Rotigine patch

[Keith1231]

My neurologist recommended this for my RLS, what do you advise?

[SueJohnson]

NO NO NO !!! It is a dopamine agonist like ropinirole and pramipexole.

[ChrisColumbus]

Your neurologist either hasn't yet caught up with last month's update to the NICE CKS guidance or just believes that he knows better.

As the guidance now says, "dopamine agonists" - pramipexole, ropinirole, rotigotine - "were previously used as first-line treatment for RLS, but the high incidence of augmentation (suggested by a worsening of RLS accompanied by the need to increase the dose of dopamine agonist) and risk of developing impulse control disorder has led to the gabapentinoids now being first-line drug treatment."

cks.nice.org.uk/topics/rest...

I see that you have previously posted that you had started on gabapentin and Sue gave you advice about taking it: has that not worked for you? If so, did you try pregabalin ?

If neither of the gabapentinoids worked, which is possible after augmenting on a dopamine agonist, the answer is not another dopamine agonist but a low dose opioid.

[Joolsg]

Keith- you were seeing Dr Rafiq who had prescribed Buprenorphine. He was referring you to someone in Cambridge.Who is this latest neurologist?

Can you tell us more about Buprenorphine ? What dose did he prescribe and why didn't it help? Side effects are very common in the first month. But most can be resolved.

If Buprenorphine didn't cover the RLS- perhaps the dose was too low.

Rotigitone is another dopamine agonist. Do NOT take it.

Here is a video by a top world expert explaining WHY Rotigitone is actually worse than the other dopamine agonists (Ropinirole & Pramipexole). UK neurologists still mistakenly believe Rotigitone doesn't cause augmentation. It does. And when it happens- it's worse than on the other DAs. At your age, augmentation would hit again within a year. You would then have to go through another BRUTAL withdrawal and I guarantee that this neurologist won't be around to help you through it or admit you to a drug rehab clinic!

The new NICE cks guidance released in February 2025 makes clear that ALL dopamine agonists are now NOT recommended.

So write to this new neurologist with a copy of NICE cks guidance & a copy of Dr Berkowski video about Rotigitone.

youtu.be/Tz7g9sxS0_I?si=VnF...(Not working as expected?)

cks.nice.org.uk/topics/rest...

[Keith1231 in reply to Joolsg]

I tried gaba for 6 months and that didn't work, left me with balance issues. Dr rafiqu sent me to se Dr Buttery he recommended Rotigine 2mg patches. I don't know which way to turn now. I exercise hoping it will strengthen my body to help with balance but it doesent.

[Joolsg in reply to Keith1231]

Please, please take our advice Keith.Rotigitone patch will quickly cause VERY severe, increased RLS.

Dr Buttery is sending you down a VERY dangerous road! Did he tell you the Rotigitone patches would cause severe, increased RLS very soon?

I understand about gabapentin.

But Buprenorphine is now the best med for refractory RLS- which is what you now have.

So again, what dose of Buprenorphine did Dr Rafiq give you and what side effects did you have? Constipation, anxiety, nausea and sweats are common. But each can be resolved.

Don't start the Rotigitone.

New NICE cks guidance was changed because the writers are aware that eventually- everyone on dopamine agonists will experience drug-induced worsening.

[Annieapple]

😩

No

[Annieapple]

😩 Keith I have had a horrendous time getting off this patch!! You WILL experience augmentation & it’s horrible & even more horrific getting off it!!

My suggestion would be to try high dose of codeine only at bedtime until things settle down & then try your Gabapentin together with the codeine.. as you gradually up your gaba reduce the codeine ..

Hard decisions but you will get through this!!

[Keith1231 in reply to Annieapple]

Thank you. I have just come off gaba, it didn't work and left me with balance issues. My legs are pressured and restless. I don't know what else to do. I have tried coding but that made me so badly constipated and didn't work.

[Annieapple in reply to Keith1231]

Sorry to hear that! Have you tried Pregablin.. I couldn’t tolerate gabapentine years ago, but I am fine on Pregablin. When I take codeine I swallow a stool softener at the same time!

[LegJimmies]

Don’t take the DA! Eventually it causes augmentation and terrible side effects.

[Merny5]

Keith, PLEASE don’t take the patch!! I was on it for about 2 years and I suffered greatly when coming off of it. I suffered from DAWS, dopamine agonists withdrawal syndrome for several years after. It’s a horrible medication!

[RLSLearner]

Assuming you have been checked/checked yourself for medications that aggravate RLS and had iron studies and even if iron is normal are on iron supplements. Got to do these before working out which med suits you best.