Transdermal Patch Drug Delivery Interactions with Exercise

Abstract

Transdermal drug delivery systems, such as the transdermal patch, continue to be a popular and convenient way to administer medications. There are currently several medications that use a transdermal patch drug delivery system. This article describes the potential untoward side effects of increased drug absorption through the use of a transdermal patch in individuals who exercise or participate in sporting events. Four studies have been reported that demonstrate a significant increase in the plasma concentration of nitroglycerin when individuals exercise compared with rest. Likewise, several case reports and two studies have been conducted that demonstrate nicotine toxicity and increased plasma nicotine while wearing a nicotine patch in individuals who exercise or participate in sporting events compared with rest. Healthcare providers, trainers and coaches should be aware of proper transdermal patch use, especially while exercising, in order to provide needed information to their respective patients and athletes to avoid potential untoward side effects. Particular caution should be given to individuals who participate in an extreme sporting event of long duration. Further research that includes more medications is needed in this area.

The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance

“…Lenz et al [99] report increased plasma nicotine levels and toxicity due to increased drug absorption during physical exercise. To prevent undesirable side effects, health professionals, trainers and coaches should therefore be aware of proper transdermal patch use, particularly while exercising.…”

“…Reducing exercise intensity and duration for the first 1–2 weeks until potential side effects are known might also help to minimize toxicity. To reduce increased exercise-induced drug absorption, athletes are encouraged to avoid exercising in extreme environmental and temperature conditions, wear appropriate breathable sports garments and drink plenty of fluids to prevent dehydration [99]. …”

A systematic review of medication administration errors with transdermal patches

“…Missing demographic data = 97 No administration error reported = 57 Intentional misuse, abuse, or suicide = 10 No transdermal patch = 5 Language = 1 A. Lampert et al [80] Evident harm NIC Exercise and application of heat No 33/m [80] Evident harm NIC Application during MRI No 52/m [87] Evident harm GTN Placement of defibrillation paddle over patch No 43/m, 70/m [94] Evident harm GTN Patch displacement…”

“…Additionally, diffusion, which is the main mechanism of transdermal drug delivery, as a temperature-dependent process might be fastened with elevated skin and/or patch temperature [78]. Moreover, also exercising can increase cutaneous blood flow and thus result in elevated drug absorption from transdermal patches [72,77,[80][81][82][83][84][85][86]. Finally, patients can experience burns during a MRI procedure while wearing a transdermal patch with a metallic backing, which leads to induction of an electric current and the production of intense heat [87][88][89][90][91][92][93].…”

“…Thus, if there is any doubt as to metal content, transdermal patches should be removed before an MRI procedure or external defibrillation [89]. The systematic literature search identified eleven cases reporting harm from heated patches [66][67][68], patch application during exercise [77,80] or an MRI procedure [87], or mistakenly placed defibrillation paddles over the patch [94][95][96].…”