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| |  Skin Reactions Associated With Transdermal Patches Rarely Cause Treatment Discontinuation: Presented at AAGP By Carole VanSickle Ellis SAVANNAH, Ga -- March 7, 2010 -- While up to 50% of patients who are treated with transdermal patches do report problems at the application site, these site reactions are seldom sufficient to lead to treatment discontinuation. The researchers who presented the findings on March 6 at the 2010 Annual Meeting of the American Association for Geriatric Psychiatry (AAGP) also outline strategies for preventing and managing these skin reactions. The study by George T. Grossberg, PhD, St. Louis University School of Medicine, St. Louis, Missouri, and colleagues did not focus on the efficacy of transdermal patches, but rather on the associated skin reactions. The recognised advantages of transdermal delivery include smooth, continuous drug delivery, which may reduce adverse events (AEs) caused by high peak plasma concentrations; increased bioavailability and reduced drug-drug interactions since the medications avoid first-pass metabolism by gastrointestinal or hepatic enzymes; and increased compliance. The team believed that physicians would more likely prescribe transdermal medication if they were more familiar with potential reactions. Medications now available in the transdermal patch form include methylphenidate for attention-deficit/hyperactivity disorder, rotigotine for Parkinson’s disease, rivastigmine for Alzheimer’s disease, selegiline for major depressive disorder, oxybutynin for overactive bladder, and lidocaine for postherpetic neuralgia. In this review, the researchers assessed the types, frequency, severity, and clinical course of skin reactions reported in 14 studies evaluating transdermal medicines in humans. The team determined that the most common application sites and symptoms were localised erythema or itching sometimes accompanied by oedema. These reactions occurred in 20% to 50% of patients, and were mild to moderate in severity. They lasted from a few days to a few weeks, and resulted in cessation of the treatment in only 1.7% to 6.8% of patients over any period of 6 months. The research team plans to next address strategies for minimising and managing irritant and allergic contact dermatitis skin reactions to transdermal patches. In the meantime, the team established a set of guidelines for preventing and managing skin reactions encountered while using transdermal skin patch medications: · Apply the patch to clean, hairless, or nearly hairless skin. Do not shave the area, but rather trim it, and use an oil-based substance, like olive oil, to remove excess adhesive. · Do not apply patches to damaged skin or areas showing signs of contact dermatitis (related to the patch or not). · Do not apply the patch to the same area of skin for at least 7 days, and rotate application sites based on specific manufacturers’ instructions. When cleaning the patch application site, avoid alcohol-based cleansers and wash gently with water. · Should symptoms begin to manifest, move the patch to a separate lymph node catchment area. Topical calamine lotion can help ease mild symptoms. · In cases of elderly who are likely to develop these reactions, sedatory antihistamines and potent topical corticosteroids can be used to help with sleep disruption and allergic dermatitis, respectively. Funding for editorial assistance for this research was provided by Novartis Pharma AG. [Presentation title: Skin Tolerability of Modern Transdermal Patches. Abstract N23]
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