Adult Dosing
Attention Deficit Hyperactivity Disorder (ADHD)
- Initial dose : Apply to the hip area 10 mg/9hrs; patch size 12.5 cm2 Daily (remove after 9 hours)
- Increase to 15 mg/9hrs; patch size 18.75 cm2 q7 days
- Max: 30 mg/9hrs; patch size 37.5 cm2 qd
Pediatric Dosing
- Safety and effectiveness in pediatric patients <6yrs of age have not been established
Attention Deficit Hyperactivity Disorder (ADHD)
- >6 yrs
- Initial dose : Apply to the hip area 10 mg/9hrs; patch size 12.5 cm2 Daily (remove after 9 hours)
- Increase to 15 mg/9hrs; patch size 18.75 cm2 q7 days
- Max: 30 mg/9hrs; patch size 37.5 cm2 qd
[Outline]
See Supplemental Patient Information
- Sudden death may occur with the use of CNS stimulant treatment at usual doses in children and adolescents having structural cardiac abnormalities or other serious heart problems. Avoid using CNS stimulant in children or adolescents with known serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or other serious cardiac problems
- Sudden deaths, stroke, and MI have been reported in adults taking methylphenidate at usual doses for ADHD. Adults are at greater risk than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems
- Therapy may cause an increase in average blood pressure. Monitor patients for changes in heart rate and blood pressure and use cautiously in patient for whom an increase in blood pressure or heart rate would be problematic
- Patients who are being considered for treatment with methylphenidate should have a careful history and physical exam to assess for the presence of cardiac disease and should get cardiac evaluation done
- Promptly undergo cardiac evaluation if sign and symptoms such as exertional chest pain, unexplained syncope or other symptoms of cardiac disease occur during treatment
- Therapy may worsen symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder
- Care should be taken while using methylphenidate to treat ADHD in patients with comorbid bipolar disorder; before starting treatment with this drug, patients with comorbid depressive symptoms should be screened to investigate whether they are at risk for bipolar disorder; screening should include psychiatric history, including a family history of suicide, bipolar disorder, and depression
- Therapy may cause hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania at usual dose; if such symptoms occur discontinue the therapy
- Methylphenidate may lower the convulsive threshold in patients with prior history of seizures, prior EEG abnormalities in absence of seizures. Discontinue the treatment in the presence of seizures
- Cases of painful and prolonged penile erections and priapism have been reported with methylphenidate. Immediate medical attention should be sought if signs or symptoms of painful or prolonged penile erections or priapism are observed
- Monitor height and weight at appropriate intervals in pediatric patients, as reports of temporary slowing in growth rate has occurred in some patients
- Difficulties with accommodation and blurring of vision have been occurred with methylphenidate use
- Methylphenidate may lead to contact sensitization; discontinue the treatment if contact sensitization is suspected. Erythema is commonly seen with use of methylphenidate. However, contact sensitization is suspected if erythema is associated with intense local reaction that does not improve within 48 hours or spreads beyond the patch site
- Advise the patient to avoid exposing the methylphenidate application site to direct external heat sources, such as hair dryers, heating pads, electric blankets, heated water beds, etc., while wearing the patch
- Advise patient to evaluate periodic CBC, differential, and platelet counts during prolonged therapy
- Therapy is associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms mostly improve after reduction in dose or discontinuation of drug
Cautions: Use cautiously in
- Continual use (may result in psychological or physical dependence)
- Cardiovascular disorder
- Hypertension
- Bipolar disorder
- Psychosis
- Seizure disorders (may lower seizure threshold)
- Substance abuse
- Hyperthyroidism
- Diabetes mellitus
- Pregnancy or lactation
- Hyperthyroidism
- Esophageal motility disorders
- Severe GI narrowing
Supplemental Patient Information
- Advise patient to apply patch to a clean, dry site on the hip, which is not oily, damaged, or irritated. Do not apply to the waistline
- Avoid touching the adhesive side of the patch during application
- Counsel parent or caregiver to use administration chart included with each carton of transdermal patches to monitor application and removal times, and method of disposal
- Advise patient to use only intact patches and do not cut the patches
Pregnancy Category:C
Breastfeeding: Limited evidence indicates that methylphenidate levels in milk are very low and might not affect nursing infants adversely. The effects of methylphenidate in milk on the neurological development of the infant have not been well studied. It is possible that large dosages of methylphenidate might interfere with milk production, especially in women whose lactation is not well established. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 29 April 2011). Manufacture recommends administer methylphenidate to a nursing woman only if the potential benefit justifies the potential risk to the child.
Pricing data from www.DrugStore.com in U.S.A.
- Daytrana 30 MG/9HR PTCH [Box] (NOVEN THERAPEUTICS)
30 9hr = $189
90 9hr = $540.98 - Daytrana 10 MG/9HR PTCH [Box] (NOVEN THERAPEUTICS)
30 9hr = $185.98
60 9hr = $369.96 - Daytrana 20 MG/9HR PTCH [Box] (NOVEN THERAPEUTICS)
30 9hr = $185.99
60 9hr = $359.97 - Daytrana 15 MG/9HR PTCH [Box] (NOVEN THERAPEUTICS)
30 9hr = $199.99
90 9hr = $528.23
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
