Neupro patch: cut or fold to lower dose?

[LunaDog31]

Can the Neupro patch be cut or folded in half? I am prescribed 2mg/24hr but can only find 3mg patches. I'm looking for a work-around for a few days. Any advice is greatly appreciated.

[Elffindoe]

With this patch the amount of drug you get usually depends on the surface area of the patch in contact with your skin. The drug diffuses at right angles to the patch and straight into the skin.

I can't really see how it's practical to fold the patch. In addition I'm not entirely certain that the drug won't diffuse sideways through the patch itself and this might mean you don't really know how much of the drug you're getting.

To reduce the dose then, the usual way is to cut the patch. This is your own choice and it is not advised by the manufacturer, but people do it.

As it's the surface area that determines the dose then it's important to cut it to the right size. Since your patches are 3mg and your prescribed dose is 2mg then cutting a patch in half means you'll only be getting 1.5mg.

You therefore would need to cut off one third of the patch.

I note thatyou are a new member, so welcome. I wonder if this also means that you are newly diagnosed with RLS and if this is your first prescription for RLS.

If this is the case then please note two things

1) Dopamine agonists such as rotigotine, the neupro patch, are no longer recommended as the first treatment for RLS. The first recommended medical treatments for RLS are either pregabalin or gabapentin.

2) If the person who prescribed you neupro is not aware of this then they should have at least warned you of the risk of major complications with any dopamine agonists, i.e. the reason they're n no longer recommended.

These are Impulse Control Disorder and Augmentation. Both these are life changing conditions. Luckily the first is not so common, but the second is very common.

I suggest you either make sure you read up about augmentation on this site OR go back to the doctor and ask to to switch to pregabalin or gabapentin instead.

In addition, if you are newly diagnosed and this is your first tretament then it may be that your doctor has missed two imprtant thgings.

1) Iron therapy. Everybody with RLS should be assessed for the need for iron therapy, as iron deficiency is the main cause of RLS. Effective iron therapy if accessible can benefit up to 60% of RLS sufferers without the need for drugs. I suggest again you read up about tbhis and again, if necessary disciuss it wioth your doctor.

2) Exacerbating factors. There are actually many things that can make RLS worse

I'll write more later

[Madlegs1 in reply to Elffindoe]

Good man, great answer!😎

I think plenty of people have cut the Neupro patch successfully.

I know I was able to cut the Fentanyl patch ok.

If the Neupro is a regular shape, then no problem. If it's ovoid ,then be extremely exact.

[Elffindoe]

Exacerbating factors are things which make RLS worse. Removing them can improve symptoms.

There are three main sources of aggravation 1) medications, 2) Triggers and 3) inflammation

medications

If you’re taking no medications at all, then this isn’t relevant to you.

If you’re taking any other medication including prescription or non-prescription regularly or intermittently, medicinal or recreational.

Identify if any medication you’re taking is known to make RLS worse.

If any are identified discuss with your doctor whether these can be stopped or replaced with an alternative.

Medications known to make RLS worse are

Virtually all anti-depressants,

All sedating antihistamines,

Proton pump and H2 inhibitor antacids

Some antiemetics e.g. metoclopramide

Some blood pressure medications

Beta blockers

Some stimulants

WITHDRAWAL from benzodiazepines or opioids.

Triggers

Triggers have an almost immediate effect

For everybody these include alcohol, nicotine, sugar, caffeine and other stimulants, (e.g. mint).

Some people find caffeine helps symptoms once they’ve started, but it won’t help prevent them.

Avoid the common triggers.

Keep a food diary to see if there are any other triggers for you not on the list e.g. MSG.

inflammation

There are two situations in which it may help.

a) You have a known inflammatory disease, particularly bowel inflammation

b) You aren’t aware of any inflammatory disease

For a) Take all treatment as prescribed or seek treatment.

This particularly includes bowel conditions such as IBS, H Pylori Bacteria, and SIBO.

For b) You can investigate if you are suffering chronic or sub-clinical inflammation. You may not experience any signs or symptoms of these.

There are therefore three options.

1) Trying a common diet.

2) Trial and error dieting

3) Sensitivity testing

1) Excessive carbohydrates are a known cause of chronic inflammation, so are diets high in substances which cause oxidative stress. Typical diets are low carbohydrate, FODMAP, low oxalate, or anti-inflammatory. Taking an anti-oxidant can help, e.g. selenium or celery juice.

2) This involves removing and adding possible dietary elements to see if removal relieves RLS and re-adding makes them worse.

3) Testing for common substances to which you may be sensitive, i.e. which aren’t full blown allergies. Common substances are gluten and lactose.

GUT HEALTH is important if natural bacteria are lost form the bowel, e.g. due to antibiotic therapy then probiotics may help restore necessary bacteria.

[Merny5]

Hello LunaDog31,Despite the manufactures recommendation not to cut the patch, I did and was successful. I made a template and measured the exact amount that I wanted to reduce and eventually eliminate the drug entirely. However, I wonder why you are unable to obtain a 2mg. patch. As I recall, the standard dosing was 1 mg, 2 mg, 3 mg., 4 mg, 6mg and 8mg. Good luck and go ahead and cut🙂

[Caperry]

Yes you can cut Neupro patch and it works just fine! 3mg cut to 2 mg would be about 2/3 of the patch, good luck

[macewan13]

Yes, you can cut it. I’ve been doing it for years on the advice of my RLS consultant.

[LunaDog31]

Thank you for the replies. My pharmacy now has the 2mg patches available. I had no trouble during the time I was cutting them though. Thanks!

[LunaDog31]

How does one find an RLS specialist? I've been seeing a movement and sleep disorder specialist but after reading many posts here I am wondering if this is the right doc.