This Clinical Resource gives subscribers additional insight related to the Recommendations published in July 2017 ~ Resource #330704 Characteristics of Transdermal Patches Transdermal patches offer an attractive route of administration for patients who are unable to swallow oral medications and to avoid the need for pain or risks associated with intravenous administration. Patches may also allow for less frequent dosing and improved adherence. Refer to the Cheat Sheet for Dos and Don ts With Patches, for things to consider that may be similar among most available patches, including application, exposure to heat, disposal, and to help determine if it is safe or appropriate to cut a patch. Use the chart below to determine how to address common questions associated with individual patches, including exposure to water and what to do if patches fall off, as these may be different from patch to patch. For guidance about when patches can be cut, see our Cheat Sheet for Dos and Don ts With Patches. Please note that this table provides information about many brand name and generic patches, yet there may be other generics patches available that are not listed. Information may be different for generic products. Products listed on the chart are representative and may not be all-inclusive. Buprenorphine (Butrans) Provide a MedGuide with each Rx (U.S.) Beige, rectangular May tape edges with first-aid tape or square (varies or cover with waterproof or with dose) semipermeable dressing for up to seven days if edges come loose. If the patch comes off, replace with a new patch, rotating sites. o Applying a new patch starts a new dosing interval. Water exposure during showering or bathing should not affect the patch. Capsaicin (Qutenza) Rectangular (14 x 20 cm), May use a dressing such as rolled gauze to keep in place for the full 60-minute treatment. Water exposure should not be an issue as patch is only applied for 60 minutes every three months. Clonidine (Catapres-TTS) Reservoir Tan, square, BI-31 (0.1 mg), BI-32 (0.2 mg), BI-33 (0.3 mg) Use round, white adhesive cover if becomes loose. If the patch comes off, replace with a new patch, rotating sites.
(Clinical Resource #330704: Page 2 of 8) Diclofenac (Flector) Provide a MedGuide with each Rx (U.S.) Estradiol (Alora) Rectangular May tape edges or cover with (10 x 14 cm), mesh netting sleeve (e.g., Curad Hold Tite, Surgilast). Do not cover with an occlusive barrier. Transparent, rectangular, 9 If patch comes off, the same patch may be reapplied. If unable to reapply, apply a new Patch should not be worn even during normal exposure to water (e.g., bathing, swimming). Advise patients to use caution when washing or drying off, to avoid catching and lifting the edge of the patch. Estradiol (Minivelle) Translucent, round, tape-like, 5 If patch comes off, same patch may be reapplied. If unable to reapply, apply a new Showering is unlikely to cause patch to fall off. Estradiol (Vivelle-Dot) Estradiol (Climara) Generics (information is the same as brand unless otherwise noted) Mylan Translucent, rectangular, tapelike, imprinted with drug name and 6 Climara Clear, oval, tapelike, imprinted with drug name and 10 Mylan Peach, round, foam disc, drug and If patch comes off, same patch may be reapplied. If unable to reapply, apply a new If patch comes off, same patch may be reapplied. If unable to reapply, apply a new Showering is unlikely to cause patch to fall off.
(Clinical Resource #330704: Page 3 of 8) Estradiol (Menostar) Clear, oval, tapelike, If patch comes off, same patch imprinted may be reapplied. with drug name If unable to reapply, apply a new and 10 Estradiol/ Levonorgestrel (Climara Pro) Clear, oval, tapelike, imprinted with drug name and 10 If patch comes off, same patch may be reapplied. If unable to reapply, apply a new Estradiol/ Norethindrone (CombiPatch) Translucent to opaque, round, tape-like, 5 If patch comes off, same patch may be reapplied, rotating sites. If unable to reapply, apply a new Estradiol/ Norelgestromin (Xulane) Peach, rectangular, tapelike, imprinted with drug name and Do not use tape or a wrap to secure. If patch comes off: o For <1 day: may reapply same patch. No back-up contraception needed. o For 24 hrs or unknown time: apply a new patch (starts a new cycle), rotating sites. Back-up contraception needed for 1 week. Patch adheres well to skin allowing daily activities such as bathing, showering, swimming, and exercising without interrupting therapy. 8
(Clinical Resource #330704: Page 4 of 8) Fentanyl (Duragesic) Provide a MedGuide with each Rx (U.S.). Generics (information is the same as brand unless otherwise noted) Actavis Mylan Sandoz Use first-aid tape on the edges or Duragesic Transparent, cover with a transparent adhesive Mylan rectangular, dressing (e.g., Bioclusive) if patch Sandoz tape-like, becomes loose. the If patch comes off, apply a new Reservoir patch, rotating sites. Actavis o Applying a new patch starts a new dosing interval. Reservoir Transparent, rectangular, central drug reservoir, Lidocaine 4% (Lidocare [OTC]) 2 Rectangular, two sizes: 2 Large: for back/shoulder Small: for arm/neck/leg No information available about how to address patches that become loose or come off. Patch should not get wet. Do not wear while bathing or swimming. 1 Lidocaine 5% (Lidoderm [Rx]) Generic (information is the same as brand unless otherwise noted) Mylan Lidoderm Rectangular (10 x 14 cm), 7 Mylan Same size as above. Lidoderm: no information available about how to address patches that are loose or come off. 7 Mylan: a hypoallergenic dressing tape may be used along patch edges to hold in place. Discard tape with patch. Patch should not get wet. Do not wear while bathing or swimming.
(Clinical Resource #330704: Page 5 of 8) Lidocaine/ Tetracaine (Synera) Methylphenidate (Daytrana) Thin drug Salmon-colored, Only applied for maximum of layer with oval, drug and 30 minutes prior to venipuncture or oxygenactivated heating procedure, so should not be an component are in issue. heating the center Important not to cover holes in component patch to allow oxygen-activated Clear, rectangular, tape-like heating to function properly. Do not use dressings, tapes, or other adhesives. If patch comes off, apply new patch, rotating sites. o Total wear time for old patch and new patch combined should be no more than nine hours. Only applied for max of 30 minutes prior to venipuncture or procedure, so shouldn t be an issue. Nicotine (NicoDerm CQ, NicoDerm CQ Clear) Reservoir with SmartControl Technology 4 Opaque or clear, square, tape-like 3 May use adhesive tape placed as an x over the patch. 4 4 Nitroglycerin (Minitran) Generic (information is the same as brand unless otherwise noted) Mylan Continued Minitran Continuous controlledrelease. Only ~14% of drug is delivered during 12-hour application. Remainder serves as reservoir and Minitran Rectangular 11 Mylan Clear, oblong, tape-like, If patch falls off, apply new patch, rotating sites. 11 11
(Clinical Resource #330704: Page 6 of 8) Nitroglycerin, continued is not delivered with normal use. Mylan Oxybutynin (Oxytrol) Clear, rectangular, tape-like, If patch comes completely off, may attempt to reapply. If unable to reattach, apply a new patch, rotating sites, and follow same dosing schedule. Rivastigmine (Exelon) Beige, round, tape-like, drug name Do not use tape, bandages, or other adhesives. If the patch comes off, apply new Rotigotine (Neupro) Tan, square, tape-like, May use bandage tape to secure edges. If patch comes off, apply a new Scopolamine (Transderm Scop) Reservoir Tan-colored, round, without other markings If patch comes off, apply a new patch, rotating sites. Limit contact with water (e.g., bathing, swimming), as this may loosen patch and cause it to fall off. Selegiline (Emsam) Provide a MedGuide with each Rx (U.S.). Clear, square, tape-like, If the patch becomes loose, press it back in place. If patch falls off, apply a new Normal exposure to water during bathing is unlikely to affect adhesion. 8 No information is available about the effects of swimming on adhesion.
(Clinical Resource #330704: Page 7 of 8) Testosterone (Androderm) Reservoir Tan without any If the patch becomes loose, rub markings, fingers firmly around the edges. 2 mg/day (round), Do not use tape to secure. 4 mg/day (oval) 9 If patch falls off before noon, apply a new patch, rotating sites. If patch falls off after noon, do not replace until a fresh patch would be applied that evening. Avoid bathing, swimming, or showering for at least three hours after applying each patch. a. Information from U.S. product labeling unless otherwise specified: Butrans (December 2016); Qutenza (July 2013); Catapres-TTS (August 2016); Flector (May 2016); Alora (August 2014); Minivelle (September 2014); Vivelle-Dot (March 2017); Climara (October 2013); estradiol patch (Mylan, May 2015); Menostar (October 2013); Climara Pro (April 2017); CombiPatch (May 2015); Xulane (March 2016); Duragesic (December 2016); fentanyl patch (Actavis, September 2014); fentanyl patch (Mylan, February 2017); fentanyl patch (Sandoz, December 2016); Lidoderm (January 2015); lidocaine patch (Mylan, January 2015); Synera (March 2014); Daytrana (January 2017); Minitran (December 2014); nitroglycerin patch (Mylan, November 2014); Oxytrol (July 2015); Exelon (November 2016); Neupro (September 2016); Transderm Scop (December 2014); Emsam (March 2015); Androderm (October 2016). Users of this resource 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.
(Clinical Resource #330704: Page 8 of 8) Project Leader in preparation of this clinical resource (330704): Beth Bryant, Pharm.D., BCPS, Assistant Editor References 1. University of Maryland. Drug notes: lidocaine patch (on the skin). http://www.umm.edu/health/medical/drugnotes/notes/lidocaine-patch-on-the-skin. (Accessed May 1, 2017). 2. Lidocare. Drug facts. http://www.lidocare.com/drugfacts. (Accessed May 1, 2017). 3. Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc.; 2016. http://www.clinicalpharmacology.com. (Accessed May 1, 2017). 4. NicoDerm CQ. https://www.nicodermcq.com/. (Accessed May 1, 2017). 5. Personal communication (verbal). Ross. Product information. Noven. Miami, FL 33186. May 2, 2017. 6. Personal communication (verbal). Aruranie. Product information. Novartis. East Hanover, NJ 07936. May 2, 2017. 7. Personal communication (verbal). Gabrielle. Product information. Endo Pharmaceuticals. Malvern, PA 19355. May 2, 2017. 8. Personal communication (verbal). Rosa. Medical information. Mylan pharmaceuticals. Morgantown, WV 26505. May 2, 2017. 9. Personal communication (verbal). Jerry. Medical information. Allergan. Parsippany, NJ 07054. May 3, 2017. 10. Personal communication (verbal). Kathleen. Medical information. Bayer. Whippany, NJ 07981. May 3, 2017. 11. Personal communication (verbal). Jerry. Medical information. Valeant. Northridge, CA 91324. May 9, 2017. Cite this document as follows: Clinical Resource, Characteristics of Transdermal Patches. Pharmacist s Letter/Prescriber s Letter. July 2017. Evidence and Recommendations You Can Trust 3120 West March Lane, Stockton, CA 95219 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249 Copyright 2017 by Therapeutic Research Center Subscribers to the Letter can get clinical resources, like this one, on any topic covered in any issue by going to PharmacistsLetter.com, PrescribersLetter.com, PharmacyTechniciansLetter.com, or NursesLetter.com
(Page 1 of 5) Technician Tutorial: The Ins and Outs of Transdermal Patches The availability of convenient products is important to most of us in today s fast-paced society. Drug products that cut down on hassle are no exception. s that come as patches can be very convenient for patients who have difficulty swallowing, are forgetful, need frequent medication dosing, etc. 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 (Minitran, etc), scopolamine (Transderm Scop [U.S.], Transderm-V [Canada]) for motion sickness and nausea, the pain med fentanyl (Duragesic), methylphenidate for ADHD (Daytrana, U.S. only), nicotine for smoking cessation (Habitrol [Canada], NicoDerm CQ [U.S.], etc), and others. Some patches, such as the pain reliever lidocaine (Lidoderm, etc, 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 dispensed from the pharmacy. Pharmacy technicians play an important role in making sure prescriptions for patches are dispensed correctly. Katie Brown is a 55-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 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? Sharing the answers to these questions with the pharmacist can help guide patient counseling. 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 many 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 Phone: 209-472-2240 ~ Fax: 209-472-2249 PharmacistsLetter.com ~ PharmacyTechniciansLetter.com
(Page 2 of 5) prescriber s 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 those instructions and an accurate days supply into the computer. Make sure you understand the units for quantity in your computer system. For example, entering 1 for one box could be confused with one patch, and vice versa. If you are unsure of which quantity to enter, check with your pharmacist. 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 (Minitran, etc) usually require the patient to remove the patch after it is worn for 12 to 14 hours. This nitrate-free interval helps prevent tolerance to the medication. Daytrana patch instructions may direct patients to apply the patch in the morning and remove it nine hours later to help avoid sleep disturbances. Always check the notes section on E-Rxs since these more detailed dosing instructions may be located there. Patch prescriptions may also include information about where to place the patch that should be included on the label. Some patches, like estrogen/norethindrone acetate (CombiPatch [U.S.], Estalis [Canada]), should be applied only on the lower abdomen (Estalis may also be applied to the buttocks), 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. and in Canada, most fentanyl generic patches are manufactured as matrix systems, but some are manufactured as reservoir systems with the drug contained inside a liquid reservoir. In 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 alerts warning of drug interactions or duplication of therapy. There have been multiple cases of death or toxicity resulting from incorrect use of fentanyl patches. As you enter Ms. Brown s Rx into the computer, you do a double-take at the sig. Does it say every 12 hours or every 72 hours? You are pretty sure 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 Rx states 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. Brown s 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? As mentioned, there are two main types of patches currently on the market: reservoir and matrix systems. To find out which type of system a patch has you can check the product information or call the manufacturer. Phone: 209-472-2240 ~ Fax: 209-472-2249 PharmacistsLetter.com ~ PharmacyTechniciansLetter.com
Phone: 209-472-2240 ~ Fax: 209-472-2249 PharmacistsLetter.com ~ PharmacyTechniciansLetter.com (Page 3 of 5) Reservoir patches should never be cut. In a reservoir system, the drug is in a liquid reservoir inside the patch. Androderm and Catapres-TTS 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. patches have the drug built into an adhesive polymer layer, which is applied directly to the skin once the patch liner is removed. Climara and Lidoderm patches are examples of matrix systems. The way the drug is included in matrix patches could be thought of as similar to the way drug is included throughout a tablet. 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. There are some exceptions to this rule, such as Lidoderm (including the OTC lidocaine 4% patches) and capsaicin (Qutenza, U.S. only) 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 s and are generally stored close to each other on the shelf. The boxes of different s 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. If your pharmacy has a barcode scanning system, make sure to scan the package. If you need more than one package to fulfill an Rx, scan each package individually, not the same package multiple times. Drug patches are generally packaged in a box with a set number of patches included in each package. For example, fentanyl boxes usually contain five patches. The normal dose is one patch every three days, which would equal two 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 pharmacy s printed label is larger than the space allotted on the box, or if there is not
Phone: 209-472-2240 ~ Fax: 209-472-2249 PharmacistsLetter.com ~ PharmacyTechniciansLetter.com (Page 4 of 5) 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 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 fentanyl patches, which would require two full boxes plus two individual patches. In this situation, verify how your pharmacist wants you to proceed. Some pharmacists may prefer that you 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. Also, warn patients that patches can look like stickers or temporary tattoos to kids. Suggest parents not apply patches in front of kids. What other information do patients need to know about their transdermal drug patches? Be sure to include the accompanying patient information from manufacturers when preparing prescriptions for drug patches. This patient information often includes details such as: Appropriate application. The protective liner should be removed before applying the drug patch. Patients should select an area of the skin that is clean, dry, hairless, nonirritated, and intact. The exact location for patch application (e.g., abdomen, upper arms, etc), is specified by the manufacturer. Patches should not be applied to the waistline or in areas where tight clothing can rub the patch off. Patients should also rotate the application site to prevent skin irritation. 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 Butrans (buprenorphine), 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. Additional information on what to do if a patch becomes loose or falls off can be found in our chart, Characteristics of Transdermal Patches (U.S. subscribers; Canadian subscribers). It can also be found in the product labeling or by calling the manufacturer.
(Page 5 of 5) 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. Before disposing of used drug patches, they should be folded in half with the adhesive side adhering to itself. In Canada (in the U.S. if possible) it s best to direct patients to an authorized collection or disposal site (e.g., drug take-back programs, pharmacies [Canada]). In the U.S., if an authorized collection site is not available most patches can be disposed of in the garbage. However, some patches (e.g., fentanyl, Daytrana) are recommended to be flushed down the toilet immediately after folding in half to prevent accidental exposure or diversion. However, if state/local laws or your facility s policies discourage flushing of meds, suggest that patients discard the patch out of reach of kids or pets. 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). In the U.S., to see a list of medications that are recommended for disposal by flushing down the toilet, the FDA has a list: https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseof Medicine/SafeDisposalofMedicines/ucm186187.htm. 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 [rotigotine], Transderm Scop [U.S.], Androderm, etc) and need to be removed prior to an 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. Guides. In the U.S., the FDA also requires that a MedGuide be dispensed with some drug patches (e.g., fentanyl patches, Emsam, Daytrana, etc). In the community pharmacy setting, remember that MedGuides must be dispensed with every new Rx and refill. Usually MedGuides are included with the product insert inside of the package. But if you aren t sure if the package contains a MedGuide, or if you are dispensing loose patches, make sure to dispense the MedGuide with it. 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. What should I consider when dealing with patches in the hospital setting? In the hospital setting, there are a few additional considerations when dealing with patches. For one, you ll want to document on med histories the date a patient last applied a patch. This way, the clinician entering their inpatient orders can ensure a new one is applied on the correct date. But don t be surprised if some patches are non-formulary, requiring a patient to be switched over to an oral form while they re in-house. Also, you may get questions from nurses about application, cutting patches, etc. Refer these questions to the pharmacist in most cases, but check with your pharmacist about answering them yourself if you feel comfortable fielding non-clinical questions, such as about proper patch disposal. Project Leader in preparation of this technician tutorial (330780): Flora Harp, PharmD Cite this document as follows: Technician Tutorial, The Ins and Outs of Transdermal Patches. Pharmacist s Letter/Pharmacy Technician s Letter. July 2017. Phone: 209-472-2240 ~ Fax: 209-472-2249 PharmacistsLetter.com ~ PharmacyTechniciansLetter.com