Practical Considerations for Optimal Transdermal Drug Delivery

Authors and Disclosures

Cheryl Durand, Abdullah Alhammad, and Kristine C. Willett

Cheryl Durand, Pharm.D., is Assistant Professor of Pharmacy Practice; Abdullah Alhammad is Pharm.D. candidate; and Kristine C. Willett, Pharm.D., is Assistant Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences—Manchester, Manchester, NH.

Address correspondence to
Dr. Durand at Massachusetts College of Pharmacy and Health Sciences—Manchester, 1260 Elm Street, Manchester, NH 03101 (cheryl.durand@mcphs.edu).

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.