280814

PL Detail-Document #280813
This PL Detail-Document gives subscribers

additional insight related to the Recommendations published in
PHARMACISTS LETTER / PRESCRIBERS LETTER

August 2012
Characteristics of Transdermal Patches

There are two main types of transdermal delivery systems: membrane controlled reservoir system and monolithic matrix system. For reservoir
patches, active drug is contained in a reservoir and delivered to the skin via a rate controlling membrane. For matrix patches, drug is integrated into
an adhesive polymer layer. This solid matrix layer is applied directly to the skin and the drug is released with the components of the matrix
controlling the rate of drug delivery. Reservoir patches should not be cut or altered due to dose-dumping effect when the rate controlling
membrane is destroyed. Its been suggested that matrix-based patches may be cut to deliver a lower dose; however, this theory has not yet been
proven. Keep in mind that half a matrix patch may not equal half a dose due to uneven cutting or less surface area. Advise patients not to cut or alter
any drug patch (regardless of the delivery system) when exact dosing is critical (e.g., fentanyl, methylphenidate) due to the potential for erratic drug
delivery. For some matrix patches (e.g., Vivelle-Dot, etc) where exact dosing isnt as critical, some clinicians feel it is okay to cut patches to deliver
lower doses. Use your judgment if a patient asks about cutting patches. Keep in mind that manufacturers do not recommend cutting or altering
patches regardless of type with the exceptions of Lidoderm and Qutenza patches. In general, drug patches should be applied to clean, dry, hairless,
nonirritated, intact skin. Site rotation and application of a topical corticosteroid can help reduce irritation associated with transdermal patches.1
Patches should not be applied to the waistline or in areas where tight clothing can rub the patch off. They should be kept away from direct
exposure to heat (heating pads, electric blankets, etc). Some patches contain aluminum and should be removed prior to undergoing MRI to
prevent skin burns.d Most patches should be disposed of in the trash; however, some should be flushed down the toilet to prevent accidental exposure
or diversion.
(A list of meds that should be flushed is available at http://www.fda.gov/Drugs/ResourcesForYou/Consumers
/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#MEDICINES.) The chart below summarizes
characteristics of commonly prescribed transdermal drug patches available in the U.S.
Brand Name
(Manufacturer)b
Buprenorphine
Butrans
Purdue
888-726-7535
Delivery
Systemc
Matrix
Appearance
Beige,
rectangular or
square.
Application
If patch
falls off
Commentsd
Apply to upper outer

arm, upper chest or
back, or side of chest.
Clip hair at application
site if necessary.
Press firmly in place for
15 seconds.
Replace patch weekly.
Avoid same application
site for at least 21 days.
Dispose of patch and replace

with a new patch at another
site.
If patch doesnt stick well,
tape edges with first-aid tape.
See-through adhesive
dressings such as Bioclusive
or Tegaderm can be used to
keep patch in place.
Avoid direct exposure to

heat.
Disposal: fold sticky sides
of patch together and
flush down the toilet or
use the patch-disposal
unit that comes with patch
and then place in trash.
More. . .
Copyright 2012 by Therapeutic Research Center
P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com ~ www.pharmacytechniciansletter.com
(PL Detail-Document #280813: Page 2 of 14)
Brand Name
(Manufacturer)b
Capsaicin
Qutenza
Appearance
Application
Matrix
Rectangular.
Relatively large
(14 cm x
20 cm).
Drug name and
dose imprinted
on patch.
Apply 1 to 4 patches to
painful area for 60
minutes.
Clip hair around
application site if
necessary for
adherence.
Repeat application
every 3 months if
necessary.
Rolled gauze may be used

to keep patch in place.
May cut patch to fit the

area of pain.
Not for home application
by patients.
Reservoir
Tan, square,
with optional
white round
adhesive cover.
Imprints:
BI-33 = 0.3 mg,
BI-32 = 0.2 mg,
BI-31 = 0.1mg.
Apply to upper outer

arm or chest.
Press firmly in place,
especially around
edges.
Rotate application site
weekly.
Replace with new patch at

different site.
Place white round adhesive
cover over patch to hold it
in place.
Adhesive cover can be

mistaken as actual drug
patch.
Adhesive cover can be
labeled with drug name
and dose.
Remove before MRI.2-5
Reapply same patch to
another site afterward.3
Matrix
White,
rectangular.
Relatively large
(10 cm x
14 cm).
Drug name and
dose imprinted
on patch.
Apply to most painful

area twice daily.
especially around
edges.

tape edges with first-aid
tape.
Mesh netting that allows air
to pass through to patch
(e.g., Curad Hold Tite,
Surgilast) can be used to
hold patch in place.
Do not wear patch while

bathing, showering, etc.
This could cause the
patch to come loose.
Remove before MRI.3,5
Reapply same patch
afterward if less than two
hours have elapsed since
patch was removed.
Apply a new patch if
longer.3
NeurogesX
877-900-6479
Clonidine
Catapres-TTS
BoehringerIngelheim
800-243-0127
Diclofenac
Flector
King
888-840-8884
Commentsd
Delivery
Systemc
If patch
falls off
More. . .
Brand Name
(Manufacturer)b
Estradiol
Alora
Delivery
Systemc
Appearance
Application
If patch
falls off
Commentsd
Matrix
Translucent,
rectangular,
tape-like.
Drug name and
dose imprinted
on patch.
Reapply same patch to an

alternate site.
If same patch does not
stick, apply a new patch and
follow same dosing
schedule.
Removal prior to MRI is

recommended because
manufacturer cannot
guarantee that the product
is free of metal.3 For
reapplication after the
procedure, follow same
instructions as for patch
falling off.3
Matrix
Translucent,
oblong, tapelike.
Drug name and
dose imprinted
on patch.
Apply to lower
abdomen, outer hip, or
upper buttock.
10 seconds.
Do not apply to breasts.
Replace patch twice
weekly using the
schedule on patch box.
at least once a week.
Apply to lower
abdomen or upper
buttock.
10 seconds.
weekly.

another site.
follow same dosing
schedule.
Bathing, showering, and

swimming may cause
Reservoir
Clear and round

(0.05 mg
strength) or
clear and
oblong (0.1 mg
strength) with
drug reservoir
in the center.
Reapply same patch.

follow same dosing
schedule.
None.
Watson
800-272-5525
Climara
Bayer
888-842-2937
Estraderm
Novartis
888-669-6682
Apply to trunk area

(abdomen or buttocks).
10 seconds.
Replace patch twice
weekly.
weekly.
More. . .
Brand Name
(Manufacturer)b
Estradiol, continued
Estradiol
Transdermal
System
Delivery
Systemc
Appearance
Application
If patch
falls off
Commentsd
Matrix
Peach, round,
foam disc.
Drug name and
dose imprinted
on patch.
Apply to lower
abdomen or upper
buttock.
10 seconds.
weekly.

another site.
follow same dosing
schedule.
Generic for Climara.

recommended because
manufacturer cannot
guarantee that the product
is free of metal.3 For
falling off.3
Matrix
Translucent,
oval, plastic
film.
Drug name
imprinted on
patch.
Apply to lower
abdomen.
10 seconds.
weekly.

another site.
If same patch dose not stick
apply a new patch to
another site.
Bathing, swimming, etc

may cause patch to come
loose.
Matrix
Clear,
rectangular,
tape-like.
Drug name and
dose imprinted
on patch.
Apply to lower
abdomen.
10 seconds.
Replace patch twice
weekly.
at least weekly.
Reapply same patch.

If same patch does not stick
apply a new patch to
another site.
Mylan
877-446-3679
Menostar
Bayer
888-842-2937
Vivelle-Dot
Novartis
888-669-6682
Might be difficult to
detect on some skin
types.
More. . .
Brand Name
(Manufacturer)b
Delivery
Systemc
Estradiol/Levonorgestrel
Matrix
Climara Pro
Bayer
888-842-2937
Estradiol/Norethindrone
Matrix
CombiPatch
Novartis
888-669-6682
Commentsd
Appearance
Application
If patch
falls off
Clear, oblong,
tape-like.
Drug name and
dose imprinted
on patch.
Apply to lower
abdomen.
10 seconds.
weekly.

another site.
If same patch wont stick,
replace with new patch and
follow same dosing
schedule.
Bathing, showering,
swimming may cause
White,
translucent,
round, tapelike.
Drug name and
dose imprinted
on patch.
Apply to lower
abdomen.
10 seconds.
Replace patch twice
weekly.
at least weekly.
Apply same patch to

another site.
stick, apply a new patch to
another site and follow
same dosing schedule.
Prior to dispensing to the

patient, store between
36-46F (2-8C).
After dispensing,
patches can be stored at
room temperature for up
to 6 months.
More. . .
Brand Name
(Manufacturer)b
Delivery
Systemc
Appearance
Ethinyl Estradiol/Norelgestromin
Matrix
Ortho Evra
Ortho-McNeil
800-526-7736
Beige, square,
tape-like.
Drug name
heat-stamped
on patch.
Application
Apply to buttock,
abdomen, upper outer
arm, or back.
Press firmly in place
for 10 seconds.
Do not apply to
breasts.
Replace patch once
weekly for 3 weeks.
Do not wear patch on
week 4.
Do not use supplemental

wraps or adhesives to hold
patch in place.
If up to 24 hours:
Apply same patch to same
site or replace with a new
patch.
No back-up contraception
needed.
Patch change day is same.
If >24 hours or unknown:
Stop current cycle and start
new cycle with a new patch.
Use back-up contraception
for first week of new cycle.
Apply to flat surface

(e.g., chest, back, flank,
upper arm).
site before application
if needed.
30 seconds.
Replace patch and
rotate site every 72
hours. Some patients
may require patch to be
replaced every 48
hours.

tape edges with first-aid
tape.
If patch detaches, replace
with new patch at another
site.
Adhesive dressings such as
Bioclusive or Tegaderm can
be used to cover the patch
completely if needed.
Double check product
labeling (of generics) for
specific products that
should be used.
Might be difficult to see

on some skin types.6
of patch together and
flush down toilet.
heat.a
Removal of Watson
generic prior to MRI is
recommended.
Manufacturer cannot
guarantee product is
metal-free.3 After
procedure, apply a new
patch to an alternate site.3
Fentanyl
Duragesic
Janssen
800-526-7736
Generics
(Info same as brand
product unless
otherwise noted)
Actavis
410-277-1235,
Mylan
877-446-3679,
Sandoz
800-525-2492,
Watson
800-272-5525
Matrix
Reservoir:
(Mylan,
transparent,
Sandoz, &
rectangular,
Duragesic)
with drug
reservoir in the
Reservoir
center.
(Actavis & Matrix:
Watson)
translucent,
rectangular,
tape-like.
Drug name and
dose imprinted
on patch.
Commentsd
If patch
falls off
None.
More. . .
Brand Name
(Manufacturer)b
Lidocaine
Lidoderm
Delivery
Systemc
Appearance
Application
Matrix
White, tapelike.
Relatively large
(10 cm x
14 cm).
Drug name
embossed on
patch, but not
readily visible.
Apply 1 to 3 patches as
directed, covering most
painful area.
Apply patches for up to
12 hours in a 24-hour
period (i.e., 12 hours
on, 12 hours off).
Salmon
colored, oval,
with drug and
heating
component in
the center.
Apply to intact skin for

20 to 30 minutes prior
to procedure.
Endo
800-462-3636
Lidocaine and Tetracaine

Thin
Synera
uniform
Zars
drug layer
905-673-6980
with
oxygenactivated
heating
component.
Commentsd
If patch
falls off
May apply medical tape to

hold in place.7
May use ACE bandages or
gauze over and around
area to hold patch in place.
Do not wrap with extreme
pressure.7
May cut patch to fit

exactly to the area of
pain.
If irritation occurs,
remove patch(es) and do
not apply until irritation
subsides.
Apply new patch to

another site.
Do not cover the holes on
the patch, which may
impede oxygen exposure.
Synera begins to heat

when patch is removed
from the pouch and is
exposed to oxygen.
Not for home use.
Remove before MRI.2-5
More. . .
Brand Name
(Manufacturer)b
Methylphenidate
Daytrana
Delivery
Systemc
Matrix
Noven
877-567-7857
Nicotine
NicoDerm CQ
or
NicoDerm CQ
Clear8
GlaxoSmithKline
800-834-5895
Reservoir
Appearance
Application
Commentsd
If patch
falls off
Clear, square,
tape-like.
Drug name
imprinted on
patch.
Apply to hip area

2 hours before effect is
needed.
30 seconds.
Remove 9 hours after
application.
Alternate hip site daily
if possible.

another site and continue
same dosing schedule.
Keep total daily wear time
to 9 hours.
detect on some skin types.
Bathing, swimming, etc.
can loosen patch.
of the patch together and
flush down toilet or place
in appropriate lidded
container (sharps, etc).
heat.
Patch must be used within
2 months once sealed tray
or outer pouch is opened.
Opaque or
clear, square,
tape-like.9
Drug name and
dose imprinted
on patch.
Apply to nonhairy skin.

10 seconds.
Replace patch once
daily.
Patch can be worn 16 or
24 hours.
If patch does not stick well

or comes loose, tape the
edges down with first-aid
tape.10
If patch detaches, replace
with new patch at another
site.10
Opaque patch contains

aluminum and clear patch
does not.10
To avoid confusion
recommend removing
patch, regardless clear or
opaque, prior to MRI.
Reapply same patch after
procedure.3
Remove patch at bedtime
if vivid dream or other
sleep disturbances occur.
More. . .
Brand Name
(Manufacturer)b
Nitroglycerin
Minitran
Delivery
Systemc
Matrix
Medicis
602-808-8800
Nitro-Dur
Mylan
877-446-3679
Clear, oval,
tape-like.
Drug name
and dose
imprinted on
patch.
Matrix
Tan, round,
tape-like.
Drug name and
dose imprinted
on patch.
Matrix
Clear, thin,
oblong, tapelike.
Drug name and
dose imprinted
on patch.
Key
908-298-4000
Nitroglycerin
Transdermal
System
Appearance
Application
Avoid application to
extremities below the
knee or elbow.
Press firmly in place.
daily.
Keep patch on for 12 to
14 hours a day and off
for 10 to 12 hours a
day.
knee or elbow.
daily.
Keep patch on for 12 to
14 hours a day and off
for 10 to 12 hours a
day.
knee or elbow.
Press patch down and
smooth out with hand.
site if needed.
Dont apply patch
immediately after
showering or bathing.
Ensure patch-free
period of 10 to 12 hours
a day.
Commentsd
If patch
falls off
another site.
Replace with new patch.
None.

another site.
More. . .
Brand Name
(Manufacturer)b
Delivery
Systemc
Oxybutynin Chloride
Matrix
Oxytrol
Watson
800-272-5525
Rivastigmine
Exelon
Novartis
888-669-6682
Appearance
Matrix
Clear,
rectangular,
tape-like.
Drug name
imprinted on
patch.
Nude, round,
tape-like.
Drug name
and dose
imprinted on
patch.
Application
Apply to abdomen,
hips, or buttocks.
Press firmly in place.
Replace patch twice
weekly.
Rotate application
site at least once a
week.
Apply to upper or lower

back, upper arm, or
chest.
especially around
edges.
Replace patch daily.
and side of body daily.
Do not use same site
within 14 days.
Commentsd
If patch
falls off
Reapply same patch at

another site and continue
same application schedule.
If patch does not stick,
apply new patch to another
site and continue same
application schedule.
Apply new patch and

continue same dosing
schedule.
Do not use overlays,
bandages, etc. to secure
patches.

recommended because
manufacturer cannot
guarantee product is free
of metal.3 For
falling off.3
Fold patch in half and

return to the original
pouch that the patch came
with before disposing.
Consider removal prior to
MRI. Exelon patch has
not been studied in
patients who undergo
MRI.3 For reapplication
after the procedure,
follow same instructions
as for patch falling off.3
More. . .
Brand Name
(Manufacturer)b
Rotigotine
Neupro
Delivery
Systemc
Matrix
Schwartz Pharma
800-477-7877
Scopolamine
Transderm Scop11
Alza
800-585-8682
Appearance
Reservoir
Application
If patch
falls off
Tan, square,
tape-like.
Patch is
unmarked.
Apply to abdomen,
thigh, hip, flank,
shoulder, or upper arm.
Shave area at least 3
days prior to applying
patch if needed.
30 seconds.
daily
Do not use same site
within 14 days.
Apply new patch to another

dosing schedule.
May apply bandage tape to
edges to hold in place.
Tan, round,
with reservoir
in the center.
Patch is
unmarked.
Apply to hairless area

behind one ear.
For motion sickness,
apply 4 hours before
needed and remove
after 3 days. Place new
patch behind the other
ear if needed.
Prior to surgery: Apply
the evening before
surgery and remove 24
hours after surgery.
For C-section: Apply
1 hour prior to
procedure.
Apply new patch behind the

other ear.
Commentsd

heat.
Remove before MRI or
cardioversion.2

Place new patch on an
alternate site following
procedure.3
More. . .
Brand Name
(Manufacturer)b
Selegiline
Emsam
Delivery
Systemc
Matrix
Somerset
304-599-2595
Testosterone
Androderm
Watson
800-272-5525
Appearance
Reservoir
Commentsd
Application
If patch
falls off
Clear, square,
tape-like.
Drug name
and dosage
imprinted on
patch.
Apply to upper torso

(below neck and above
waist), upper thigh, or
outer upper arm.
especially around
edges.
daily.
Apply new patch to another

dosing schedule.

heat.
Beige, tapelike.
Drug name
and dose
imprinted on
patch.
2.5 mg/day =
round
5 mg/day =
oblong
Apply to back,
abdomen, upper arms,
or thighs.
Do not apply to the
scrotum or to bony
parts of the body.
Apply between 8 PM
and midnight.
especially around
edges.
Replace patch every 24
hours.
at least every 7 days.
Reapply patch if falls off

before noon.
Apply new patch at regular
patch application time if
patch falls off after noon.
Do not use tape to secure
patches.
Apply OTC topical

hydrocortisone cream
after patch removal if mild
skin irritation occurs.
0.1% triamcinolone
acetonide cream can be
applied to the skin under
the central reservoir to
reduce severity of skin
irritation.
Avoid swimming,
showering, or washing for
a minimum of 3 hours
after application.
For reapplication after the
falling off.3
More. . .

a. Avoid direct exposure to heat (e.g., heating pads, saunas, hot tubs, heated water beds, etc) while wearing a fentanyl patch as heat exposure may
increase fentanyl absorption and potentially cause serious toxicity.12,13
b. Listing is not all-inclusive of generic products. Information for generics may differ from brand product.
c. Delivery systems may be broken down into subcategories including drug reservoir membrane-modulated systems, microreservoir, adhesive
matrix, and polymer matrix.1 However, this information isnt readily available from manufacturers and doesnt change general use of patches.
d. Only patches that contain aluminum need to be removed prior to MRI to prevent burns. However, some institutions may require that all drug
patches are removed prior to MRI to avoid confusion. In addition, some manufacturers do not test products for metallic content. It may be best to
err on the side of caution.2-5
U.S. product labeling used for the above chart: Butrans (June 2011), Qutenza (June 2012), Catapres TTS (May 2012), Flector (August 2011),
Alora (November 2009), Climara (December 2007), Estraderm (March 2007), Estradiol Transdermal System (Mylan, August 2008), Menostar (June
2009), Vivelle-Dot (August 2004), CombiPatch (May 2006), Climara Pro (May 2007), Duragesic (July 2012), Fentanyl Transdermal System (Mylan,
December 2009), Fentanyl Transdermal System (Sandoz, July 2009), Fentanyl Transdermal System (Actavis, October 2009), Fentanyl Transdermal
System (Watson, September 2008), Lidoderm (March 2010), Synera (March 2012), Daytrana (November 2010), Nitroglycerin Transdermal System
(Mylan, October 2008), Nitro-Dur (May 2012), Minitran (January 2012), Ortho-Evra (December 2011), Oxytrol (April 2011), Exelon (August 2010),
Neupro (April 2012), Transderm Scop (February 2006), Emsam (May 2009), Androderm (April 2012).
Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making
clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and internet links in this article were current as of the date of publication.
More. . .
Project Leader in preparation of this PL DetailDocument:

Stacy A. Hester, R.Ph., BCPS,
Assistant Editor
7.
References
1.
2.
3.
4.
5.
6.
Ball AM, Smith KM. Optimizing transdermal drug

therapy. Am J Health Syst Pharm 2008;65:1337-46.
FDA. Public health advisory: risk of burns during
MRI scans from transdermal drug patches with
metallic
backings.
March
9,
2009.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDru
gSafetyInformationforPatientsandProviders/DrugSafe
tyInformationforHeathcareProfessionals/PublicHealth
Advisories/ucm111313.htm.
(Accessed July 18,
2012).
Hong I, Gabay M, Lodolce A. Safety concerns
involving transdermal patches and magnetic
resonance imaging (MRI).
Hosp Pharm
2010;45:771-8.
Hulisz DT. Are topical patches safe during MRI or
CT scans?
May 2, 2008.
Medscape.
http://www.medscape.com/viewarticle/572561.
(Accessed July 19, 2012).
University of Illinois at Chicago. Drug Information
Group.
Transdermal patches during MRI
procedures:
risk
of
serious
burns.
http://dig.pharm.uic.edu/faq/transdermal.aspx.
(Accessed July 19, 2012).
Fentanyl transdermal system: taking another look.
Patient safety advisory. Pennsylvania Patient Safety
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9.
10.
11.
12.
13.
Reporting
System.
June
2007.
http://patientsafetyauthority.org/ADVISORIES/Adviso
ryLibrary/2007/jun4(2)/Pages/53.aspx.
(Accessed
July 18, 2012).
Personal communication (verbal).
Medical
Information Department. Endo. Chadds Ford, PA
19317. July 20, 2012.
NicoDerm
CQ.
http://www.nicodermcq.com/NicodermCQ_Product.a
spx. (Accessed July 18, 2012).
Clinical Pharmacology [database online]. Tampa,
FL:
Gold
Standard,
Inc.;
2012.
http://www.clinicalpharmacology.com.
(Accessed
July 14, 2012).
Personal communication (verbal).
Customer
Information. GlaxoSmithKline. Research Triangle
Park, NC 27709. July 23, 2012.
Transderm Scop.
Information for patients.
http://www.transdermscop.com/transderm-scoppatient-information.htm. (Accessed July 18, 2012).
PL Detail-Document, Safe Use of Fentanyl
(Duragesic)
Patches.
Pharmacists
Letter/Prescribers Letter. October 2007.
FDA. Fentanyl transdermal system (marketed as
Duragesic) information.
December 21, 2007.
http://www.fda.gov/Drugs/DrugSafety/PostmarketDru
gSafetyInformationforPatientsandProviders/ucm1149
61.htm. (Accessed July 18, 2012).
Cite this document as follows: PL Detail-Document, Characteristics of Transdermal Patches.

Letter/Prescribers Letter. August 2012.
Pharmacists
Evidence and Recommendations You Can Trust

3120 West March Lane, P.O. Box 8190, Stockton, CA 95208 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249
Subscribers to the Letter can get PL Detail-Documents, like this one,

on any topic covered in any issue by going to www.pharmacistsletter.com,
www.prescribersletter.com, or www.pharmacytechniciansletter.com
(Page 1 of 5)
Technician Training Tutorial:

Dispensing the Right Patch with the Right Instructions
The availability of convenient products is important to most of us in todays fast-paced society. Drug
products that cut down on hassle are no exception. Medications that come as patches can be very
convenient for patients. Many drugs are available in transdermal dosage forms, where drug is absorbed
across the skin and into the bloodstream. Available transdermal patches include estrogens (Climara, etc),
testosterone (Androderm), the blood pressure med clonidine (Catapres-TTS, U.S. only), the heart med
nitroglycerin (Nitro-Dur, etc), scopolamine for motion sickness and nausea, the pain med fentanyl
(Duragesic), methylphenidate for ADHD (Daytrana, U.S. only), nicotine for smoking cessation, and
others. Some patches, such as the pain reliever lidocaine (Lidoderm, U.S. only), have a local effect
similar to topical creams and ointments. Patches are considered sustained-release dosage forms and are
often dosed less frequently than capsules or tablets, which can be a big deal when it comes to improving
medication adherence. As with any other dosage form, mix-ups can occur when prescriptions for drug
patches are filled in the pharmacy. Pharmacy technicians play an important role in making sure
prescriptions for patches are filled and dispensed correctly.
Katie Brown is a 65-year-old patient at your pharmacy. She has been a pharmacy customer for
many years. She suffers from chronic pain and fills her medications at your pharmacy on a regular
basis. She presents with a prescription for Duragesic 25 mcg/hr, apply one patch every 72 hours.
What information should you ask when a patient drops off a prescription for a transdermal drug
patch?
Some questions such as allergy information, date of birth, address, etc., are commonly asked when patients
drop off any prescription. Additional information that may be helpful for patients getting a patch includes:
Has the patient used drug patches before?
Has the patient used a similar drug in another form (e.g., oral formulation)?
If another form of drug was used, how much of the drug was the patient taking daily?
What should you consider when entering a transdermal drug patch prescription into the
computer?
Computer entry. Transdermal drug patches have specific instructions on how long to wear a patch or where
on the body the patch should be placed. Dosing instructions may vary among different patches, but should
always be entered exactly as written on the prescription. Additional label space may be required for detailed
instructions.
In most cases, transdermal drug patches are replaced once or twice weekly. Directions may also be
written use as directed, where dosing instructions are communicated directly to the patient from the
prescribers office. If this is the case, let the pharmacist know so that he or she can clarify the directions
for use so that you can enter an accurate days supply into the computer.

Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.pharmacytechniciansletter.com
(Page 2 of 5)
Be alert for specific dosing instructions commonly seen with patch prescriptions that should be included
on the label. For example, instructions on transdermal nitroglycerin patches (Nitro-Dur, etc) usually
require the patient to remove the patch after it is worn for 12 to 14 hours. This helps the patches work
better to treat heart problems. Methylphenidate (Daytrana) patch instructions may direct patients to apply
the patch in the morning and remove it nine hours later to help avoid sleep disturbances.
Patch prescriptions may also include information about where to place the patch that should be included
on the label. Some patches like CombiPatch (U.S. only) should be applied only on the lower abdomen,
while others like Androderm may be applied to the back, abdomen, upper arms, or thighs. Check with
your pharmacist if you have questions about any of the application or dosing instructions for a patch.
Product selection. Fentanyl patches, for example, are available in a generic form. Some generic patches
may look or feel different from each other or from the brand. For example, in the U.S. some fentanyl
generic patches are manufactured as reservoir systems with the drug contained inside a liquid reservoir.
However, other fentanyl patches use a matrix system. In Canada, most of the fentanyl patches use a
matrix system. The active drug is contained in an adhesive polymer layer of a small, thin patch with no
liquid reservoir. Different patches may look and feel different to patients. Alert patients if you are
dispensing a patch from a different generic manufacturer than has been used in the past by writing a note
or affixing the appropriate auxiliary labeling.
Duplicate therapy. As with other prescriptions, pharmacists should be alerted to drug-drug or drugdisease interaction computer alerts when entering patch prescriptions. Watch especially for duplication of
an existing oral medicine with the same drug in a patch form. In many cases, a patch may take the place
of an oral drug, so patients need to stop the oral form of a medicine when starting a patch. Due to the
toxic nature of fentanyl, it is especially important to watch for drug interactions or pain medicine
overdose. There have been multiple cases of death or toxicity resulting from incorrect use of fentanyl
patches.
As you enter Ms. Browns Rx into the computer, you do a double-take at the sig. Does it say
every 12 hours or every 72 hours? You know that the correct dosing interval for fentanyl
patches is every 72 hours. You ask the pharmacist to look at the Rx. She verifies that the
interval should be every 72 hours and you continue with inputting the prescription.
After you enter the prescription into the computer, you check your stock of fentanyl patches and
realize that you do not have enough 25 mcg/hour fentanyl patches to fill Ms. Browns Rx.
However, you do have three boxes of generic fentanyl 50 mcg/hour patches.
Can patients cut patches to get half of a dose, similar to cutting tablets to get half of a dose?
There are two main types of patches currently on the market: reservoir and matrix systems.
Reservoir patches should never be cut. In a reservoir system, the drug is in a liquid reservoir inside the
patch. Androderm (testosterone) and Catapres-TTS (clonidine) are examples of reservoir patches.
Cutting into the reservoir can cause dose-dumping, which could lead to the patient getting too much drug
all at one time and serious side effects.
Matrix patches have the drug built into an adhesive polymer layer, which is applied directly to the skin
once the patch liner is removed. Climara (estradiol) and Lidoderm (lidocaine) patches are examples of
matrix systems. The way drug is included in matrix patches could be thought of as similar to the way
drug is included throughout a tablet.

Phone: 209-472-2240 ~ Fax: 209-472-2249
(Page 3 of 5)
It has been suggested that matrix-based patches may be cut to deliver a lower dose; however, this theory
has not yet been proven or substantiated. Patients should be especially careful not to cut or alter drug
patches where exact dosing is critical (e.g., fentanyl, methylphenidate) regardless of whether they come in
matrix or reservoir formulation due to the potential of erratic drug delivery rate.
For some matrix patches (e.g., Climara, etc) where exact dosing is not as critical, some clinicians feel that
it is probably okay to cut the patches to deliver lower doses. However, most manufacturers do not
recommend cutting or altering patches in any way regardless of patch type. Patients should also avoid
partially removing the protective liner of drug patches as a strategy to decrease the amount of drug
delivered into the bloodstream.
At this time, the only exceptions to this rule are Lidoderm (U.S.) and capsaicin (Qutenza [U.S.]) patches.
The U.S. prescribing information for these patches states that they can be cut into smaller sizes with
scissors (prior to removal of the liner) to get a smaller dose.
Alert your pharmacist to any patient questions about altering the dose of a patch by cutting it or using
more than one patch at a time.
You check with the pharmacist and she reiterates that it is NOT a good idea for the patient to cut
fentanyl patches. Exact dosing of this medication is critical. The prescription should NOT be
filled with fentanyl 50 mcg/hour patches. You know that your order for the day is coming in
shortly and that it will contain fentanyl 25 mcg/hour patches. You tell Ms. Brown that you can
have her prescription ready in about two hours. She agrees to come back before closing to pick
up her patches.
What else should you consider when dispensing/labeling a patch prescription?
Product selection. Most drug patches come in multiple strengths and are generally stored close to each other
on the shelf. The boxes of different strengths often look similar and can add to the potential for error. To
avoid a mix-up, pay close attention when you pull a patch to fill a prescription. Verify the NDC number
(DIN in Canada) on the label against the stock box as a double check.
Drug patches are generally packaged in a box with a set number of patches included in each package. For
example, fentanyl or Duragesic boxes usually contain five patches. The normal dose is one patch every two
to three days, so most patients use two to three boxes of fentanyl patches for a 30-day supply. For clonidine
patches that are changed weekly, there are four patches per box, so just one box is needed for a 28-day
supply.
Prescription labeling. Most boxes come with space for the prescription label. Affix the prescription label
to the designated space, taking care to avoid covering the expiration date, NDC number (DIN in Canada),
or any dosing calendars or application instructions that are on the box. Ask your pharmacist for
instructions if your pharmacys printed label is larger than the space allotted on the box, or if there is not
space for auxiliary labels. Many pharmacies butterfly the label in this situation, or fold a portion of the
label over on itself so that the full label can be included in a smaller space.
Many patches, such as estradiol products, come in boxes with a one-month supply. If multiple boxes of
patches are required to fill one prescription, many pharmacists and technicians will tape the boxes
together and affix one label to the taped boxes. If you tape multiple boxes together for dispensing, be
sure that the drug name, dose, NDC (DIN in Canada), and expiration date of each box is still visible for
the pharmacist to check. Also, make sure you do not tape over the opening to the boxes so that patients
can easily access the patches in each box. If boxes are dispensed separately, each box needs to be labeled
Phone: 209-472-2240 ~ Fax: 209-472-2249
(Page 4 of 5)
individually to ensure patients have labeled instructions for each dose. To avoid any confusion, it is best
if the patient opens just one box at a time, using that box completely and then moving on to the next box.
Sometimes the drug patch may be ordered individually or in small quantities. For example, a prescription
may be written for 12 Duragesic patches, which would require two full boxes plus two individual
patches. In this situation, most pharmacists prefer for you to label the boxes and then place the two
individual patches in a small, clear sealable bag and affix another label to the bag. It is important to mark
the opened inventory box, usually with a large X. This will show that the stock box has been opened
and prevent it from being dispensed as a full box unknowingly in the future.
Auxiliary labeling. All drug patches should have a for external use only auxiliary label to specify that
they are to be used externally. This may seem obvious, but patients misperceptions about their medications
are often surprising.
The majority of transdermal drug patches are stored at room temperature. However, keep in mind that
CombiPatch (U.S.) and Estalis (Canada) should be stored in the refrigerator PRIOR to dispensing. Patients
may keep them at room temperature AFTER they leave the pharmacy. Make sure to include an auxiliary
label indicating that they can only be stored for up to six months outside of the refrigerator.
Transdermal drug patches generally come in packages that are not child resistant. It is important that the
patient is aware of this and stores the package in a safe place that is out of reach of children. There have
been cases of toxicity and death from children applying or ingesting discarded fentanyl patches. To
remind patients of this, always apply an auxiliary label that says package not child resistant and/or
keep out of reach of children.
What other information do patients need to know about their transdermal drug patches?
In addition to auxiliary labels and the patient drug information that prints out from your computer, be sure to
include the accompanying patient information from manufacturers of drug patches that often includes
information about:
Appropriate application. The protective liner should be removed before applying the drug patch. Patients
should select a clean, dry, hairless area that is specified by the manufacturer for patch application and rotate
the application site. We have this information on our chart, Characteristics of Transdermal Patches (U.S.
subscribers; Canadian subscribers). Unless specified by the manufacturer, drug patches should not be
covered or held in place with tape, bandages, etc. This may affect the drug delivery rate. Exceptions
include some fentanyl patches and lidocaine (Lidoderm), for which first-aid tape can be used on the edges of
the patch if needed. Patients also may need to know what to do if a patch falls off before it is time to switch
patches. This information is also included in the charts mentioned above.
Old patches should be removed before applying a new patch to avoid overdose or toxicity. A specific
application site rotation schedule is often included in the patient information from the manufacturer. This
can help reduce any kind of skin irritation that could be caused by the patch.
Appropriate disposal. Used drug patches should be folded in half with the adhesive side adhering to itself
prior to disposal. Most drug patches are disposed of in the garbage. Some patches (e.g., fentanyl,
methylphenidate [Daytrana]) should be flushed down the toilet immediately after folding in half to prevent
accidental exposure or diversion. Buprenorphine (Butrans) patches can either be flushed down the toilet or
disposed of in the trash when used with their special disposal units (U.S. only). Patients should wash their
hands after applying or handling patches to prevent accidental drug exposure and absorption (i.e., through
the skin of the fingers or after rubbing eyes/nose with hands).
Phone: 209-472-2240 ~ Fax: 209-472-2249
(Page 5 of 5)
Avoiding heat exposure. Heat exposure may increase drug absorption from patches and can potentially lead
to overdose and toxicity. Patients should avoid exposure to direct heat sources such as heating pads, saunas,
hot tubs, or heated water beds while wearing some patches (e.g., fentanyl, etc).
Removing patches before undergoing MRI. Some patches contain aluminum material (e.g., Catapres-TTS
[U.S.], Habitrol [Canada], NicoDerm CQ [U.S.], Neupro [U.S.], Transderm Scop [U.S.], Androderm, etc)
and need to be removed prior to MRI to avoid skin burns. One school of thought is that all patches should
be removed prior to MRI, to avoid confusion and to err on the side of caution.
Medication Guides. In U.S., the FDA also requires that a MedGuide be dispensed with some drug patches
(e.g., Duragesic, Emsam, Daytrana, etc).
Ms. Brown returns later in the day to pick up her prescription. You have included appropriate
auxiliary labels on the box, as well as a MedGuide in the bag, even though Ms. Brown has filled
this prescription several times before.
Cite this document as follows: PL Technician Training Tutorial, Dispensing the Right Patch with the Right
Instructions. Pharmacists Letter/Pharmacy Technicians Letter. August 2012.

Phone: 209-472-2240 ~ Fax: 209-472-2249

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PL Detail-Document #280813

This PL Detail-Document gives subscribers

PHARMACISTS LETTER / PRESCRIBERS LETTER

Characteristics of Transdermal Patches

Apply to upper outer

Dispose of patch and replace

Avoid direct exposure to

(PL Detail-Document #280813: Page 2 of 14)

Rolled gauze may be used

May cut patch to fit the

Apply to upper outer

Replace with new patch at

Adhesive cover can be

Apply to most painful

If patch doesnt stick well,

Do not wear patch while

(PL Detail-Document #280813: Page 3 of 14)

Reapply same patch to an

Removal prior to MRI is

Reapply same patch to

Bathing, showering, and

Clear and round

Reapply same patch.

Apply to trunk area

(PL Detail-Document #280813: Page 4 of 14)

Reapply same patch to

Generic for Climara.

Reapply same patch to

Bathing, swimming, etc

Reapply same patch.

(PL Detail-Document #280813: Page 5 of 14)

Reapply same patch to

Apply same patch to

Prior to dispensing to the

(PL Detail-Document #280813: Page 6 of 14)

Do not use supplemental

Apply to flat surface

If patch doesnt stick well,

Might be difficult to see

(PL Detail-Document #280813: Page 7 of 14)

Apply to intact skin for

Lidocaine and Tetracaine

May apply medical tape to

May cut patch to fit

Apply new patch to

Synera begins to heat

(PL Detail-Document #280813: Page 8 of 14)

Apply to hip area

Replace with new patch at

Apply to nonhairy skin.

If patch does not stick well

Opaque patch contains

(PL Detail-Document #280813: Page 9 of 14)

Replace with new patch.

Replace with new patch at

(PL Detail-Document #280813: Page 10 of 14)

Apply to upper or lower

Reapply same patch at

Apply new patch and

Removal prior to MRI is

Fold patch in half and

(PL Detail-Document #280813: Page 11 of 14)

Apply new patch to another

Apply to hairless area