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Suggest dosage of NeuPro patch for Parkinson's when having hallucinations and confusions

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Posted on Fri, 13 Feb 2015
Question: Who knows the most about using the NeuPro patch for Parkinson's. I am having trouble getting our neurologist to recommend what level of rotigotine my husband should be on. He has been on 2 mg for almost a month. After doing some research, talking with the company that makes the drug, and also talking to Med Sask, I think the next step would be to increase dosage to 4 mg, and keep the levodopa at the minimum level. According to the package directions, someone with advanced Parkinson's should start with 4 mg and increase after the second week by 2 mg per week until the right dose is reached (8-16 mg) in about to 7 weeks. My husbands neurologist wants him 1. to go off the patch and back on levodopa, even though he's improving 2. wants him to stay on the 2 mg patch and increase the levodopa to the level he was previously taking. That being 2 levodopa every 2 hours during the day and 1 Sinemet CR at bedtime.
My husband was hallucinating, confused, tired, on levodopa. He feels better on the patch.
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Answered by Dr. Sudhir Kumar (3 hours later)
Brief Answer:
I would prefer increasing NeuPro dose.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted the diagnosis, medications and symptoms of your husband.

I would agree that it is preferable to increase the dose of NeuPro in your husband, with advanced Parkinson's disease. Already he is having side effects with levodopa, as well as rapid on off phenomena. So, there is not much use of increasing the dose of levodopa. This would lead to more adverse effects.

On the other hand, your husband has shown improvement with Rotigotine patch. It makes more sense to increase the dose to at least reach 8 mg per day.

You should discuss this with the neurologist.

I hope it helps.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Sudhir Kumar (22 minutes later)
It's nice to know I'm not completely out to lunch, but what to do about the neurologist, that is another thing. I think we will have to find another neurologist that we can talk to with a little more openness. Do you know any good neurologists in Saskatoon, Sask. Canada. Our family doctor will not go against Dr. XXXXXXX and order the Neupro patch so we will have to find a new neurologist I think. Thanks for you opinion. I really appreciate it. XXXX
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Answered by Dr. Sudhir Kumar (11 minutes later)
Brief Answer:
I personally do not know any neurologist there.

Detailed Answer:
Thank you for getting back.

As of now, I personally do not know a neurologist with experience in treating PD in Saskatoon area. However, I hope you would be able to find one there.

In the meanwhile, if I get to know someone, would let you know.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by : Dr. Shanthi.E
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Dr. Sudhir Kumar

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Suggest dosage of NeuPro patch for Parkinson's when having hallucinations and confusions

Brief Answer: I would prefer increasing NeuPro dose. Detailed Answer: Hi, Thank you for posting your query. I have noted the diagnosis, medications and symptoms of your husband. I would agree that it is preferable to increase the dose of NeuPro in your husband, with advanced Parkinson's disease. Already he is having side effects with levodopa, as well as rapid on off phenomena. So, there is not much use of increasing the dose of levodopa. This would lead to more adverse effects. On the other hand, your husband has shown improvement with Rotigotine patch. It makes more sense to increase the dose to at least reach 8 mg per day. You should discuss this with the neurologist. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist