramipexole (up to 2 mg/d), or cabergoline (up to 3 mg/d). The tolerability of the rotigotine switch was evaluated by the number of subjects completing the scheduled 28-day treatment period, need for rotigotine dose reductions, and dropouts due to adverse events. Efficacy assessment relied on changes in Unified Parkinson's Disease Rating Scale from the baseline to the end of treatment in PD symptoms and subject preference of dopaminergic agonist. RESULTS Of 116 PD subjects enrolled, 104 completed the 28-day rotigotine treatment. Fifteen subjects required rotigotine dose adjustment; of these, 11 completed the trial. The most common adverse events (generally mild or moderate in intensity) were application site reactions, nausea, and somnolence. The change to rotigotine was well tolerated. Rotigotine was preferred by 77% of subjects who were not adequately controlled by their previous oral dopaminergic agonist. The predetermined rotigotine substitutions provided improvements over baseline in Unified Parkinson's Disease Rating Scale II and III subscales. CONCLUSIONS Subjects and clinicians found the overnight switch to rotigotine convenient, well tolerated, and effective for control of PD signs and symptoms for subjects previously receiving low-to-moderate doses of oral dopaminergic agonists.
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Affiliation(s)
- Peter A LeWitt
- Department of Neurology, Wayne State University School of Medicine, and Henry Ford Hospital-Franklin Pointe Medical Center, 26400 West 12 Mile Road, Southfield, MI 48034, USA.
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Kenney C, Jankovic J. Rotigotine transdermal patch in the treatment of Parkinson’s disease and restless legs syndrome. Expert Opin Pharmacother 2007; 8:1329-35. [PMID: 17563266 DOI: 10.1517/14656566.8.9.1329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dopamine agonists are effective in delaying levodopa-induced dyskinesia in early Parkinson's disease (PD) and reducing motor fluctuations in advanced PD. Rotigotine, a novel dopamine receptor agonist, improves motor function in both early and advanced PD using a transdermal route of administration. A smaller, but convincing body of data, supports its ability to ameliorate the symptoms of restless legs syndrome as well. The side-effect profile mimics other dopamine agonists, with the addition of application-site reactions, most of which are mild-to-moderate. Advantages over existing dopamine agonists include once-daily administration, absence of food interactions, maintenance of stable plasma levels and utility in patients with swallowing difficulties.
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Affiliation(s)
- Christopher Kenney
- Parkinson's disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, Texas 77030, USA.
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