Practical Considerations for Optimal Transdermal Drug Delivery

Cheryl Durand; Abdullah Alhammad; Kristine C. Willett

Am J Health Syst Pharm. 2012;69(2):116-124.

Abstract and Introduction

Abstract

Purpose The properties of various transdermal drug delivery system (TDDS) products are reviewed, with safety recommendations and guidance on addressing questions frequently posed by patients and caregivers.
Summary Drug delivery via a TDDS can offer many advantages over other methods of administration, but those benefits can be compromised by improper use or alteration of medication patches or a lack of awareness of the properties of different patch types (reservoir, matrix, drug-in-adhesive). To assess current TDDS technologies and recommended practices for safe and effective use of medication patches, a literature search for articles on commonly used TDDS products available in the United States was conducted; supplemental information was obtained from package inserts and through direct communication with manufacturers. In addition to recommendations on the site and duration of TDDS application and proper patch disposal, clinicians must consider (1) potential problems with cutting patches as a method of dosage adjustment, (2) safety concerns related to the electric conductivity of metal-containing patches, (3) appropriate strategies for managing patch adhesion failures, and (4) the advisability of writing on patches for medication safety or compliance reasons. Clinicians should also be prepared to counsel patients about TDDS-specific recommendations on the avoidance of sunlight and other external heat sources during the use of a medication patch.
Conclusion Practical considerations related to transdermal drug delivery include the appropriateness of cutting patches, the implications of their containing metallic components, and whether they may be covered with tape or written on. Manufacturers of patches provide some useful information on these topics.

Introduction

With the administration of medication via a transdermal drug delivery system (TDDS), or medication patch, come several practical considerations. Questions about whether a particular patch can be cut or contains metal and questions about the appropriateness of covering patches with tape or writing on them are commonly posed by both patients and caregivers. Additionally, it is important to be aware of recommendations on the site of application, duration of application, proper disposal, and avoidance of external heat. Each of these considerations is discussed in this article.

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^aTelephone communication with Mark Cataldo, medical information department, Purdue Pharma, 2011 May 25.
^bTelephone communication with Tiffany Navarrete, medical information department, NeurogesX, 2011 May 26.
^cTelephone communication with Anne Brennan, medical information department, Boehringer Ingelheim, 2011 May 25.
^dTelephone communication with Danny Hart, medical information department, Mylan Pharmaceuticals, 2011 May 25.
^eTelephone communication with Paul Jones, medical information department, Par Pharmaceutical, 2011 May 25.
^fTelephone communication with Erika M, medical information department, Teva Pharmaceuticals, 2011 May 26.
^gTelephone communication with Lori Stone, medical information department, King Pharmaceuticals, 2011 May 26.
^hTelephone communication with Manish Tatel, medical information department, Watson Pharmaceuticals, 2011 May 26.
ⁱ Telephone communication with Barbara K, medical information department, Bayer Healthcare Pharmaceuticals, 2011 May 26.
^jTelephone communication from Ketu Patel, medical information department, Novartis Pharmaceuticals, 2011 Jan 19.
^kWritten communication with Michael L, medical information department, Ortho-McNeil-Janssen Pharmaceuticals, 2011 May 27.
^lTelephone communication with Diana Deubin, medical information department, Apotex, 2011 May 27.
^mTelephone communication with Judi A, medical information department, Sandoz, 2011 May 27.
ⁿWritten communication with Phyllis L, medical information department, ProStraken, 2011 Nov 21.
^oTelephone communication with Denise Klug, medical information department, Endo Pharmaceuticals, 2011 May 26.
^pTelephone communication with Thomas Marriott, medical information department, Zars Pharma, 2011 May 27.
^qTelephone communication with Michael Cushman, medical information department, Noven Pharmaceuticals, 2011 May 27.
^rTelephone communication with Suzette Miller, medical information department, GlaxoSmithKline Consumer Healthcare, 2011 May 27.
^sTelephone communication with Jake O, medical information department, Novartis Consumer Health, 2011 May 27.
^tTelephone communication with Shannon Bullock, medical information department, Graceway Pharmaceuticals, 2011 May 27.
^uTelephone communication with Nancy Pietroski, medical information department, Key Pharmaceuticals, 2011 Jan 20.
^vTelephone communication with Stephanie R, medical information department, Hercon Laboratories, 2011 May 27.
^wTelephone communication with Allison L, medical information department, Kremers Urban, 2011 May 27.
^xTelephone communication with Steward N, medical information department, Ortho-McNeil Pharmaceutical, 2011 May 31.
^yTelephone communication with Chris Bess, medical information department, UCB, 2011 May 27.
^zTelephone communication with Joan N, medical information department, Alza, 2011 May 27.
^aa Telephone communication with Mark Cross, medical information department, Somerset Pharmaceuticals, 2011 May 27.

Appendix

Appendix—Characteristics of and Clinical Considerations for Using Transdermal Patches

Buprenorphine (Butrans, Purdue Pharma)^[13]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: aluminum in ionic form compatible with magnetic resonance imaging (MRI)a
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive, Tegaderm) if problems persist
Advisability of writing on patch: not recommended^a
Location of patch application: upper outer arm, upper chest, upper back, or side of chest
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Capsaicin (Qutenza, NeurogesX)^[14]

Patch design: drug in adhesive matrix
Advisability of cutting patch: acceptable
Metal components: none^b
Recommendation on use of adhesive tape: not recommended^b
Advisability of writing on patch: not recommended^b
Location of patch application: on area with most pain
Duration of patch application: 60 minutes
Recommendation on patch disposal: dispose of immediately after use in accordance with local biomedical waste procedures
Recommendation on external heat: none

Clonidine (Catapres-TTS, Boehringer Ingelheim)^[15]

Patch design: reservoir
Advisability of cutting patch: acceptable c
Metal components: aluminum
Recommendation on use of adhesive tape: apply manufacturer-supplied adhesive cover directly over patch
Advisability of writing on patch: acceptable on the adhesive cover only^c
Location of patch application: upper outer arm or chest
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Clonidine (generic, Mylan Pharmaceuticals)^[16]

Patch design: matrix
Advisability of cutting patch: not recommended^d
Metal components: none d
Recommendation on use of adhesive tape: apply manufacturer-supplied adhesive cover directly over patch
Advisability of writing on patch: not recommended^d
Location of patch application: upper outer arm or chest
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Clonidine (generic, Par Pharmaceutical)^[17]

Patch design: reservoir
Advisability of cutting patch: not recommended^e
Metal components: aluminum
Recommendation on use of adhesive tape: apply manufacturer-supplied adhesive cover directly over patch
Advisability of writing on patch: acceptable; pencil recommended^e
Location of patch application: upper outer arm or chest
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Clonidine (generic, Teva Pharmaceuticals)^[18]

Patch design: reservoir
Advisability of cutting patch: not recommended^f
Metal components: aluminum
Recommendation on use of adhesive tape: apply manufacturer-supplied adhesive cover directly over patch
Advisability of writing on patch: not recommended^f
Location of patch application: upper outer arm or chest
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Diclofenac epolamine (Flector, King Pharmaceuticals)^[19]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^g
Metal components: none g
Recommendation on use of adhesive tape: edges of patch may be taped down; patients may overlay the patch with a mesh netting sleeve (e.g., Curad Hold Tite, Surgilast Tubular Elastic Dressing) if problems persist
Advisability of writing on patch: not recommended
Location of patch application: on most painful area
Duration of patch application: 12 hours (apply twice a day)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol (Alora, Watson Pharmaceuticals)^[20]

Patch design: adhesive matrix drug reservoir
Advisability of cutting patch: not recommended^h
Metal components: none h
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^h
Location of patch application: lower abdomen, upper quadrant of the buttock, or outer aspect of hip
Duration of patch application: 3 or 4 days (apply twice a week)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none
Estradiol (Climara, Bayer Healthcare Pharmaceuticals)^[21]
Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommendedⁱ
Metal components: noneⁱ
Recommendation on use of adhesive tape: tape edges with a first-aid tape only (e.g., Durapore, Micropore)ⁱ
Advisability of writing on patch: not recommendedⁱ
Location of patch application: lower abdomen or upper quadrant of buttock
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol (Estraderm, Novartis Pharmaceuticals)^[22]

Patch design: reservoir
Advisability of cutting patch: not recommended^j
Metal components: none
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^j
Location of patch application: trunk of body, including buttocks and abdomen
Duration of patch application: 3 or 4 days (apply twice a week)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol (Menostar, Bayer HealthCare Pharmaceuticals)^[23]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommendedⁱ
Metal components: noneⁱ
Recommendation on use of adhesive tape: tape edges with a first-aid tape only (e.g., Durapore, Micropore)ⁱ
Advisability of writing on patch: not recommendedⁱ
Location of patch application: lower abdomen
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol (Vivelle-Dot, Novartis Pharmaceuticals)^[24]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^j
Location of patch application: abdomen
Duration of patch application: 3 or 4 days (apply twice a week)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol (generic, Mylan Pharmaceuticals)^[25]

Patch design: matrix
Advisability of cutting patch: not recommended^d
Metal components: none d
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^d
Location of patch application: lower abdomen or upper quadrant of buttock
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol/levonorgestrel (Climara Pro, Bayer HealthCare Pharmaceuticals)^[26]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommendedⁱ
Metal components: noneⁱ
Recommendation on use of adhesive tape: edges may be taped with first-aid tape only (e.g., Durapore, Micropore)ⁱ
Advisability of writing on patch: not recommendedⁱ
Location of patch application: lower abdomen
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Estradiol–norethindrone (CombiPatch, Novartis Pharmaceuticals)^[27]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^j
Location of patch application: lower abdomen
Duration of patch application: 3 or 4 days (apply twice a week)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Fentanyl (Duragesic, Ortho-McNeil-Janssen Pharmaceuticals)^[28]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: none k
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive, Tegaderm) if problems persist
Advisability of writing on patch: not recommended^k
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid^[28]

Fentanyl (generic, Apotex)^[29]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none l
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive) if problems persist
Advisability of writing on patch: not recommended^l
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Fentanyl (generic, Mylan Pharmaceuticals)^[30]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none d
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive, Askira Derm) if problems persist
Advisability of writing on patch: not recommended^d
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Fentanyl (generic, Sandoz)^[31]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none, but patch contains small amount of titanium dioxide in the ink used for imprinting; it is not affected by MRI^m
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive, Tegaderm) if problems persist
Advisability of writing on patch: not recommended^m
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Fentanyl (generic, Teva Pharmaceuticals)^[32]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: aluminum
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape; patients may overlay the patch with a transparent adhesive film dressing (e.g., Bioclusive, Tegaderm) if problems persist
Advisability of writing on patch: not recommended^e
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Fentanyl (generic, Watson Pharma)^[33]

Patch design: reservoir
Advisability of cutting patch: not recommended
Metal components: none h
Recommendation on use of adhesive tape: edges may be taped with a first-aid tape
Advisability of writing on patch: not recommended^h
Location of patch application: chest, back, flank, or upper arm
Duration of patch application: 3 days
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Granisetron (Sancuso, ProStrakan)^[34]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: none n
Recommendation on use of adhesive tape: edges may be taped with any type of medical tape
Advisability of writing on patch: not recommendedⁿ
Location of patch application: upper outer arm
Duration of patch application: up to 7 days, de-pending on duration of chemotherapy regimen
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Lidocaine (Lidoderm, Endo Pharmaceuticals)^[35]

Patch design: drug in adhesive matrix
Advisability of cutting patch: acceptable
Metal components: none o
Recommendation on use of adhesive tape: may apply any type of medical tape anywhere on the patch
Advisability of writing on patch: not recommended^o
Location of patch application: on most painful area
Duration of patch application: up to 12 hours within a 24-hour period
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: avoid

Lidocaine–tetracaine (Synera, Zars Pharma)^[36]

Patch design: reservoir p
Advisability of cutting patch: not recommended
Metal components: aluminum p
Recommendation on use of adhesive tape: may apply any type of medical tape around the edges^p; do not cover the holes on the patch
Advisability of writing on patch: acceptable; marker recommended^p
Location of patch application: site of procedure
Duration of patch application: 20–30 minutes, prior to procedure
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Methylphenidate (Daytrana, Noven Pharmaceuticals)^[37]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: none q
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^q
Location of patch application: hip area
Duration of patch application: apply 2 hours before an effect is needed; duration up to 9 hours
Recommendation on patch disposal: fold in half with sticky sides together; flush down toilet
Recommendation on external heat: avoid

Nicotine (Nicoderm CQ, GlaxoSmithKline Consumer Healthcare)^[38]

Patch design: reservoir r
Advisability of cutting patch: not recommended
Metal components: opaque patch contains aluminum, clear patch does not^r
Recommendation on use of adhesive tape: secure with two pieces of medical or sports tape placed in an "X" over the patch
Advisability of writing on patch: not recommended^r
Location of patch application: hairless, clean, dry skin
Duration of patch application: 16–24 hours
Recommendation on patch disposal: fold in half with sticky sides together; replace in pouch and discard carefully
Recommendation on external heat: none

Nicotine (generic, Novartis Consumer Health)^[39]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: aluminum
Recommendation on use of adhesive tape: apply any type of medical tape anywhere on the patch^s
Advisability of writing on patch: not recommended^s
Location of patch application: hairless, clean, dry skin
Duration of patch application: 24 hours
Recommendation on patch disposal: fold in half with sticky sides together; replace in pouch and discard carefully
Recommendation on external heat: none

Nitroglycerin (Minitran, Graceway Pharmaceuticals)^[40]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^t
Metal components: none t
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: acceptable t
Location of patch application: chest, shoulder, upper arm, or back
Duration of patch application: 12–14 hours per day followed by patch-free interval of 10–12 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Nitroglycerin (Nitro-Dur, Key Pharmaceuticals)^[41]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^u
Metal components: none u
Recommendation on use of adhesive tape: not recommended^u
Advisability of writing on patch: not recommended^u
Location of patch application: hairless, clean, dry skin
Duration of patch application: 12–14 hours per day followed by patch-free interval of 10–12 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Nitroglycerin (generic, Hercon Laboratories)^[42]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^v
Metal components: none
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^v
Location of patch application: any area of skin except the extremities beyond the knee or elbow; chest preferred
Duration of patch application: 12–14 hours per day followed by patch-free interval of 10–12 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Nitroglycerin (generic, Kremers Urban)^[43]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^w
Metal components: none w
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^w
Location of patch application: any area of skin except the extremities beyond the knee or elbow; chest preferred
Duration of patch application: 12–14 hours per day followed by patch-free interval of 10–12 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Nitroglycerin (generic, Mylan Pharmaceuticals)^[44]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended^d
Metal components: none d
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^d
Location of patch application: any area of skin except the extremities beyond the knee or elbow; chest preferred
Duration of patch application: 12–14 hours per day followed by patch-free interval of 10–12 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Norelgestromin–ethinyl estradiol (Ortho Evra, Ortho-McNeil Pharmaceutical)^[45]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none x
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^x
Location of patch application: buttock, abdomen, upper arm, or upper torso
Duration of patch application: 7 days
Recommendation on patch disposal: fold in half with sticky sides together; place in sturdy container, preferably with child-resistant cap, and discard in trash
Recommendation on external heat: none

Oxybutynin (Oxytrol, Watson Pharma)^[46]

Patch design: drug in adhesive matrix
Advisability of cutting patch: acceptable h
Metal components: none h
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^h
Location of patch application: abdomen, hip, or buttock
Duration of patch application: 3 or 4 days (apply twice a week)
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Rivastigmine (Exelon, Novartis Pharmaceuticals)^[47]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: none j
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: acceptable; use thin ballpoint pen before applying patch
Location of patch application: upper or lower back (recommended), upper arm, or chest
Duration of patch application: 24 hours
Recommendation on patch disposal: fold in half with sticky sides together; return to pouch and discard carefully
Recommendation on external heat: avoid

Rotigotine (Neupro, UCB)^[48]

Patch design: matrix
Advisability of cutting patch: not recommended
Metal components: aluminum^[49]
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^y
Location of patch application: abdomen, thigh, hip, flank, shoulder, or upper arm
Duration of patch application: 24 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: avoid

Scopolamine (Transderm Scop, Alza)^[50]

Patch design: reservoir
Advisability of cutting patch: not recommended
Metal components: aluminum
Recommendation on use of adhesive tape: may apply any type of medical tape or bandages around edges^z
Advisability of writing on patch: not recommended
Location of patch application: behind ear
Duration of patch application: for motion sickness, apply 4 hours before antiemetic effect needed (duration up to 3 days); for perioperative use, apply the evening before scheduled surgery and keep in place for 24 hours after surgery
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Selegiline (Emsam, Somerset Pharmaceuticals)^[51]

Patch design: drug in adhesive matrix
Advisability of cutting patch: not recommended
Metal components: none^aa
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^aa
Location of patch application: upper torso, upper thigh, or outer surface of upper arm
Duration of patch application: 24 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: avoid

Testosterone (Androderm, Watson Pharma)^[52]

Patch design: reservoir
Advisability of cutting patch: not recommended
Metal components: aluminum
Recommendation on use of adhesive tape: not recommended
Advisability of writing on patch: not recommended^h
Location of patch application: back, abdomen, upper arm, or thigh
Duration of patch application: 24 hours
Recommendation on patch disposal: fold in half with sticky sides together
Recommendation on external heat: none

Note: Some pharmaceutical company representatives declined to divulge their surname or provide the requested information in written form.

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Practical Considerations for Optimal Transdermal Drug Delivery

Abstract and Introduction

Abstract

Introduction

Tables

References

Authors and Disclosures

Authors and Disclosures

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Appendix

Appendix—Characteristics of and Clinical Considerations for Using Transdermal Patches

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