Rotigotine transdermal patch in Parkinson's disease: a narrative review of pharmacology, clinical evidence, special-population management, and health economics.

Background: Parkinson's 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. Objective: 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. Methods: Narrative review of randomized controlled trials, meta-analyses, regulatory documents, pharmacoeconomic models, and prospective observational studies identified through structured literature search and bibliographic screening. Results: Transdermal bioavailability is approximately 37% versus less than 5% for oral rotigotine. Pivotal Chinese trials SP0914 (early PD: UPDRS II + III -4.9 vs. -0.2) and SP1037 (advanced PD: placebo-adjusted off-time reduction -1.20 h/d [95% CI -1.83 to -0.57]; within-group change -2.36 h/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. Conclusion: Rotigotine provides CDS for patients with PD when oral delivery is unreliable; individualized patient selection, structured pharmaceutical care, and updated pharmacoeconomic evaluation are warranted.