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Background: D2 receptor antagonists have been a mainstay in treating schizophrenia. Dopamine agonists used in the treatment of Parkinsonism can aggravate psychosis. Dopaminergic drugs with emphasis on other receptor subtypes with less D2 activation could reduce Parkinsonism in schizophrenic patients without seriously aggravating Parkinsonism. Rotigitine acts primarily on D3 receptors, while activity on other dopamine receptors is 8-20 times less. We report the successful treatment of a schizophenic patient with rotigitine and contend that its effectiveness relates to rotigitine’s receptor profile. Methods: Single case study with follow-up. Results: A 67 year old woman with longstanding schizophrenia developed severe, progressive Parkinsonian features over 2 years despite stable antipsychotic therapy. More than one tablet of levodopa-carbidopa 100/25 precipitated psychosis. Risperidone was changed to cloazapine without benefit in Parkinsonism. The rotigitine patch was introduced and increased to 8 mg/24 hours without aggravating her mental status and produced considerable improvement in Parkinsonian features. Conclusions: Rotigitine is worth exploring as a treatment for severe Parkinsonism in patients with schizophrenia.
