“Cheat Sheet” for Dos and Don’ts With Patches

Some things are the same for many patches, regardless of medication or manufacturer. Use this “cheat sheet” to address common questions about patches. For more specific information about appearance, delivery system, and what to do if patches fall off, see our chart, Characteristics of Transdermal Patches (U.S. subscribers; Canadian subscribers).

Application

  • Patches should be applied to clean, dry, hairless, nonirritated, intact skin.1
    • Avoid areas where tight clothing can loosen or rub the patch off (e.g., waistline).
  • Manufacturers may recommend areas to use or areas to avoid based on the specific medication.
    • For example, estrogen patches should not be applied directly to the breast.1
  • Patients or caregivers should be instructed to wash hands after applying patches.1

To Cut or Not to Cut

  • Though most manufacturers do not recommend cutting patches regardless of the delivery system, a few may be approved to be cut (e.g., Lidoderm and Qutenza [both only available in the U.S.]).
  • Advise patients not to cut or alter any drug patch (regardless of the delivery system) when exact dosing is critical (e.g., fentanyl, methylphenidate).
  • Delivery systems and the importance of dosing precision can help answer if a patch can be cut.
    • Reservoir-based patches should NEVER be cut due to potential for “dose dumping”.1
    • Some matrix-based patches may be able to be cut to deliver a lower dose; however, half a matrix patch may not equal half a dose due to uneven cutting or less surface area.
      • Limited data indicate cutting some estradiol patches is safe (e.g., Climara).1

Disposal

  • Fold used and unused patches in half (sticky sides together), to prepare for disposal.
  • Check product labeling for disposal options (e.g., product disposal packs) and recommendations.
  • In Canada (in the U.S., if possible), recommend authorized collection or disposal sites (e.g., drug take-back programs, pharmacies [Canada]).2,3
  • In the U.S., if disposing of patches at home:

Exposure to Heat

  • Remind patients to avoid exposing patches to heat sources (e.g., electric blankets, heating pads, hot tubs, saunas), as this can increase drug delivery and possibly lead to toxicity and/or overdose.1

Irritation

  • Encourage application site rotation and consider recommending a topical corticosteroid to help reduce irritation associated with transdermal patches (e.g., hydrocortisone 1% cream).1

Magnetic Resonance Imaging (MRI)

  • Remove patches that contain metal prior to MRI to prevent burns (e.g., Androderm, Neupro, NicoDerm CQ [U.S.], NicoDerm [Canada]).4,5
  • It may be safest to remove all patches prior to MRI, unless it is certain a patch does NOT contain any metal (e.g., not all manufacturers test for metal content).1,4

Project Leader in preparation of this clinical resource (330704): Beth Bryant, Pharm.D., BCPS, Assistant Editor

References

  1. Ball AM, Smith KM. Optimizing transdermal drug therapy. Am J Health Syst Pharm 2008;65:1337-46.
  2. Drug Enforcement Agency. Diversion control division: national take-back initiative. https://www.deadiversion.usdoj.gov/drug_disposal/takeback/. (Accessed May 3, 2017).
  3. Government of Canada. Safe disposal of prescription drugs. https://www.canada.ca/en/health-canada/services/safe-disposal-prescription-drugs.html. (Accessed May 3, 2017).
  4. Government of Canada. Health Canada endorsed important safety information on magnetic resonance imaging systems. April 2005. http://healthycanadians.gc.ca/recall-alert-rappel-avis/
    hc-sc/2005/14350a-eng.php
    . (Accessed May 3, 2017).
  5. FDA. Public health advisory: risk of burns during MRI scans from transdermal drug patches with metallic backings (archived content). March 9, 2009. https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafety
    InformationforPatientsandProviders/ucm111313.htm
    . (Accessed April 30, 2017).

Cite this document as follows: Clinical Resource, “Cheat Sheet” for Dos and Don’ts With Patches. Pharmacist’s Letter/Prescriber’s Letter. July 2017.

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