Methylphenidate (Transdermal)

Methylphenidate transdermal is a medication used in the treatment of children with attention deficit hyperactivity disorder (ADHD).

Overview

Methylphenidate is a central nervous system stimulant used to treat attention deficit hyperactivity disorder (ADHD). It works by improving concentration in patients who are restless, overactive and cannot pay attention for a long time. It is used as part of a full program that includes educational, psychological and social treatment. Methylphenidate patch is applied to an intact hipbone skin. The patch is removed after 9 hours and the same dosage repeated at the same time on a daily basis. The parent is required to monitor the child's growth closely since the medication may slowly lead to weight loss and slow down the growth rate when used for an extended period. The drug should be used with caution in patients with hypertension, skin diseases, heart diseases and epilepsy since it may worsen the condition or cause adverse side effects.

Condition treated

  • Attention Deficit Hyperactivity Disorder (ADHD)

Type Of Medicine

  • Central Nervous System stimulant

Side Effects

Along with the needed effects, Methylphenidate may sometimes cause unwanted effects. Although not all the side effects mentioned here might occur, it's important to seek medical attention when they appear. The most common side effect is increased heartbeat. Other commonly experienced effects are chest pains, joint pains, skin hives and rashes, fever, muscle cramps, headache, loss of appetite, stomach pains, nervousness, trouble sleeping, stuffy nose and unusually warm skin.

Methylphenidate may also cause other side effects although their occurrence is rare. This includes cases of patients having black and tarry stools, blood in stool or urine, change in vision or blurred vision, flaking, skin dryness, crusting, soreness, swelling or severe redness on the skin.

The medicine can also cause confusion, depression, and numbness in the hands, difficult or painful urination, red and irritated eyes, pale and cold fingertips and toes, hearing, feeling and seeing things are not there, or a severe headache. Also, the drug may cause ulcers, sores or white spots in the mouth, slurring of speech, sudden coordination loss, red, irritated eyes, yellow skin, unusual weakness or tiredness and weight loss.

In case of overdose, methylphenidate causes symptoms like anxiety, agitation, bigger or dilated pupils, confusion, dark colored urine, diarrhea, dry mouth, eyes, nose and throat, faintness or dizziness when suddenly waking up from a sleeping position, increased sensitivity to light and loss of consciousness. An overdose can also cause slow, fast or irregular heartbeat, muscle twitching, muscle pains, overactive reflexes, rapid or shallow breathing, tremors and unusual restlessness or excitement.

Methylphenidate can cause other adverse reactions which need immediate medical help. Some of them are hypersensitivity, libido changes, dyskinesia, pulse changes, blood pressure, and drowsiness.

Most children experience insomnia, abdominal pains, tachycardia, loss of appetite and weight loss when they use the drug for a long time. Not all methylphenidate side effects need medical attention as most of them go away as the body adjusts itself to the drug. Also, your doctor may give you some tips on what to do to reduce the side effects. Check with your healthcare provider if the effects become persistent and bothersome.

Dosage

Methylphenidate is applied to intact skin. The dosage (patch) is administered for 9 hours. I.e. if the patch is paced at 6.00am, it should be removed at 3.00pm. Before using the medication, be sure to follow the following instructions:

Methylphenidate dosing chart

Each methylphenidate carton has a dosing chart that can help you to keep a track on your patch. It shows when to apply the patch on the hip area, when to remove the patch and how and where to throw the patch away. When using the patch, note down the specific time and date that you have applied it. For instance, if the patch is applied at 6.00am and removed at 3.00pm, the time should be noted and used at the same time on the following day.

Also, note the disposal method. If you place a patch on your child and after some time find that it is missing, ask the child when the patch went missing, how it came off and where it is.

Methylphenidate is applied to the hip area. Do not place the patch around the waist area because movement and clothing can dislocate the patch. When applying another patch on the following day, use the other hip. Ensure that there is no itching, redness or small bumps at the site where the patch is applied.

Before you apply the medicine, ensure that your skin is freshly washed (clean), cold and dry, does not have any lotion, powder or oil, and does not have irritation or any cuts.

When applying the medication, first open the outer pouch or sealed tray and throw away the drying agent - small packet. Each patch is kept in its protective pouch. Carefully cut the pouch with scissors and do not reduce the patch.

In case you accidentally damage any patch while cutting the seal, do not use it.

To apply, gently remove the patch from the pouch and observe it well to be sure that it has not been damaged. The patch easily separates from the liner. Throw away the patch when you find it hard to remove the protective liner. The liner is made up of three layers; the protective liner that is removed before the patch is put on, the adhesive with medicine layer that sticks to the skin and the outside backing layer that is seen after the patch is placed on the surface.

Apply the patch immediately after removing it from the protective pouch. Gently peel off the liner that covers the sticky surface of the patch but do not touch the sticky side with your fingers. In case you accidentally touch it, apply the patch first then immediately wash your hands with clean water. Apply the patch to the hip of the patient by gently pressing the sticky side firmly in the place then smooth it downwards. While still holding the sticky side facing down, fold the other half of the patch back. Hold one edge of the remaining liner and peel it off slowly.

After removing the protective liner, there should not be the adhesive glue that is sticking to the liner. Press the patch firmly with the palm of your hand for about 30 seconds to ensure that the patch sticks well. Rub the patch edges with your fingers then wash the hands once you are done. Note down the time that you have a patch on the dosing chart. The chart will help you to know the time that you should remove the patch.

When removing the patch after the 9-hour dosing period, peel it off gently, and if it's too sticky, you will need something to help you in removing it. Apply an oil product like olive oil, mineral oil or petroleum jelly to the edges of the patch. Spread the oil gently underneath the sides of the patch. Apply the lotion or oil product to the skin if any adhesive glue remains after removing the patch. In case you find any challenges while removing the patch, don't hesitate to seek medical attention.

Fold the used methylphenidate patch twice then press it firmly so that the sticky side can stick to itself. Put the used patch in a well-closed container or flush it down the toilet. Do not flush the liners or the protective pouches down the toilet. They should only be discarded in a container with lids. Wash your hands thoroughly once you are done with handling the patch. Remember to write down the time that you have removed the patch in the dosing chart. Also, the patches that have not been used or that are no longer needed should be safely thrown away. To do so, remove the patches from their pouches and the liners. Fold the patches and flush them in the toilet then throw the liners in a container.

The recommended dose is

  • Week 1-10 mg/9 hour patch on daily basis
  • Week 2-15 mg/9 hour patch on regular basis
  • Week 3-20 mg/9 hour patch on daily basis
  • Week 4-30 mg/9 hour patch on daily basis

Methylphenidate dosage should be well titrated to effect. The final dosage, wear time and dose titration is given depending on the patient's condition and the response shown to the medication patients who are converting from other methylphenidate formulation are required to follow the titration schedule provided by the healthcare provider.

The adherence of the patches can be affected to water exposure when bathing, showering or swimming. The patches should not be used with tape, dressings or other adhesives. In cases where the patch does not entirely stick to the skin after application, or when it becomes detached, it should be discarded and a new patch used. The recommended hours that the patch should remain on the hip is 9 hours regardless of how many patches have been used.

There is no evidence available either from studies or controlled clinical trials that have been done to show how long a patient with ADHD should be treated with Methylphenidate transdermal. It is however agreed that ADHD pharmacological treatment may be required for extended periods. The effectiveness of the drug, when used for extended periods of more than seven weeks, has not yet been evaluated. If a physician decides to use the drug for an extended period, he should periodically re-evaluate the benefits of the medicine. The drug can be permanently or temporarily discontinued depending on the patient's condition.

The medication can be removed before the 9 hours are over in case the patient gets undesired side effects. Plasma concentrations decline when the patch gets removed, although absorption continues to take place. In case you miss a dose, apply the patch as soon as possible when you remember. Also, do not use two patches at the same time.

The safety and efficiency of the drug in small children have not yet been established.

Methylphenidate should therefore not be used in small children below the age of six years. In case of overdose, all patches should immediately be removed from the patient. The hip area where the patches were placed should also be washed to remove any adhesive that could be remaining. Intensive care of the patient should be maintained to maintain adequate respiratory and circulation exchange. The efficiency and safety of the drug on extracorporeal hemodialysis or peritoneal dialysis for overdosage has not yet been established.

Interactions

Drugs interact with others in the body regardless of the intake route. Some reactions are dangerous and may reduce the effectiveness of some medicines or cause adverse side effects. It's essential for a patient to keep a record of the drugs that they are currently taking. If the doctor finds any medicines that interact, the dosage may be changed or the drug discontinued.

Using the following medicines while still using methylphenidate can reduce the effectiveness of the drug. Inform your doctor if you are using any of them. The doctor will outweigh the benefits and risks of the drugs and decide to reduce or discontinue one of the medications.

  • Coumarin anticoagulants like phenytoin, Phenobarbital, primidone
  • Tricyclic medicines like clomipramine, imipramine, and desipramine
  • Selective serotonin inhibitors.

Methylphenidate should not be used together with any MAO inhibitors. Patients who have recently used monoamine oxidase inhibitors should disclose the information to the healthcare provider. Also, methylphenidate transdermal should not be used on patients with hypotension or vasopressor agents as the medicine can worsen the blood pressure condition.

Warnings

Before using methylphenidate transdermal, let your healthcare provider know if you have:

Also let your healthcare provider know if you are expectant, planning to become pregnant soon or breastfeeding. Keep a record of the drugs that you are currently taking including the prescribed medications, non prescribed, herbal medicines and vitamin supplements. This will help the doctor in preventing interactions from taking place.

Methylphenidate can worsen psychotic symptoms in patients with psychotic disorders like schizophrenia. It can also worsen psychotic symptoms including behavior problems and thought disorders. Sudden death cases have been reported in those with heart problems even when they apply the standard dose. Ask your doctor if it's appropriate to use the medicine in your situation. Also, inform your healthcare provider if your patient develops chest pains, fainting, and shortness of breath or chest tightness.

All medications used to treat ADHD including Methylphenidate are associated with blood vessels problems that cause Reynaud's disease in the fingers or toes. Inform your doctor when you experience numbness or cold in your toes and fingers.

Methylphenidate may sometimes cause high blood pressure. In many cases, the blood pressure increases at a slow rate hence does not cause significant problems. However, the risk can be elevated to patients who already have high blood pressure, arrhythmias, congestive heart failure or a recent heart attack.

There have been cases of priapism in patients using ADHD medications like Methylphenidate. This adverse effect causes a long lasting and a painful erection that can permanently damage the penis. It occurs in males of all ages including the small boys who might not recognize it or be resistant to seeking medical or parental help. Prompt treatment is usually required to avoid further damage.

Methylphenidate can lead to weight loss and temporarily reduce the growth rate in children. However, the slowing down rate usually is minor, and children can eventually catch up to their usual growth rate. As a parent, you need to monitor your child's weight and growth rate while he or she is on this medication.

While on Methylphenidate medication, do not expose the application site to direct sunlight or external sources of heat like hairdryers, electric blankets, heating pads, and heated water beds. When the patch gets heated, the extent and rate of absorption increases and this increased absorption is an overdose and may cause some unwanted effects.

Methylphenidate can interact with some medicines and cause adverse reactions. This may result in severe side effects like increased heart rate, high blood pressure, or bleeding. Some of the drugs that can cause interactions include seizure medications, tricyclic antidepressants, and warfarin.

Storage

Store at room temperature and keep away from direct sunlight and moisture. The recommended storage temperature is 68° F to 77° F (20° C to 25° C). Do not freeze or keep in a refrigerator. Keep the unused patches in their respective pouches and only open them when you want to use them. Throw away the used pouches in a safe container and flush the applied patches down the toilet. Keep the medicine out of reach of children.

Summary

Methylphenidate is a central nervous system stimulant that is used to treat attention deficit hyperactivity disorder (ADHD). It helps in improving concentration and reducing restlessness in children who cannot concentrate for a long time. The medication is applied to intact skin around the hip area of the patient. A patch is placed on the hip 2 hours before the effect is needed and removed after 9 hours. Methylphenidate is indicated for children between 6 to 17 years.

It's important to follow all the instructions given on the label before using the methylphenidate. When you want to use the patch, the sealed pouch should be carefully opened to remove the liner. The drug is administered by firmly pressing the patch against the skin for 30 seconds. When the patch has been well placed, it should stay even when bathing or swimming, the hip area where the patch will be placed should be kept clean and dry. Tight clothing or waistbands should be avoided while wearing the patch to avoid interfering with the patch. The time when the patch is put on and removed should be well noted down on the dosage dashboard to repeat the same dosage at the same time in the following day. The effects of the drug may remain unnoticed for the first 2 hours.

Methylphenidate may sometimes cause unwanted effects like nausea, weight loss, vision problems, mild skin bumps, redness or itching, sleeping problems or a sore throat and stuffy nose. Most of these effects stop after some time but immediate medical attention is required when some of the impacts persist and become bothersome. This drug should not be used by patients who have taken an MAO inhibitor like furazolidone, linezolid, rasagiline especially in the last 14 days. It is not suitable for patients who are allergic or who have glaucoma, Tourette's syndrome, agitation or anxiety as it may worsen the conditions. Since the medicine is applied to the skin, it should be used with caution in patients with skin problems. Methylphenidate is part of a full treatment program hence for better results the patient should also be involved in educational and psychological treatment.