NEUPRO 2 mg /24 H Трансдермальный Пластырь

Сергей Ильясов

Сергей Ильясов — опытный врач-невролог и квалифицированный психиатр, предоставляющий онлайн-консультации для взрослых и подростков. Сочетая глубокую неврологическую экспертизу с современным психиатрическим подходом, он обеспечивает комплексную диагностику и эффективное лечение широкого спектра состояний, затрагивающих как физическое, так и психическое здоровье.

Доктор помогает пациентам в таких случаях:

Хронические головные боли (мигрень, головная боль напряжения), боли в спине, невропатические боли, головокружения, онемение конечностей, нарушения координации.
Тревожные расстройства (панические атаки, генерализованное тревожное расстройство), депрессия (в том числе атипичная и резистентная), нарушения сна (бессонница, сонливость, кошмары), стресс, выгорание.
Хронические болевые синдромы и психосоматические симптомы (например, синдром раздражённого кишечника на нервной почве, вегетососудистая дистония).
Поведенческие нарушения и трудности с концентрацией внимания у подростков (включая СДВГ, расстройства аутистического спектра), нервные тики.
Нарушения памяти, фобии, обсессивно-компульсивное расстройство (ОКР), эмоциональные качели, а также поддержка при посттравматическом стрессовом расстройстве (ПТСР).

Благодаря двойной специализации в неврологии и психиатрии, Сергей Ильясов предлагает интегрированную и доказательную помощь при сложных состояниях, требующих междисциплинарного подхода. Его консультации направлены на точную диагностику, разработку индивидуального плана лечения (включая фармакотерапию и психотерапевтические методики) и долгосрочную поддержку, адаптированную к уникальным потребностям каждого пациента.

Запишитесь на онлайн-консультацию с доктором Сергеем Ильясовым, чтобы получить квалифицированную помощь и улучшить своё самочувствие уже сегодня.

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Инструкция по применению NEUPRO

Содержание инструкции

Neupro 1 mg/24 h transdermal patch, 3 mg/24 h transdermal patch
Neupro 2 mg/24 h transdermal patch
Neupro 4 mg/24 h transdermal patch, 6 mg/24 h transdermal patch, 8 mg/24 h transdermal patch
Neupro 2 mg/24 h, 4 mg/24 h, 6 mg/24 h, 8 mg/24 h

Neupro 1 mg/24 h transdermal patch, 3 mg/24 h transdermal patch

Rotigotina

Read this leaflet carefully before you start to take this medicine as it contains important information for you.

Keep this leaflet. You may need to read it again.
If you have any questions, ask your doctor, pharmacist or nurse.
This medicine has been prescribed for you only. Do not pass it on to others, even if their symptoms are the same as yours, as it could be harmful.
If you get any side effects, even those not listed in this leaflet, tell your doctor, pharmacist or nurse. See section 4. Contents of this leaflet

1. What Neupro is and what it is used for
2. What you need to know before you take Neupro
3. How to take Neupro
4. Possible side effects
5. How to store Neupro
6. Contents of the pack and other information

1. What is Neupro and what is it used for

What is Neupro
Neupro contains the active substance rotigotine.
It belongs to the class of medicines called “dopamine agonists”. Dopamine is a substance
present in the brain responsible for the transmission of messages, the function of which is important for
movement.

What is Neupro used for
Neupro is indicated in adults for the treatment of signs and symptoms of:

Restless Legs Syndrome- this may be associated with discomfort in the legs and arms, an irresistible need to move the legs, sleep disturbances, a feeling of fatigue or drowsiness during the day. Treatment with Neupro reduces these symptoms and decreases their duration.

2. What you need to know before you take Neupro

Do not take Neupro if:

you are allergicto rotigotineor to any of the other ingredientsof this medicine (listed in section 6)
you are going to have a magnetic resonance imaging(MRI) scan (diagnostic images of the inside of the body, obtained using magnetic fields instead of x-rays)
you are going to have “cardioversion” (a specific treatment for an abnormal heart rhythm). Immediately before undergoing magnetic resonance imaging (MRI) or cardioversion, you must remove the Neupro patch to avoid skin burns, as the patch contains aluminum. You can then reapply a new patch. If any of the above conditions apply to you, do not use Neupro. If you are unsure, ask your doctor, pharmacist or nurse before use.

Warnings and precautions
Talk to your doctor, pharmacist or nurse before taking Neupro. This is because:

your blood pressureneeds to be checked regularly while you are using Neupro, especially at the beginning of treatment. Neupro can change your blood pressure.
your eyesneed to be checked regularly while you are using Neupro. If you notice any vision problems between check-ups, contact your doctor immediately.
if you have severe liver problems, your doctor may need to adjust the dose. If your liver problems get worse during treatment, contact your doctor immediately.
skin problemsmay occur caused by the patch - see “Skin problems caused by the patch” in section 4.
you may feel very sleepy or fall asleep suddenly -see “Driving and using machines”in section 2.
the symptoms of Restless Legs Syndromemay start earlier than usual, be more severe and involve other limbs. If you experience these symptoms before or after starting treatment with Neupro, contact your doctor as the treatment may need to be adjusted. Medicines used to treat Restless Legs Syndrome must be reduced or stopped gradually. Tell your doctor if you experience symptoms such as depression, anxiety, fatigue, sweating or pain after stopping or reducing treatment with Neupro. Loss of consciousness may occurNeupro can cause loss of consciousness. This can happen especially when you start using Neupro or when the dose is increased. Tell your doctor if you lose consciousness or feel dizzy. Abnormal changes in behaviour and thinkingNeupro can cause unwanted effects that change behaviour (the way you act). It may be helpful to tell a family member or caregiver that you are taking Neupro, so they can tell you or the doctor if they are concerned about any changes in your behaviour. Tell your doctor if you or a family member/caregiver notices that you are excessively using the medicine or developing a strong desire for high doses of Neupro or other medicines used to treat Restless Legs Syndrome. See “Abnormal changes in behaviour and thinking”in section 4 for more information. Children and adolescentsDonot give this medicine to childrenunder 18 years of age because the safety and effectiveness of the medicine in this age group have not been established. Other medicines and NeuproTell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This includes medicines you buy without a prescription or herbal medicines. While using Neupro do not take the following medicines - because they can reduce its effect:
“antipsychotic” medicines - used to treat certain mental disorders
metoclopramide - used for nausea (feeling sick) and vomiting.

Tell your doctor before using Neupro if you are taking:

sedative medicines such as benzodiazepines or medicines used to treat mental disorders or depression.
medicines that lower blood pressure. Neupro can lower blood pressure when you get up - this effect can be worsened by medicines used to lower blood pressure. Your doctor will tell you if it is safe for you to continue taking these medicines while using Neupro. Neupro with food, drinks and alcoholBecause rotigotine passes into the blood through the skin, food and drinks have no effect on how the medicine is absorbed by the body. Ask your doctor if you can drink alcohol while using Neupro. Pregnancy and breastfeedingDo not use Neupro if you are pregnant. This is because the effects of rotigotine on pregnancy and the unborn baby are not known. Do not breastfeed during treatment with Neupro. This is because rotigotine can pass into breast milk and have effects on the baby. Also, it is likely to cause a reduction in the amount of milk produced. If you are pregnant, suspect you may be pregnant, or are planning to become pregnant, or if you are breastfeeding, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machinesNeupro can cause very strong sleepiness and can make you fall asleep suddenly. If this happens to you, do not drive. In rare cases, patients have fallen asleep while driving vehicles and have caused accidents. Also, if you feel very sleepy do not use tools or machines - or do anything else that could put yourself or others at risk of serious injury. Neupro contains sodium metabisulfite (E223)Sodium metabisulfite (E223) can, rarely, cause severe hypersensitivity reactions (allergic reactions) and bronchospasm (breathing problems caused by a narrowing of the airways).

3. How to take Neupro

Use this medicine following exactly the instructions of your doctor or pharmacist. If you have
any doubts consult your doctor or pharmacist.

What dosage to use
Neupro is available in patches with different dosages that release the medicine for 24 hours. The dosages
are 1 mg/24 h, 2 mg/24 h and 3 mg/24 h for the treatment of Restless Legs Syndrome.

The initial dose is one 1 mg/24 h patch per day.
Starting from the second week, the daily dose may be increased by 1 mg per week, up to reaching the appropriate maintenance dose for you. This occurs when you and your doctor establish that the symptoms are adequately controlled and the undesirable effects caused by the medicine are acceptable.
Always follow your doctor's instructions exactly.
The maximum dose is 3 mg per day.

If you need to stop therapy, see “If you stop treatment with Neupro”in section 3.

How to use Neupro patches
Neupro is a patch to be applied to the skin.

Make sure you have removed the old patch before applying a new one.
Apply the new patch to a different area of skinevery day.
Leave the patch on the skin for 24 hours, then remove it and apply a new one.
Change the patchesevery dayat about the same time.
Do not cut Neupro patches into pieces.Where to apply the patchApply the adhesive part of the patch to clean, dry and healthy skin, in the following regions, as indicated in grey, in the figures on the side:

Human body seen frontally, laterally and posteriorly with dark areas indicating the drug application sites

Shoulder or upper arm.
Abdomen.
Side (between the ribs and hips).
Thigh or hip.

To avoid skin irritation

Apply the patch to a different area of theskin every day. For example, put it one day on the right side of the body, then the next day on the left side of the body. One day on the upper part of the body, then on the lower part of the body, the next day.
Do notreapply Neupro twice to the same area of skinwithin 14days.
Do notapply the patch to wounded or damaged skin, or to skinreddened or irritated. If you have skin problems due to the patch, see “Skin problems caused by the patch”in section 4, for further information. To prevent loss or detachment of the patch
Do notapply the patch to an area that may be rubbed by tight clothing.
Do notuse creams, oils, lotions, powdersor other skin productswhere you will apply the patch. Also do not apply them over or near another patch that you have already applied.
If you need to apply the patch to an area covered with hair, you must shavethe area at least threedays beforeapplying the patch.
If the edges of the patch lift, the patch can be further secured with medical adhesive tape. If the patch detaches, apply a new patch for the remainder of the day - then replace the patch at the same time as usual.
Do not letthe patch area be exposed to heat- for example, excessive sunlight, sauna, very hot baths, heating pads or hot water bottles. This is because the medicine may be released faster. Contact your doctor or pharmacist if you think the heat applied has been excessive.

Human arm with injection area highlighted by dark squares and a central white square to indicate the site

Always check that the patch has not detached after some activities such as bathing, showeringor physical activity.
If the patch has caused skin irritation, do not exposethe affected area to sunlight,as the skin may change color. How to use the patch
Each patch is packaged in a separate sachet.
Before opening the sachet, decide where to apply the new patch and make sure you have removed the old patch.
Apply the Neupro patch to the skin immediately after opening the sachet and removing the protective film.

Hands opening a sealed sachet containing a medicine, with text visible on the packaging and fingers preparing to

1.
To open the sachet, hold it
with both hands.
Separate the two layers of the
film.

Hands opening a white paper wrapper folded in half to reveal the contents inside

Hands opening a sealed sachet containing an adhesive medical patch beige in color

Open the sachet.

Hands opening a sealed sachet, probably containing a medicine, with a neat and precise cut on the top

Remove the patch from the
sachet.

Hands opening a white paper wrapper, probably containing a medicine or medical device

5
The adhesive part of the patch
is covered by a transparent
protective layer.

Hold the patch with both hands, with the protective layer facing you.

Hands holding a transparent glass vial containing a clear liquid probably medicine

Fold the patch in two. This allows you to open the S-shaped opening line.

Two hands opening a white and silver paper wrapper to reveal the contents inside

Detach one side of the protective lining.
Do not touch the adhesive part of the patch with your fingers.

Hand applying a white patch on a bent arm showing its clear skin and muscle shape

Hold the other side of the protective lining in your hand.
Then apply the adhesive half of the patch to the skin.
Press firmly on the adhesive part of the patch.

Hand applying a patch on a bent arm with clear skin and visible muscles

Fold the other
half of the patch backwards and detach
the other side of the protective
layer.

10.

Press firmly on the patch with the palm of your hand.
Hold for 30 seconds.

Arm with hand applying pressure on a point, stopwatch with indication of 30 seconds in the background

This process allows you to
make sure that the patch
is in contact with the skin and
that the corners adhere
well.
Wash your hands with water and
soap immediately
after handling the
patch.

How to remove a used patch

Remove the used patch slowly and carefully.
Gently wash the affected area with lukewarm water and mild soap. This allows you to remove any adhesive residue left on the skin by the patch. For adhesive residue that does not come off with water, you can also use a small amount of baby oil.
Do not use alcohol or other solvents - for example, nail polish remover. They can cause irritation.

If you use more Neupro than you should
Using higher doses of Neupro than prescribed by your doctor can cause undesirable effects such as
feeling unwell (nausea) or vomiting, low blood pressure, seeing or hearing things that are not
real (hallucinations), feeling confused, extreme drowsiness, involuntary movements and
convulsions.
In these cases, contact your doctor or hospital immediately. They will give you instructions on how to proceed.

If you forget to replace the patch at the usual time

If you forgot to replace the patch at the usual time, apply a new one as soon as you remember. Remove the old patch and use a new one.
If you forgot to apply a new patch after removing the old one, apply a new one as soon as you remember. In both cases, apply a new patch at the usual time the next day. Do not apply a double dose to make up for a missed dose. If you stop treatment with NeuproDo not stop using Neupro without informing your doctor. An abrupt interruption can cause you to develop a clinical condition called “neuroleptic malignant syndrome” which could be life-threatening. The signs include: loss of muscle movements (akinesia), muscle rigidity, fever, unstable blood pressure, accelerated heartbeat (tachycardia), confusion, reduced state of consciousness (e.g., coma). If your doctor has told you to stop treatment with Neupro, the daily dose must be reduced gradually:
Restless Legs Syndrome -reduction of 1 mg on alternate days. If you have any doubts about the use of this medicine, ask your doctor or pharmacist or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
If you notice any side effect, contact your doctor or pharmacist or
the nurse.

More frequent side effects at the beginning of therapy
You may feel unwell (nausea)and vomiting,at the beginning of therapy. These effects are
usually mild or moderate and last only for a short time. Contact your doctorif they last for a long
time or worry you.

Skin problems caused by the patch

The patch may cause redness and a feeling of itching on the skin where it has been applied - these reactions are usually mild or moderate.
The reactions usually disappear a few hours after the patch is removed.
Tell your doctor ifyou have a skin reaction that lasts more than a few days and is severe or if it spreads outside the area of skin covered by the patch.
Avoid exposing the areas of skin that have any skin reaction caused by the patch to sunlight and sunbeds.
To avoid skin reactions, apply the patch each day to a different area and do not use the same area again for 14 days. Loss of consciousness may occurNeupro can cause loss of consciousness. This can happen particularly when you start using Neupro or when the dose is increased. Tell your doctor if you lose consciousness or feel dizzy. Abnormal changes in behaviour and thinkingTell your doctor if you notice any changes in behaviour, thinking or both,listed below. They may decide how to manage or reduce the symptoms.It may be helpful to tell a family member or carer that you are

family member or carer can tell you or the doctor if they are concerned about any
changes in your behaviour. Neupro can cause unusual urges or desires that lead you
to be unable to resist the impulse, drive or temptation to perform certain activities that
could harm you or others.
These can include:

a strong urge to gamble excessively - even though it has a serious negative impact on you or your family
altered or increased sexual interest and behaviour that causes you or others considerable distress, for example an increased sexual drive
uncontrollable shopping or spending
eating large amounts of food in a short period of time (binge eating) or compulsive eating (eating more food than normal and more than needed to satisfy your appetite).

Neupro can cause other abnormal thoughts and behaviours. These can include:

abnormal thoughts about reality
delusions, hallucinations (seeing or hearing things that are not real)
confusion
disorientation
aggressive behaviour
agitation
rambling.

Tell your doctor if you notice any changes in behaviour, thinking or both,
listed above.
They may decide how to manage or reduce the symptoms.
Allergic reactions
Contact your doctor if you notice signs of an allergic reaction - these can include swelling of the face,
tongue and/or lips.

Side effects when using Neupro for restless legs syndrome
Tell your doctor or pharmacist if you notice any of the following side effects:

Very common: may affect more than 1 in 10 people

headache
feeling unwell (nausea)
feeling weak (fatigue)
skin irritation under the patch, such as redness and itching Common: may affect up to 1 in 10 people
itching
feeling irritable
allergic reactions
increased sexual activity
high blood pressure
vomiting, heartburn
swelling of the legs and feet
feeling sleepy, sudden sleep onset without warning signs, difficulty sleeping, sleep disorders, unusual dreams
inability to resist the impulse to perform an action that could cause harm, including excessive gambling, repetitive actions with no purpose, uncontrollable shopping or spending
eating large amounts of food in a short period of time (binge eating) or compulsive eating (eating more food than normal and more than needed to satisfy your appetite)

Uncommon: may affect up to 1 in 100 people

feeling agitated
feeling dizzy when standing up due to low blood pressure Rare: may affect up to 1 in 1000
aggressive behaviour
disorientation Not known: frequency cannot be estimated from the available data
a strong desire for high doses of medicines like Neupro - more than needed to control the condition. This is also known as “dopamine dysregulation syndrome” and can lead to excessive use of Neupro
feeling or seeing things that are not real (hallucinations)
nightmares
paranoia
confusion
psychotic disorders
delusions
rambling
dizziness
loss of consciousness, involuntary movements (dyskinesia)
involuntary muscle spasms (convulsions)
blurred vision
vision disturbances such as seeing colours or lights
vertigo (a sensation of spinning)
feeling your heartbeat (palpitations)
abnormal heart rhythm
low blood pressure
hiccups
constipation, dry mouth
stomach discomfort and pain
diarrhoea
flushing, increased sweating
generalised itching, skin irritation
generalised skin rash
inability to achieve or maintain an erection
weight loss, weight gain
increased or abnormal liver function test results
increased levels of creatine phosphokinase (CPK) (CPK is an enzyme mainly found in skeletal muscle)
falls
rhabdomyolysis (a rare, serious muscle disorder that causes muscle pain, tenderness and weakness and can lead to kidney problems) Tell your doctor or pharmacist if you notice any of the side effects listed above.

Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any side effects not
listed in this leaflet. You can also report side effects directly through the national reporting system listed in
Annex V.
By reporting side effects you can help provide more information on the safety of
this medicine.

5. How to store Neupro

Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the label and the packaging.
Do not store at temperatures above 30°C.

Disposal of used or unused patches

Used patches still contain the active substance “rotigotine”, which may be harmful to other people. Fold the used patch with the adhesive side inwards. Replace the patch in its original sachet and dispose of it safely, out of the reach of children.
Do not dispose of any medicine in wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This will help protect the environment.

6. Package Contents and Other Information

What Neupro contains
The active ingredient is rotigotine.

1 mg/24 h: Each patch releases 1 mg of rotigotine in 24 hours. Each 5 cm patch contains 2.25 mg of rotigotine.
3 mg/24 h: Each patch releases 3 mg of rotigotine in 24 hours. Each 15 cm patch contains 6.75 mg of rotigotine. The other ingredients are:
Poly(dimethylsiloxane, trimethylsilyl silicate)-copolymerized, povidone K90, sodium metabisulfite (E223), ascorbyl palmitate (E304) and DL-α-tocopherol (E307).
Support layer: polyester film coated with silicone and aluminum, colored with a pigment layer (titanium dioxide (E171), pigment yellow 13, pigment red 166, pigment yellow

12) and bearing the inscription (pigment red 146, pigment yellow 180, pigment black 7).

Protective layer: polyester film coated with transparent fluoropolymer. Description of Neupro and package contentsNeupro is a transdermal patch. It is thin and consists of three layers. It is a square patch, with rounded corners. The outer part of the support layer is beige in color and displays the inscription Neupro 1 mg /24 h or 3 mg/24 h. Neupro is available in the following packs:

The boxes contain 7, 14, 28, 30 or 84 (multipack containing 3 packs of 28) transdermal patches sealed in individual sachets.
Not all pack sizes may be marketed.

Marketing Authorisation Holder
UCB Pharma S.A.
Allée de la Recherche 60
B-1070 Brussels
Belgium

Manufacturer
UCB Pharma S.A.
Chemin du Foriest
B-1420 Braine l’Alleud
Belgium
For further information on this medicinal product, contact the local representative of the Marketing Authorisation Holder:

België/Belgique/Belgien
UCB Pharma SA/NV
Tél/Tel: +32-(0)2 559 92 00

Lietuva
UCB Pharma Oy Finland
Tel: +358-92 514 4221 (Suomija)

България
Ю СИ БИ България ЕООД
Te л. : + 359-(0) 2 962 30 49

Luxembourg/Luxemburg
UCB Pharma SA/NV
Tél/Tel: +32-(0)2 559 92 00

Česká republika
UCB s.r.o.
Tel: + 420-221 773 411

Magyarország
UCB Magyarország Kft.
Tel.: + 36-(1) 391 0060

Danmark
UCB Nordic A/S
Tlf.: + 45-32 46 24 00

Malta
Pharmasud Ltd.
Tel: +356-21 37 64 36

Deutschland
UCB Pharma GmbH
Tel: + 49-(0) 2173 48 48 48

Nederland
UCB Pharma B.V.
Tel: +31-(0)76-573 11 40

Eesti
UCB Pharma Oy Finland
Tel: +358-92 514 4221 (Soome)

Norge
UCB Nordic A/S
Tlf: +45-32 46 24 00

Ελλάδα
UCB Α.Ε.
Τηλ: +30-2109974000

Österreich
UCB Pharma GmbH
Tel: + 43-(0)1 291 80 00

España
UCB Pharma S.A.
Tel: + 34-91 570 34 44

Polska
UCB Pharma Sp. z o.o.
Tel.: + 48-22 696 99 20

France
UCB Pharma S.A.
Tél: + 33-(0)1 47 29 44 35

Portugal
BIAL-Portela & Cª, S.A.
Tel: +351-22 986 61 00

România
UCB Pharma România S.R.L.
Tel: + 40-21 300 29 04

Hrvatska
Medis Adria d.o.o.
Tel: +385-(0)1 230 34 46

Ireland
UCB (Pharma) Ireland Ltd.
Tel: + 353-(0)1-46 37 395

Slovenija
Medis, d.o.o.
Tel: + 386-1 589 69 00

Ísland
UCB Nordic A/S
Sími: + 45 / 32 46 24 00

Slovenská republika
UCB s.r.o., organizačná zložka
Tel: + 421-(0)2 5920 2020

Italia
UCB Pharma S.p.A.
Tel: + 39-02 300 791

Suomi/Finland
UCB Pharma Oy Finland
Puh/Tel: +358-92 514 4221

Κύπρος
Lifepharma (Z.A.M.) Ltd
Τηλ: + 357-22 05 63 00

Sverige
UCB Nordic A/S
Tel: + 46-(0)40 29 49 00

Latvija
UCB Pharma Oy Finland
Tel: +358-92 514 4221 (Somija)

Other sources of information
More detailed information on this medicinal product is available on the website of the European Medicines Agency: https://www.ema.europa.eu.

Neupro 2 mg/24 h transdermal patch

Rotigotina

Read this leaflet carefully before you start to take this medicine because it contains
important information for you.

Keep this leaflet. You may need to read it again.
If you have any questions, ask your doctor, pharmacist or nurse.
This medicine has been prescribed for you only. Do not pass it on to others, even if their symptoms are the same as yours, as it could be harmful.
If you get any side effects, even those not listed in this leaflet, tell your doctor, pharmacist or nurse. See section 4.

Contents of this leaflet

1. What Neupro is and what it is used for
2. What you need to know before you take Neupro
3. How to take Neupro
4. Possible side effects
5. How to store Neupro
6. Contents of the pack and other information

1. What is Neupro and what is it used for

What is Neupro used for
Neupro is indicated in adults for the treatment of signs and symptoms of:

Parkinson's disease -Neupro can be used alone or in combination with another medicine called levodopa.
Restless Legs Syndrome -this may be associated with discomfort in the legs and arms, an irresistible need to move the legs, sleep disturbances, a feeling of fatigue or drowsiness during the day. Treatment with Neupro reduces these symptoms and decreases their duration.

2. What you need to know before you take Neupro

Do not take Neupro if:

you are allergicto rotigotineor to any of the other ingredientsof this medicine (listed in section 6)
you need to undergo a magnetic resonance imaging (MRI) scan(diagnostic images of the inside of the body, obtained using magnetic fields instead of x-rays)
you need to undergo “cardioversion”(a specific treatment for an abnormal heart rhythm).

Immediately before undergoing magnetic resonance imaging (MRI) or cardioversion you must
remove the Neupro patch to avoid skin burns, as the patch contains aluminium.
You can then apply a new patch afterwards.
If any of the above conditions apply to you, do not use Neupro. If you have doubts, contact your
doctor or pharmacist first.

Warnings and precautions
Talk to your doctor, pharmacist or nurse before taking Neupro. This is because:

your blood pressuremust be checked regularly while you are using Neupro, particularly at the beginning of treatment. Neupro can change your blood pressure.
your eyesmust be checked regularly while you are using Neupro. If you notice any vision problems between check-ups, contact your doctor immediately.
if you have severe liver problems, your doctor may need to adjust the dose. If your liver problems worsen during treatment, contact your doctor immediately.
skin problemsmay occur caused by the patch - see “Skin problems caused by the patch” in section 4.
you may feel very sleepy or fall asleep suddenly- see “Driving and using machines” in section 2.
involuntary muscle contractions may occur causing abnormal movements or postures, often repetitive (dystonia), abnormal posture or lateral bending of the back (also called pleurototonia or Pisa syndrome). If this happens, your doctor may want to change the therapy.
the symptoms of Restless Legs Syndromemay start earlier than usual, be more intense and involve other limbs. If you experience these symptoms before or after starting treatment with Neupro, contact your doctor as the treatment may need to be adjusted. Medicines used to treat Parkinson's disease and Restless Legs Syndrome must be reduced or stopped gradually. Tell your doctor if you experience symptoms such as depression, anxiety, fatigue, sweating or pain after stopping or reducing treatment with Neupro. Loss of consciousness may occurNeupro can cause loss of consciousness. This can happen particularly when you start using Neupro or when the dose is increased. Tell your doctor if you lose consciousness or feel dizzy. Abnormal changes in behaviour and thinkingNeupro can cause unwanted effects that change behaviour (the way you act). It may be helpful to tell a family member or caregiver that you are taking Neupro, so they can tell you or the doctor if they are worried about any changes in your behaviour. These include:
a strong urge to take high doses of Neupro or other medicines used to treat Parkinson's disease and Restless Legs Syndrome
unusual urges or desires that you cannot resist and this could harm you or others - these symptoms are mainly present in patients with Parkinson's disease
abnormal thinking and behaviour - most of the symptoms concern patients with Parkinson's disease. See “Abnormal changes in behaviour and thinking”in section 4 for more information.

Children and adolescents
Donot give this medicine to children under 18 years of agebecause the safety and efficacy of the medicine in this age group has not been established.

Other medicines and Neupro
Tell your doctor or pharmacist if you are taking, have recently taken or might take
any other medicines. This includes medicines you buy without a prescription or herbal medicines.
If you are being treated with Neupro and levodopa at the same time, some unwanted effects
may worsen. These include seeing or hearing things that are not real (hallucinations),
involuntary movements related to Parkinson's disease (dyskinesia) and swelling of the legs and
feet.
While using Neupro do not take the following medicines – because they can reduce its effect:

“antipsychotic” medicines - used to treat certain mental disorders
metoclopramide - used for nausea (feeling sick) and vomiting. Tell your doctor before using Neupro if you are taking:
sedative medicines such as benzodiazepines or medicines used to treat mental disorders or depression
medicines that lower blood pressure. Neupro can lower blood pressure when you stand up - this effect may be worsened by medicines used to lower blood pressure. Your doctor will tell you if it is safe for you to continue taking these medicines while using Neupro. Neupro with food, drinks and alcoholBecause rotigotine passes into the blood through the skin, food and drinks have no effect on how the medicine is absorbed by the body. Ask your doctor if you can drink alcohol while using Neupro. Pregnancy and breastfeedingDo not use Neupro if you are pregnant. This is because the effects of rotigotine on pregnancy and the unborn baby are unknown. Do not breastfeed during treatment with Neupro. This is because rotigotine can pass into breast milk and have effects on the baby. Also, it is likely to cause a reduction in the amount of milk produced. If you are pregnant, suspect you may be pregnant, or are planning to become pregnant, or if you are breastfeeding, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machinesNeupro can cause very strong sleepiness and can make you fall asleep suddenly. If this happens to you, do not drive. In isolated cases, patients have fallen asleep while driving vehicles and have thus caused accidents. Also, if you feel very sleepy do not use tools or machines - or do anything else that could put you or others at risk of serious injury. Neupro contains sodium metabisulphite (E223)Sodium metabisulphite (E223) can, rarely, cause severe hypersensitivity reactions (allergic reactions) and bronchospasm (breathing problems caused by a narrowing of the airways).