The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches

Patches

“…Nicotine for smoking cessation was the first transdermal treatment to achieve substantial commercial success, which significantly raised the profile of transdermal treatments within the general population and promoted the development of other transdermal medications. 18 Table 2 outlines transdermal systems used in the management of psychiatric and neuropsychiatric disorders in the order of their development. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] As mentioned, a transdermal patch for motion sickness using scopolamine was the first patch to be introduced to the United States market.…”

“…39 Transdermal clonidine was the next patch developed with the intent that it would provide steady-state plasma concentrations and reduce the incidence of most adverse effects seen with oral formulations. 18,20 The α 2 -adrenergic agonist clonidine is indicated for the treatment of hypertension in adults 40 but has a wide range of uses in psychiatric patients, such as attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (Table 2). Transdermal clonidine provides extended therapeutic efficacy, as it is applied only once every 7 days.…”

“…25 Methylphenidate transdermal system is a drug-in adhesive patch for which the dose delivered is dependent on the corresponding size of the patch and wear time. 18,25 Steady dosing leads to higher peak plasma concentrations of methylphenidate compared with extended-release oral formulations, indicating that absorption of this drug may be greater through the skin, very likely due to a lack of first-pass metabolism. 41 Additionally, several laboratory classroom studies have shown that steady dosing provided by the methylphenidate patch over many hours results in significantly improved scores on ADHD measures.…”

“…A transdermal formulation of the MAOI selegiline received FDA marketing approval for the treatment of major depressive disorder in 2006, with no hypertensive crises reported in any of the controlled clinical trials. 18,26 Transdermal selegiline has a better safety and tolerability profile than oral MAOIs, which results in less need for dietary restrictions at lower doses. 45 A quantitative review 45 of 5 studies that investigated effects of transdermal selegiline on major depressive disorder found the highest significant adverse event versus placebo was application site reaction, with 28.5% for selegiline versus 13.5% for placebo, resulting in a number needed to harm (NNH) of 7 (95% CI, 6-10).…”

“…Rotigotine is a dopamine agonist of the non-ergoline class developed in the mid-1980s that is indicated for the treatment of Parkinson's disease. 18,46 The patch formulation of rotigotine received FDA approval in 2007 and is the first transdermal treatment for Parkinson's disease. 27 Despite the benefits gained from dopaminergic treatments, the inability to deliver these drugs in a continuous manner has limited their efficacy.…”