Evaluation of Cutting Transdermal Drug Delivery Systems

In January 2009, Hospital Pharmacy published an article entitled “ISMP Medication Error Report Analysis” that contained a section on the ‘Risk of Cutting Certain Medication Patches.’ ¹ The article highlighted the risk of cutting fentaNYL patches, but also described several delivery systems for transdermal products: reservoir membrane–modulated systems, microreservoir systems, drug-inadhesive layer systems, and matrix systems. Each system offers a unique mechanism for drug delivery; however, these unique mechanisms are often not considered in drug prescribing because typically 1 drug is only available in 1 delivery mechanism. Thus, confusion may arise when 1 type of patch may be cut for dose optimization versus cutting another type will disrupt the control mechanism imposed by the patch. For example, Lidoderm (lidocaine) patches are considered drug-in-adhesive layer systems and can be safely cut to deliver a smaller dose, whereas most fentaNYL patches are considered reservoir membrane–modulated systems and cutting the patch will disrupt the membrane, allowing the entire dose to be available immediately.

Table 1 summarizes manufacturer information regarding whether a specific patch may be cut, and will be a good resource for practitioners in the optimization of patient care. However, it will be essential for practitioners to always double-check if the product design has been updated.

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Table 1.

Manufacturer Rocommendations For Cutting Transdermal Drug Delivery Systems

Drug Patch a	Release Rate	Manufacturer	Phone Number b	Cut in Half?	Notes
Alora	Estradiol 0.025 mg/24 h Estradiol 0.05 mg/24 h Estradiol 0.075 mg/24 h Estradiol 0.1 mg/24 h	Watson	(973) 355–8398	Not recommended
Menostar	Estradiol 0.014 mg/24 h	Berlex	(888) 842–2937	No
Estradiol Transdermal System	Estradiol 0.025 mg/24 h Estradiol 0.0375 mg/24 h Estradiol 0.05 mg/24 h Estradiol 0.06 mg/24 h Estradiol 0.075 mg/24 h Estradiol 0.1 mg/24 h	Mylan	(304) 599–2595	No
Climara	Estradiol 0.025 mg/24 h Estradiol 0.0375 mg/24 h Estradiol 0.05 mg/24 h Estradiol 0.06 mg/24 h Estradiol 0.075 mg/24 h Estradiol 0.1 mg/24 h	Bayer	(888) 842–2937	No
Vivelle-Dot	Estradiol 0.025 mg/24 h Estradiol 0.0375 mg/24 h Estradiol 0.05 mg/24 h Estradiol 0.075 mg/24 h Estradiol 0.1 mg/24 h	Novartis	(862) 778–8300	No
Estraderm	Estradiol 0.05 mg/24 h Estradiol 0.1 mg/24 h	Novartis	(862) 778–8300	No
Ortho Evra	Norelgestromin 0.15 mg, ethinyl estradiol 0.02 mg/24 h	Ortho-McNeil	(908) 218–6000	No
Nitroglycerin Transdermal	Nitroglycerin 0.1 mg/h Nitroglycerin 0.2 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h	Mylan	(304) 599–2595	No
Nitroglycerin Transdermal	Nitroglycerin 0.2 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h	Hercon Labs	(717) 764–1191	No
Nitroglycerin Transdermal	Nitroglycerin 0.2 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h	Major	(800) 875–0123	No
Minitran	Nitroglycerin 0.1 mg/h Nitroglycerin 0.2 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h	3M	(651) 733–1110	No
Nitro-Dur	Nitroglycerin 0.1 mg/h Nitroglycerin 0.2 mg/h Nitroglycerin 0.3 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h Nitroglycerin 0.8 mg/h	Key Pharmaceuticals (Graceway)	(800) 328–0255	No
Nitrek	Nitroglycerin 0.2 mg/h Nitroglycerin 0.4 mg/h Nitroglycerin 0.6 mg/h	Bertek (Mylan)	(304) 599–2595	No
Catapres	Clonidine 0.1 mg/24 h Clonidine 0.2 mg/24 h Clonidine 0.3 mg/24 h	Boehringer Ingelheim	(203) 798–9988	No - Blood pressure Yes - ADHD, Tourette
Oxytrol	Oxybutynin 3.9 mg/24 h	Watson	(973) 355–8398	Yes	Use professional judgement
Daytrana	Methylphenidate 1.1 mg/h Methylphenidate 1.6 mg/h Methylphenidate 2.2 mg/h Methylphenidate 3.3 mg/h	Shire	(859) 669–8000	No	Has not been studied
Fentanyl Transdermal System	Fentanyl 12.5 mcg/h Fentanyl 25 mcg/h Fentanyl 50 mcg/h Fentanyl 100 mcg/h	Sandoz	(609) 627–8500	No
Fentanyl Transdermal System	Fentanyl 12.5 mcg/h Fentanyl 25 mcg/h Fentanyl 50 mcg/h Fentanyl 100 mcg/h	Mylan	(304) 599–2595	No
Duragesic	Fentanyl 12.5 mcg/h Fentanyl 25 mcg/h Fentanyl 50 mcg/h Fentanyl 75 mcg/h Fentanyl 100 mcg/h	Janssen	(609) 526–7736	No
Transderm-Scop	Scopolamine 1.5 mg	Baxter	(888) 229–0001	No
Sancuso	Granisetron 3.1 mg/24 h	ProStrakan	(908) 234–1096	No
Exelon	Rivastigmine 4.6 mg/24 h Rivastigmine 9.5 mg/24 h	Novartis	(862) 778–8300	No
Emsam	Selegiline 6 mg/24 h Selegiline 9 mg/24 h Selegiline 12 mg/24 h	Bristol-Myers Squibb	(800) 332–2056	No
Nicotine Transdermal System (All Steps)	Nicotine 7 mg/24 h Nicotine 14 mg/24 h Nicotine 21 mg/24 h	Novartis	(862) 778–8300	No
Nicotine Transdermal System (All Steps)	Nicotine 7 mg/24 h Nicotine 14 mg/24 h Nicotine 21 mg/24 h	Watson	(973) 355–8398	No
Nicoderm CQ (All Steps)	Nicotine 7 mg/24 h Nicotine 14 mg/24 h Nicotine 21 mg/24 h	GlaxoSmith Kline	(888) 825–5249	No
Flector	Diclofenac 1.3%, 180 mg/patch	Alpharma	(732) 465–3600	Yes	Amount of diclofenac delivered is diffusion controlled and is proportional to the surface area of the patch in contact with the skin
Dentipatch	Lidocaine 46.1 mg/patch	Noven	(888) 556–6836	Yes	Company does not support; however, has heard of it being done without any adverse events
Lidoderm	Lidocaine 5%/patch	Endo	(610) 558–9800	Yes	Other half of patch must be discarded if not used immediately

a

Facts & Comparisons 4.0. St. Louis, MO: Wolters Kluwer Health Inc; 2009.

b

Red Book. 112th ed. New York, NY: Thomson Healthcare; 2008.