Low doses of rotigotine in patients with antipsychotic-induced parkinsonism

The aim of this study was to evaluate in a group of patients with psychosis the effect of the dopamine agonist rotigotine on neuroleptic-induced extrapyramidal symptoms (EPSs), a set of movement disorders such as pseudoparkinsonism, dyskinesias, akinesia, and akathisia that occur as result of taking drugs that block dopamine receptors.

Twenty patients with psychosis with EPSs were clinically evaluated before and after the administration of rotigotine. The drug was started at a dosage of 2 mg daily and gradually increased until the best clinical benefit was achieved (mean ± SD, dosage, 3.2 ± 1.8 mg; range, 2-8 mg). The neurological status was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) total and UPDRS section III, the Simpson-Angus Scale, and the Barnes Akathisia Rating Scale. The Positive and Negative Syndrome Scale and the Hamilton Depression Rating Scale were used to appraise possible modifications of the psychiatric conditions.

Compared with baseline, there was a significant improvement in the UPDRS total, the UPDRS section III, the Simpson-Angus Scale (P < 0.0001), and the Barnes Akathisia Rating Scale (P < 0.05), without changes in the Positive and Negative Syndrome Scale and the Hamilton Depression Rating Scale (P < 0.05). All patients tolerated rotigotine well, except 1 who dropped out of the trial because of the recurrence of his psychotic symptoms.

The results of this observational study suggest that low doses of rotigotine are well tolerated in patients with psychosis and are effective in neuroleptic-induced EPSs.