{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:53:27Z","timestamp":1791276807083,"version":"4.1.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Parkinson\u2019s disease (PD) requires lifelong dopaminergic therapy, yet oral routes are frequently compromised by gastrointestinal dysfunction, dysphagia, and perioperative fasting. Abrupt withdrawal of oral dopaminergic drugs may precipitate severe motor deterioration or parkinsonism-hyperpyrexia syndrome. Rotigotine transdermal patch delivers 24-h continuous dopaminergic stimulation (CDS) via a non-ergot dopamine agonist (DA) formulation that bypasses first-pass metabolism and gastrointestinal absorption, and may be particularly useful when oral dopaminergic delivery becomes unreliable or is not possible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To synthesize published evidence on rotigotine pharmacology, clinical efficacy, management in vulnerable populations, safety, real-world effectiveness, and health economics, with emphasis on the incremental contribution of a scenario-based, Asia\/China-inclusive, and pharmacy-oriented narrative relative to prior general reviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Narrative review of randomized controlled trials, meta-analyses, regulatory documents, pharmacoeconomic models, and prospective observational studies identified through structured literature search and bibliographic screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Transdermal bioavailability is approximately 37% versus less than 5% for oral rotigotine. Pivotal Chinese trials SP0914 (early PD: UPDRS II + III \u22124.9 vs. \u22120.2) and SP1037 (advanced PD: placebo-adjusted off-time reduction \u22121.20\u00a0h\/d [95% CI \u22121.83 to \u22120.57]; within-group change \u22122.36\u00a0h\/d) demonstrated efficacy; meta-analyses support motor and selected non-motor benefits, including sleep, mood, and gastrointestinal tolerability, whereas swallowing-related signals remain preliminary and based mainly on small observational studies. Perioperative fasting, dysphagia, end-stage disease, and hepatorenal impairment represent clinically important scenarios in which non-oral delivery may be considered, although supporting evidence outside pivotal motor trials is often limited. Application-site reactions (ASRs) are the principal local adverse events; structured 14-day site rotation reduced ASR from 50.0% to 20.3% (P = 0.0373). Chinese cost-effectiveness analyses reported an incremental cost-effectiveness ratio of 1,118,617.81 CNY per quality-adjusted life year versus pramipexole immediate-release at market price, with price-sensitivity thresholds of 28.5% and 9.5% reductions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rotigotine provides CDS for patients with PD when oral delivery is unreliable; individualized patient selection, structured pharmaceutical care, and updated pharmacoeconomic evaluation are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1933610","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:30:25Z","timestamp":1791275425000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rotigotine transdermal patch in Parkinson\u2019s disease: a narrative review of pharmacology, clinical evidence, special-population management, and health economics"],"prefix":"10.3389","volume":"17","author":[{"given":"Xuelin","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongfang","family":"Qian","sequence":"additional","affiliation":[{"name":"Beijing North Medical Health Economic Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Beijing North Medical Health Economic Research Center","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Business Administration, Shenyang Pharmaceutical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yatong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1177\/1877718X251356896","article-title":"Discontinuation or acute unplanned cessation of oral dopaminergic medications in persons with Parkinson's disease: a practice review","volume":"15","author":"Beckers","year":"2025","journal-title":"J. Parkinson's Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s13318-013-0153-x","article-title":"Influence of hepatic impairment on the pharmacokinetics of the dopamine agonist rotigotine","volume":"39","author":"Cawello","year":"2014","journal-title":"Eur. J. Drug Metabolism Pharmacokinet."},{"key":"B3","volume-title":"Technical Review Report of Rotigotine Transdermal Patch","year":"2022"},{"key":"B4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3109\/00207454.2011.617016","article-title":"Outcomes from switching from rotigotine patch to alternate therapies in Parkinson's disease","volume":"122","author":"Chitnis","year":"2012","journal-title":"Int. J. Neurosci."},{"key":"B5","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1080\/14737175.2017.1336087","article-title":"Switching from an oral dopamine receptor agonist to rotigotine transdermal patch: a review of clinical data with a focus on patient perspective","volume":"17","author":"Chung","year":"2017","journal-title":"Expert Rev. Neurother."},{"key":"B6","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1002\/mds.30162","article-title":"Update on treatments for Parkinson's disease motor fluctuations \u2013 an international Parkinson and movement disorder society evidence-based medicine review","volume":"40","author":"de Bie","year":"2025","journal-title":"Mov. Disord."},{"key":"B7","doi-asserted-by":"publisher","first-page":"362","DOI":"10.2174\/0118715249289689240607064642","article-title":"The smart drug delivery of rotigotine using transdermal patch for the successful management of Parkinson's disease","volume":"25","author":"Dharmian","year":"2025","journal-title":"Central Nerv. Syst. Agents Med. Chem."},{"key":"B8","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.jns.2012.05.010","article-title":"Plasma levodopa peak delay and impaired gastric emptying in Parkinson's disease","volume":"319","author":"Doi","year":"2012","journal-title":"J. Neurological Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1002\/mds.28139","article-title":"Parkinsonism-hyperpyrexia syndrome in Parkinson's disease","volume":"35","author":"Factor","year":"2020","journal-title":"Mov. Disord."},{"key":"B10","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1097\/01.NAJ.0000425744.76107.9f","article-title":"Perioperative medication withholding in patients with Parkinson's disease: a retrospective electronic health records review","volume":"113","author":"Fagerlund","year":"2013","journal-title":"Am. J. Nurs."},{"key":"B11","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s40520-013-0136-4","article-title":"Rotigotine for anxiety during wearing-off in Parkinson's disease with dementia","volume":"25","author":"Fanciulli","year":"2013","journal-title":"Aging Clin. Exp. Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/s40263-019-00646-y","article-title":"Rotigotine transdermal patch: a review in Parkinson's disease","volume":"33","author":"Frampton","year":"2019","journal-title":"CNS Drugs"},{"key":"B13","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1002\/mdc3.12912","article-title":"Impact of residual drug in the pharynx on the delayed-on phenomenon in Parkinson's disease patients","volume":"7","author":"Fukae","year":"2020","journal-title":"Mov. Disord. Clin. Pract."},{"key":"B14","first-page":"1147","article-title":"Research progress of non-oral rotigotine therapy in Parkinson's disease","volume":"38","author":"Geng","year":"2021","journal-title":"J. Apoplexy Nerv. Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1016\/j.parkreldis.2015.08.014","article-title":"Parkinsonism hyperpyrexia syndrome following deep brain stimulation","volume":"21","author":"Govindappa","year":"2015","journal-title":"Park. Relat. Disord."},{"key":"B16","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1002\/mdc3.70320","article-title":"Parkinsonism-hyperpyrexia syndrome following deep brain stimulation battery depletion during the COVID-19 pandemic: a case series and review of the literature","volume":"13","author":"Habibi","year":"2026","journal-title":"Mov. Disord. Clin. Pract."},{"key":"B17","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1111\/ijcp.12885","article-title":"Higher levels of apomorphine and rotigotine prescribing reduce overall secondary healthcare costs in Parkinson's disease","volume":"70","author":"Heald","year":"2016","journal-title":"Int. J. Clin. Pract."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e01840","DOI":"10.1213\/XAA.0000000000001840","article-title":"Parkinsonism-hyperpyrexia syndrome during general anesthesia: a case report","volume":"18","author":"Hiramoto","year":"2024","journal-title":"A&A Pract."},{"key":"B19","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.jns.2019.06.021","article-title":"Effects of the rotigotine transdermal patch versus oral levodopa on swallowing in patients with Parkinson's disease","volume":"404","author":"Hirano","year":"2019","journal-title":"J. Neurological Sci."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2765","DOI":"10.2169\/internalmedicine.55.6808","article-title":"Transdermal patch of rotigotine attenuates freezing of gait in patients with Parkinson's disease: an open-label comparative study of three non-ergot dopamine receptor agonists","volume":"55","author":"Ikeda","year":"2016","journal-title":"Intern. Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1080\/00207454.2020.1807976","article-title":"Real-world safety and effectiveness of rotigotine in patients with Parkinson's disease: analysis of a post-marketing surveillance study in Japan","volume":"132","author":"Ito","year":"2022","journal-title":"Int. J. Neurosci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s13318-025-00938-3","article-title":"Development of a physiologically-based pharmacokinetic model for quantitative interpretation of transdermal drug delivery of rotigotine, a dopamine agonist for treating Parkinson's disease","volume":"50","author":"Jang","year":"2025","journal-title":"Eur. J. Drug Metabolism Pharmacokinet."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2698","DOI":"10.1016\/j.clinthera.2009.10.018","article-title":"Pharmacokinetics of a once-daily extended-release formulation of pramipexole in healthy male volunteers: three studies","volume":"31","author":"Jenner","year":"2009","journal-title":"Clin. Ther."},{"key":"B24","unstructured":"Pharmacoeconomic Evaluation of Rotigotine Versus Pramipexole in Parkinson's disease\n          \n          \n            \n              Jiang\n              D.\n            \n          \n          Wuhan, China\n          Huazhong University of Science and Technology\n          \n          2020"},{"key":"B25","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/1471-2377-11-100","article-title":"Overnight switch from ropinirole to transdermal rotigotine patch in patients with Parkinson disease","volume":"11","author":"Kim","year":"2011","journal-title":"BMC Neurol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1089\/jpm.2022.0258","article-title":"Management of motor symptoms for patients with advanced Parkinson's disease without safe oral access: a scoping review","volume":"26","author":"Kim","year":"2023","journal-title":"J. Palliat. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s00702-006-0606-3","article-title":"Rotigotine transdermal system for perioperative administration","volume":"114","author":"Korczyn","year":"2007","journal-title":"J. Neural Transm."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1111\/ene.15789","article-title":"Gastrointestinal barriers to levodopa transport and absorption in Parkinson's disease","volume":"30","author":"Leta","year":"2023","journal-title":"Eur. J. Neurology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1002\/mds.26082","article-title":"Levodopa therapy for Parkinson's disease: pharmacokinetics and pharmacodynamics","volume":"30","author":"LeWitt","year":"2015","journal-title":"Mov. Disord."},{"key":"B30","first-page":"29","article-title":"Cost-effectiveness analysis of rotigotine versus pramipexole in Parkinson's disease","volume":"38","author":"Li","year":"2021","journal-title":"Health Econ. Res."},{"key":"B31","doi-asserted-by":"publisher","first-page":"630","DOI":"10.3390\/pharmaceutics16050630","article-title":"Using polymers as crystal inhibitors to prevent the crystallization of the rotigotine patch","volume":"16","author":"Liu","year":"2024","journal-title":"Pharmaceutics"},{"key":"B32","doi-asserted-by":"publisher","first-page":"248","DOI":"10.23750\/abm.v90i2.6945","article-title":"Safety and efficacy of rotigotine in hospitalized patients with vascular parkinsonism aged 75 and older","volume":"90","author":"Marchitto","year":"2019","journal-title":"Acta Bio Medica Atenei Parm."},{"key":"B33","volume-title":"Parkinson's disease in Adults: Diagnosis and Management","year":"2017"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e0309297","DOI":"10.1371\/journal.pone.0309297","article-title":"Prescription trends in Japanese advanced Parkinson's disease patients with non-motor symptoms: J-FIRST","volume":"19","author":"Nomoto","year":"2024","journal-title":"PLoS One"},{"key":"B35","doi-asserted-by":"publisher","first-page":"101193","DOI":"10.1016\/j.jddst.2019.101193","article-title":"Preparation and physicochemical characterization of rotigotine drug-in-adhesive patch containing crystal growth inhibitor","volume":"53","author":"Oh","year":"2019","journal-title":"J. Drug Deliv. Sci. Technol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/WNF.0000000000000114","article-title":"Rotigotine transdermal patch does not make Parkinson disease patients sleepy during daytime","volume":"38","author":"Ohta","year":"2015","journal-title":"Clin. Neuropharmacol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e339699","DOI":"10.7759\/cureus.79801","article-title":"Parkinsonism hyperpyrexia syndrome: a rare cause of temperature elevation","volume":"17","author":"Rosado","year":"2025","journal-title":"Cureus"},{"key":"B38","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1159\/000488138","article-title":"Dysphagia causes symptom fluctuations after oral L-DOPA treatment in a patient with Parkinson disease","volume":"10","author":"Sato","year":"2018","journal-title":"Case Rep. Neurology"},{"key":"B39","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s00210-008-0341-4","article-title":"The in vitro receptor profile of rotigotine: a new agent for the treatment of Parkinson's disease","volume":"379","author":"Scheller","year":"2005","journal-title":"Naunyn. Schmiedebergs Arch. Pharmacol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.clineuro.2017.03.012","article-title":"Rotigotine may control drooling in patients with Parkinson's disease: preliminary findings","volume":"156","author":"Schirinzi","year":"2017","journal-title":"Clin. Neurology Neurosurg."},{"key":"B41","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1185\/03007995.2015.1030376","article-title":"Caregivers\u2019 and physicians\u2019 attitudes to rotigotine transdermal patch versus oral Parkinson's disease medication: an observational study","volume":"31","author":"Sieb","year":"2015","journal-title":"Curr. Med. Res. Opin."},{"key":"B42","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1002\/mds.23441","article-title":"Rotigotine effects on early morning motor function and sleep in Parkinson\u2019s disease: a double-blind, randomized, placebo-controlled study (RECOVER)","volume":"10","author":"Trenkwalder","year":"2011","journal-title":"Lancet Neurology"},{"key":"B43","volume-title":"Package Insert: Rotigotine Transdermal Patch","year":"2021"},{"key":"B44","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3389\/fnins.2017.00574","article-title":"Parkinson's disease medication alters small intestinal motility and microbiota composition in healthy rats","volume":"11","author":"Van Kessel","year":"2017","journal-title":"Front. Neurosci."},{"key":"B45","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1038\/s41467-019-08294-y","article-title":"Gut bacterial tyrosine decarboxylases restrict levels of levodopa in the treatment of Parkinson's disease","volume":"10","author":"Van Kessel","year":"2019","journal-title":"Nat. Commun."},{"key":"B46","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s11325-016-1414-0","article-title":"An observational clinical and video-polysomnographic study of the effects of rotigotine in sleep disorder in Parkinson's disease","volume":"21","author":"Wang","year":"2017","journal-title":"Sleep Breath."},{"key":"B47","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jns.2018.07.006","article-title":"Rotigotine transdermal patch for the treatment of neuropsychiatric symptoms in Parkinson's disease: a meta-analysis of randomized placebo-controlled trials","volume":"393","author":"Wang","year":"2018","journal-title":"J. Neurological Sci."},{"key":"B48","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1016\/j.ncl.2013.04.012","article-title":"The development of the rotigotine transdermal patch","volume":"31","author":"Waters","year":"2013","journal-title":"Neurol. Clin."},{"key":"B49","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1212\/01.wnl.0000252355.79284.6a","article-title":"Randomized, blind, controlled trial of transdermal rotigotine in early Parkinson disease","volume":"68","author":"Watts","year":"2007","journal-title":"Neurology"},{"key":"B50","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.parkreldis.2014.12.011","article-title":"Reduction of gastrointestinal symptoms in Parkinson's disease after a switch from oral therapy to rotigotine transdermal patch: a non-interventional prospective multicenter trial","volume":"21","author":"Woitalla","year":"2015","journal-title":"Park. Relat. Disord."},{"key":"B51","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1111\/bph.12988","article-title":"Rotigotine is a potent agonist at dopamine D1 receptors as well as at dopamine D2 and D3 receptors","volume":"172","author":"Wood","year":"2015","journal-title":"Br. J. Pharmacol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"106266","DOI":"10.1016\/j.clineuro.2020.106266","article-title":"How to introduce a rotigotine patch to Parkinson's disease patients taking oral dopamine agonists","volume":"199","author":"Yasutaka","year":"2020","journal-title":"Clin. Neurology Neurosurg."},{"key":"B53","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.parkreldis.2016.04.020","article-title":"Rotigotine transdermal patch in Chinese patients with early Parkinson's disease: a randomized, double-blind, placebo-controlled pivotal study","volume":"28","author":"Zhang","year":"2016","journal-title":"Park. Relat. Disord."},{"key":"B54","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.parkreldis.2017.08.015","article-title":"Rotigotine transdermal patch in Chinese patients with advanced Parkinson's disease: a randomized, double-blind, placebo-controlled pivotal study","volume":"44","author":"Zhang","year":"2017","journal-title":"Park. and Relat. Disord."},{"key":"B55","first-page":"753","article-title":"Meta-analysis of efficacy and safety of rotigotine transdermal patch in Parkinson's disease","volume":"39","author":"Zhang","year":"2020","journal-title":"Chin. J. New Drugs Clin. Remedies"},{"key":"B56","doi-asserted-by":"publisher","first-page":"8839543","DOI":"10.1155\/padi\/8839543","article-title":"Patient-reported outcomes of rotigotine in Parkinson's disease: real-world evidence on symptom control and quality of life from China","volume":"2025","author":"Zhu","year":"2025","journal-title":"Parkinson's Dis."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1933610\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:30:28Z","timestamp":1791275428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1933610\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":56,"alternative-id":["10.3389\/fphar.2026.1933610"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1933610","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1933610"}}