Patients Reaching for Stick-on Solutions to Medical Problems

FORT WORTH, Texas _ Forget about popping pills. Today, many people are slapping on skin patches instead.

Transdermal patches have come a long ways since 1979 when the first one was approved to treat motion sickness. Since then more than 35 others have followed, including patches that prevent osteoporosis, treat Attention Deficit Hyperactivity Disorder and relieve chronic pain.

For some consumers, patches are a way to avoid the side effects associated with oral medications. For others, they’re a way to deliver medications to a noncompliant patient. For many, patches are simply convenient.

“You can put some on once a week so you’re not constantly having to take medicine every three or four hours,” said Dan Hopper, chief pharmacist at the University of North Texas Health Science Center.

Patches also are also less likely than oral medications to cause liver problems, Hopper said. Unlike pills that are metabolized by the liver, patches deliver a controlled dosage through the skin.

On the downside, patches can be harmful, especially if they are left on the skin too long. In 2005 the Food and Drug Administration investigated reports of deaths linked to fentanyl skin patches used to treat severe chronic pain. Concerns about patch-related overdoses were raised but the product has remained on the market as a controlled substance.

When using patches, consumers should follow the directions carefully, Hopper said. Some can cause skin irritation when left on too long. Others must be placed on different areas of the body each time and removed on a strict schedule. Although patches have been designed to stay on when swimming, showering or exercising, users should check to make sure the patches _ some as small as a nickel _ stay in place.

Patches tend to be expensive. Four weekly patches of estradiol, which is used to reduce the symptoms of menopause, cost about $31. But a 30-day supply in tablet form is $7.99.

When the patch containing nitroglycerin was first introduced to treat angina it was very expensive, Hopper said. But since a generic version became available, the price has dropped to less than $1 each.

As a result of the popularity of patches, more are in the pipeline. A patch that would deliver insulin is being studied. Other patches being considered include vaccines for diseases like the flu and medications for wheezing associated with asthma.

_Alzheimer’s patch

Drug: Exelon (rivastigmine)

What it’s for: Mild to moderate Alzheimer’s disease; Parkinson’s disease dementia.

How it’s used: Applied every 24 hours to back, chest or upper arm

Advantages: Can improve memory and ability to perform everyday tasks. Eliminates or reduces nausea and vomiting associated with the capsule. Designed for compliance.

Possible side effects: Drowsiness, dizziness, indigestion, weakness

FDA approved: 2007

Average monthly cost: The patch was approved in July and will be available in September. Cost has not been established. Pills are about $185.

_Parkinson’s patch

Drug: Neupro (rotigotine)

What it’s for: Early stage Parkinson’s disease

How it’s used: Apply daily to alternating places on the stomach, hip, flank, shoulder or upper arm. Should not be applied where clothes may rub it.

Advantages: Parkinson’s results from the loss of dopamine-producing brain cells. This drug mimics the action of dopamine.

Possible side effects: Dizziness, nausea, insomnia, sudden onset of sleep while engaged in routine activities such as driving

FDA approved: 2007

Average monthly cost without insurance: $500

_ADHD patch

Drug: Daytrana (methylphenidate)

What it’s for: Attention deficit hyperactivity disorder, or ADHD, in children ages 6-12.

How it’s used: Patch should be applied two hours before desired result to alternating hips. Avoid waistline. Should be removed after nine hours. Effects continue three hours after removal. If not removed after nine hours, your child may have difficulty sleeping at night. Can be removed earlier to avoid late nights.

Advantages: Delivers medication without the hassle of taking pills or going to the school nurse. Good for children who have trouble swallowing pills.

Possible side effects: Same as with Ritalin. Weight loss, irritability, stomach upset, insomnia

FDA approved: 2006

Average monthly cost without insurance: About $130

_Depression patch

Drug: Emsam (selegiline)

What it’s for: Major depression in adults

How it’s used: Applied every 24 hours to upper chest, back, thigh or outer, upper arm. Do not use in same place two days in a row.

Advantages: At the lowest dose it can be used without the dietary restrictions (such as aged cheese and wine) needed for all oral MAO inhibitors.

Possible side effects: Mild skin reaction at patch site. Low blood pressure. Less-common side effects include headache, difficulty sleeping, indigestion and sore throat. Sudden severe headache, fast or slow heart beat, chest pains require immediate medical attention.

FDA approved: 2006

Average monthly cost without insurance: About $450

_Stop smoking patch

Drug: Habitrol, Nicoderm CQ, Nicotrol (nicotine) Available over the counter

What it’s for: Smoking cessation

How it’s used: Applied daily at the same time. Upper arm best. Avoid using lotion at site. Do not apply more than one patch at a time

Advantages: Reduces nicotine withdrawal symptoms by gradually releasing nicotine into the bloodstream. Different strengths available depending on level of dependency. For someone with a pack-a-day habit, start with highest strength (21 mg) and reduce dosage over 10 weeks.”

Possible side effects: Skin redness, itching, burning, irregular heartbeat, nausea, dizziness, weakness

FDA approved: 1996

Average monthly cost: $60

_Birth control patch

Drug: Ortho Evra by Ortho-McNeil (estrogen progestin)

What it’s for: Prevents pregnancy

How it’s used: Applied weekly on the same day and time to upper outer arm, upper torso, abdomen or buttocks. Use for three weeks, then skip a week.

Advantages: Decreases the chances a woman will miss a dose.

Possible side effects: Patches and pills contain the same amount of estrogen. But with the patch, women are exposed to about 60 percent more estrogen in their blood than with birth control pills. Patch users develop blood clots at a higher rate than pill users. There is a risk of stroke, heart attack and death. Smoking increases these risks, especially among women over age 35.

FDA approved: 2001

Average monthly cost without insurance: $50

_Hormone replacement therapy patch

Drug: Climara, Menostar once weekly (estradiol only), Climara Pro (estradiol and levonorgestrel). Other brands are available as patches but must be changed more frequently.

What it’s for: Menopausal symptoms including hot flashes, vaginal dryness and night sweats. The estradiol and patch is for women who have their uterus. Also for prevention post-menopausal osteoporosis (low doses of estrogen can help keep bones from getting weaker)

How it’s used: Applied every seven days to fatty areas of the skin, preferably lower abdomen or upper buttocks. Should not be applied to breast.

Advantages: Continuous delivery of hormone. With the addition of levonorgestrel, Climara Pro can be used in women who have not had a hysterectomy. Climara is only for women who had undergone a hysterectomy.

Possible side effects: Estrogen increases the risk of endometrial cancer. There’s conflicting evidence that estrogen increases a woman’s breast cancer risks. Headache, back pain, breast tenderness, fluid retention. Using estrogen with or without progestin may increase risk of heart attack, stroke, certain cancers and blood clots.

FDA approved: 1996 for menopausal symptoms; 2002 for osteoporosis, 2006 with levonorgestrel added

Average monthly cost without insurance: $32

_Post-shingles pain patch

Drug: Lidoderm (lidocaine 5 percent)

What it’s for: Relieves post-shingles pain that makes skin extremely sensitive to touch or temperature.

How it’s used: Up to three patches applied to most painful areas. Should not be used where there are blisters. Should be worn no more than 12 hours at a time.

Advantages: Relieves pain.

Possible side effects: Irritation, itching, burning, dizziness, headache, nausea

FDA approved: 1999

Average cost without insurance: $187 but can be used as needed

_Motion sickness and nausea patch

Drug: Transderm Scop (scopolamine)

What it’s for: Treats nausea, prevents motion sickness. Often used with chemotherapy.

How it’s used: Patch applied behind the ear for three days. Should be applied at least four hours before chemotherapy begins.

Advantages: Reduces activity of the nerve fibers in the inner ear.

Possible side effects: About 65 percent of users experience dry mouth, and 17 percent report drowsiness.

FDA approved: 1979

Average cost: $32 four patches

_Angina patch

Drug: Minitran (nitroglycerin) generic

What it’s for: Controls and prevents chest pain

How it’s used: Applied to chest, inside upper arm or shoulder for 12 hours. Must be removed for 10-12 hours daily.

Advantages: Increases the supply of blood and oxygen to the heart and decreases workload.

Possible side effects: Dizziness, headache, flushing

FDA approved: Generic approved in 1996

Average monthly cost without insurance: $30 generic, $75 brand name

Overactive-bladder patch

Drug: Oxytrol (oxbutynin)

What it’s for: Treats muscle spasms of the bladder

How it’s used: Applied to abdomen, hip or buttock twice a week

Advantages: Provides continuous bladder control and bypasses metabolism process in the liver.

Possible side effects: Blurred vision, constipation, diarrhea, dizziness, drowsiness

FDA approved: 2003

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ARCHIVE GRAPHIC on MCT Direct (from MCT Graphics, 202-383-6064): 20041202 Drug patches

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