NEUPRO 6 mg/24h TRANSDERMAL PATCH

2. What you need to know before you use Neupro

Do not use Neupro if:

• you are allergicto rotigotineor 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, created using magnetic energy instead of X-ray energy)

• you need a ‘cardioversion’ (specific treatment for heart rhythm disturbances).

You must remove the Neupro patch just before having a magnetic resonance imaging (MRI) scan or cardioversion to avoid skin burns because the patch contains aluminum. You can put on a new patch when these tests are finished.

Do not use Neupro if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist first.

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before you start using Neupro, because:

• you should have your blood pressurechecked regularly while you are using Neupro, especially when you start treatment. Neupro may affect your blood pressure.

• you should have your eyesightchecked regularly while you are using Neupro. If you notice any problems with your eyesight between checks, you should tell your doctor immediately.

• if you have severe liver problems, your doctor may need to adjust your dose. If your liver problems get worse while you are using Neupro, you should tell your doctor as soon as possible.

• you may have skin reactionscaused 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.

You may have involuntary muscle contractions that cause abnormal movements or postures, often repeated (dystonia), abnormal postures, or lateral flexion of the spine (also called pleurosthosis or Pisa syndrome). If this happens, your doctor may decide to adjust your medication.

If you experience these symptoms after you start treatment with Neupro, contact your doctor.

You may lose consciousness

Neupro may cause loss of consciousness. This can happen especially when you start treatment with Neupro or when your dose is increased. Tell your doctor if you lose consciousness or feel dizzy.

Changes in behavior and abnormal thoughts

Neupro may cause side effects that change your behavior (the way you act). If your family or caregiver, or your doctor, are worried about changes in your behavior, it may be helpful to tell a family member or caregiver that you are using this medicine and for them to read this leaflet.

This includes:

• anxiety or an overwhelming urge to behave in a way that is unusual for you and that you cannot control and that may harm you or others

• abnormal thoughts or behaviors.

For more information, see ‘Changes in behavior and abnormal thoughts’ in section 4.

Children and adolescents

This medicine must notbe given to childrenunder 18 years because its safety and efficacy in this age group are not known.

Using Neupro with other medicines

Tell your doctor or pharmacist if you are using, have recently used, or might use any other medicines. This includes medicines that you buy without a prescription and herbal medicines.

If you are being treated with Neupro and levodopa at the same time, some side effects may get worse. These include seeing or hearing things that are not real (hallucinations), uncontrolled movements related to Parkinson's disease (dyskinesia), swelling in the legs and feet.

Do not take the following medicines while you are using Neupro - they may reduce its effect:

• ‘antipsychotic’ medicines - used to treat certain mental illnesses
• metoclopramide - used to treat nausea and vomiting.

Talk to 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 may lower your blood pressure when you stand up - this effect may be worse if you are taking medicines to lower your blood pressure.

Your doctor will tell you if it is safe to take these medicines while you are using Neupro.

Using Neupro with food, drinks, and alcohol

Since rotigotine enters the bloodstream through the skin, taking food or drinks does not affect how this medicine is absorbed. You should talk to your doctor if you can drink alcohol while you are using Neupro.

Pregnancy and breastfeeding

Do 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 while you are using Neupro. This is because rotigotine may pass into breast milk and affect your baby. It is also likely to reduce the amount of milk produced.

If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before using this medicine.

Driving and using machines

Neupro may make you feel very sleepy and you may fall asleep suddenly. If this happens, do not drive. In rare cases, people have fallen asleep while driving and had accidents.

Do not use tools or machines if you feel very sleepy - or do any activity in which you could put yourself or others at risk of serious harm.

Neupro contains sodium metabisulfite (E223)

Neupro contains sodium metabisulfite (E223), a substance that can rarely cause severe allergic reactions and bronchospasm (difficulty breathing due to narrowing of the airways).

3. How to use Neupro

Follow exactly the administration instructions of this medication indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist.

What patch dose to use

The dose of Neupro you need depends on your disease – see below.

Neupro is available in patches of different doses that release the medication over 24 hours. The doses are 2 mg/24 h, 4 mg/24 h, 6 mg/24 h, and 8 mg/24 h for the treatment of Parkinson's disease.

• You may need to use more than one patch to achieve the necessary dose prescribed by your doctor.

• For doses higher than 8 mg/24 h (doses prescribed by your doctor above the available doses), several patches should be used to achieve the final dose. For example, a daily dose of 10 mg can be achieved using a 6 mg/24 h patch and a 4 mg/24 h patch.

• The patches cannot be cut into pieces.

Treatment of Parkinson's Disease

Patients who are not taking levodopa – initial stages of Parkinson's disease

• Your starting dose will be a 2 mg/24 h patch per day.

• From the second week, the daily dose will be increased by 2 mg weekly – until the appropriate maintenance dose for you is reached.

• For most patients, the appropriate dose is between 6 mg and 8 mg per day. This is usually achieved between 3 and 4 weeks.

• The maximum dose is 8 mg per day.

Patients who are taking levodopa - advanced stages of Parkinson's disease

• Your starting dose will be a 4 mg/24 h patch per day.

• From the second week, the daily dose will be increased by 2 mg weekly – until the appropriate maintenance dose for you is reached.

• For most patients, the appropriate dose is between 8 mg and 16 mg per day. This is usually achieved between 3 and 7 weeks.

• The maximum dose is 16 mg per day.

If you need to stop taking this medication, see “If you interrupt treatment with Neupro” in section 3.

How to use Neupro patches

Neupro is a patch that is applied to the skin.

• Check that the used patch has been removed before putting on a new one.
• Place the new patch on a different area of skin each day.

• Leave the patch on the skin for 24 hours, then remove it and put on a new one.

• Change the patchapproximately at the same time every day.
• Do not cutNeupro patches into pieces

If you need to stop taking this medication, see “If you interrupt treatment with Neupro”in section 3.

How to use Neupro patches

Neupro is a patch that is applied to the skin.

• Check that the used patch has been removed before putting on a new one.
• Place the patch on a different area of skin each day.
• Leave the patch on the skin for 24 hours, then remove it and put on a new one.
• Change the patchapproximately at the same time every day.
• Do not cut Neupro patches into pieces.

If you continue to have skin problems caused by the patch, see “Skin problems causedby the patch” in section 4 for more information.

To prevent the patch from peeling off or detaching

• Do notplace the patch in an area where it may suffer friction from tight clothing.

• Do notuse creams, oils, lotions, powdersor any other skin productwhere you will place the patch. Nor on top of or near another patch that you are already using.

• If you need to place a patch on an area of skin where you have hair, at least 3 days beforeplacing it on that site, you should shave(depilate) the skin area.

• If the edges of the patch peel off, you can secure the patch with tape.

If the patch falls off, you should put on a new one for the rest of the day, and the next day, place a new patch at the usual time.

• You should avoidthat the patch area gets heated– for example, too much sunlight, saunas, hot baths, or hot water bottles. This is because the medication could be released more quickly. If you think you have overheated, contact your doctor or pharmacist.
• Always check that the patch has not fallen off after activities such as bathing, showering, or exercising.
• If the patch has irritated your skin, you should keepthe irritated area protected from direct sunlight. This is because sun exposure could cause changes in skin color.

How to use the patch

• Each patch is individually packaged in an envelope.

• Before opening the envelope, decide where you will place the new patch and check that the used patch has been removed.

• When you have opened the envelope and removed the disposable layer of the patch, you should immediately place the patch on the skin.

How to remove the used patch

• Remove the used patch slowly and carefully.

• Gently wash the area with lukewarm water and mild soap. This will remove any remaining adhesive from the skin. You can also use a little baby oil to remove any remaining adhesive.

• Do not use alcohol or other liquid solvents - such as nail polish remover. This could irritate your skin.

If you use more Neupro than you should

Using higher doses of Neupro than your doctor has indicated may cause adverse effects such as nausea or vomiting, decreased blood pressure, seeing or hearing things that are not real (hallucinations), confusion, extreme drowsiness, involuntary movements, and convulsions.

In these cases, inform your doctor or go to the hospital as soon as possible. They will indicate what you should do.

If you forget to change the patch at the usual time

• If you have forgotten to change the patch at the usual time, change it as soon as you remember. Remove the used patch and place a new one.

• If you have forgotten to put on a new patch after removing the used patch, as soon as you remember, put on a new one.

In both cases, the next day, place a new one at the usual time. Do not use a double dose to make up for the forgotten doses.

If you interrupt treatment with Neupro

Do not stop using Neupro without first consulting your doctor. A sudden interruption could cause a condition called ‘neuroleptic malignant syndrome’ that can put your life at risk. The signs include: loss of muscle movement (akinesia), muscle stiffness, fever, unstable blood pressure, increased heart rate (tachycardia), confusion, decreased consciousness (e.g., coma).

If your doctor indicates that you should interrupt treatment with Neupro, the daily doseof Neupro should be gradually reduced:

• Parkinson's disease- should be reduced by 2 mg every two days.

If you have any other doubts about the use of this medication, ask your doctor, pharmacist, or nurse.

4. Possible Adverse Effects

Like all medicines, this medicine can cause adverse effects, although not all people suffer from them. Inform your doctor or pharmacist if you notice any adverse effect.

Most Likely Adverse Effects at the Start of Treatment

You may experience nauseaand vomiting at the start of treatment. These effects are usually mild or moderate and last for a short time. You should consult your doctorif the effects last for a long time or if you are concerned.

Skin Problems Caused by the Patch

• You may experience redness and itching in the area of the skin where the patch has been applied – these reactions are usually mild or moderate.

• These reactions usually disappear a few hours after removing the patch.

• Consult your doctorif you have a skin reaction that lasts for more than a few days, if it is severe, or if it spreads beyond the area covered by the patch.
• Avoid exposure to the sun and sunlamps in the areas of skin that show any type of reaction caused by the patch.

• To help prevent skin reactions, you should apply the patch to a different site each day and only use the same area again after 14 days.

You May Experience Loss of Consciousness

Neupro can cause loss of consciousness. This can happen especially when starting treatment with Neupro or when increasing the dose. Inform your doctor if you lose consciousness or feel dizzy.

Changes in Behavior and Abnormal Thoughts

Inform your doctor if you notice any change in behavior, thought, or both, as indicated below.

Your doctor will indicate how to manage or reduce the symptoms.

If your family or caregiver, or your doctor, are concerned about changes in your behavior, it may be helpful to tell a family member or caregiver that you are using this medicine and to read the package insert. Neupro can cause anxiety or an overwhelming urge to behave abnormally and be unable to control the impulse, attack, or temptation to perform certain actions that may harm you or others.

These actions may include:

• strong addiction to gambling – even seriously affecting you or your family

• altered or increased sexual interest and behavior that causes great concern for you and others - for example, increased sexual desire

• uncontrolled shopping or excessive spending

• episodes of binge eating (eating large amounts of food in a short period) or compulsive eating (eating more food than normal or more than needed to satisfy your appetite).

Neupro can cause other abnormal behaviors and thoughts, which may include:

• abnormal thoughts about reality

• delusional ideas and hallucinations (seeing or hearing things that are not real)
• confusion

• disorientation

• aggressive behavior
• agitation

• delirium.

Inform your doctor if you notice any change in your behavior, thought, or both, as indicated above.

Your doctor will indicate how to manage or reduce the symptoms.

Allergic Reactions

Inform your doctor if you notice signs of an allergic reaction – which may include swelling of the face, tongue, or lips.

Adverse Effects if You Use Neupro for Parkinson's Disease

Inform your doctor, pharmacist, or nurse if you experience any of the following adverse effects:

Very Common: may affect more than 1 in 10 patients

• headache

• drowsiness or dizziness
• nausea, vomiting
• skin irritation at the patch application site, such as redness and itching

Common: may affect up to 1 in 10 patients

• falls
• hypo
• weight loss

• swelling in the legs and feet

• feeling of weakness (fatigue), feeling of tiredness
• increased heart rate (palpitations)
• constipation, dry mouth, stomach burning
• redness, increased sweating, itching
• vertigo (feeling of spinning)

• seeing or hearing things that are not real (hallucinations)

• low blood pressure when standing up, high blood pressure

• difficulty staying asleep, sleep disorders, difficulty sleeping, nightmares, strange dreams

• involuntary movements related to Parkinson's disease (dyskinesia)

• loss of consciousness, feeling of dizziness when standing up due to a drop in blood pressure

• inability to control the impulse to perform a harmful action, including addiction to gambling, repetitive actions without sense, compulsive shopping, or excessive spending

• episodes of binge eating (eating large amounts of food in a short period), compulsive eating (eating more food than normal or more than needed to satisfy your appetite)

Uncommon: may affect up to 1 in 100 patients

• blurred vision
• weight gain
• allergic reaction

• decrease in blood pressure

• increased heart rate
• increased sexual desire
• abnormal heart rhythm

• stomach discomfort and pain

• generalized itching, skin irritation

• suddenly falling asleep without warning

• inability to achieve or maintain an erection
• feeling agitated, disoriented, confused, or paranoid
• abnormal liver test results or elevated
• visual disturbances such as seeing colors or lights

• increase in creatine phosphokinase (CPK) levels (CPK is an enzyme found mainly in skeletal muscle).

Rare: may affect up to 1 in 1,000 patients

• delusional ideas
• delirium
• feeling of irritability
• aggressive behavior
• psychotic disorders
• rash on large areas of the body

• involuntary muscle spasms (convulsions)

Not Known: frequency not known

• anxiety about taking high doses of medicines like Neupro – more than necessary for the treatment of the disease. This is known as 'dopaminergic dysregulation syndrome' and can lead to excessive use of Neupro
• diarrhea

• dropped head syndrome

• rhabdomyolysis (a rare, severe muscle disorder that causes pain, sensitivity, and weakness of the muscles and can cause kidney problems)

Inform your doctor, pharmacist, or nurse if you experience any of these adverse effects.

Reporting Adverse Effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, even if it is a possible adverse effect that is not listed in this package insert. You can also report them directly through the national reporting system included in Appendix V. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Neupro

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiration date that appears on the label and on the carton.

Do not store above 30°C.

What to Do with Used and Unused Patches

• Used patches still contain the active ingredient, 'rotigotine', which can be hazardous to others. Fold the used patch with the adhesive side inward. Put the patch in the original envelope and then throw it away in a safe place, out of the reach of children.

• Medicines should not be disposed of through wastewater or household waste. Ask your pharmacist how to dispose of the packaging and any unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Neupro

The active ingredient is rotigotine.

• 4 mg/24 h:

A patch releases 4 mg of rotigotine every 24 hours. Each 20 cm2 patch contains 9.0 mg of rotigotine.

• 6 mg/24 h:

A patch releases 6 mg of rotigotine every 24 hours. Each 30 cm2 patch contains 13.5 mg of rotigotine.

• 8 mg/24 h:

A patch releases 8 mg of rotigotine every 24 hours. Each 40 cm2 patch contains 18.0 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).
• Covering layer: Polyester film, siliconized, aluminized, colored with a pigment layer (titanium dioxide (E171), yellow pigment 13, red pigment 166, yellow pigment 12) and printed (red pigment 146, yellow pigment 180, black pigment 7).
• Disposable coating: Transparent polyester film coated with fluoropolymer.

Disposable coating: Transparent polyester film coated with fluoropolymer.

Appearance of the Product and Package Contents

Neupro is a transdermal patch. It is thin and has three layers. It is square in shape with rounded corners. The outer part is brown in color and bears the inscription Neupro 4 mg/24 h, Neupro 6 mg/24 h, or Neupro 8 mg/24 h.

Neupro is available in the following formats:

Cartons containing 7, 14, 28, 30, or 84 (multiple package containing 3 packages of 28) patches, each patch is included in an individual envelope.

Not all pack sizes may be marketed.

Marketing Authorization 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

You can request more information about this medicine by contacting the local representative of the marketing authorization holder:

Date of Last Revision of this Package Insert:

Other Sources of Information

Detailed information about this medicine is available on the website of the European Medicines Agency https://www.ema.europa.eu