View Full Version : 30mg Patch Not Enough


sohcahtoa1277
01-20-10, 03:40 PM
I, like many others, have tried multiple medications for my severe Adult ADD. I have been on 54mg of Concerta with a 20mg methylphenidate boost at 3PM, 20mg Adderall 4 times a day, 60mg Adderall XR in the morning, 40mg Ritalin twice daily, 150mg Wellbutrin SR daily, 100mg desipramine daily, and 60mg Strattera. Of these the only that work are the stimulants. I seem to respond best to a high-dose extended-release medication in the morning followed by a booster in the evening.

The main problem is the side effects: headaches, sweating, nervouseness, stiffness. My doctor has recently prescribed 30mg Daytrana - apply one patch daily to alternating sites. I've been on it for a week and have some good news and bad news. The good news is that it is, BY FAR, the smoothest stimulant medication I've ever used. Also it lasts all day long - sometimes I don't even take it off at night as it helps me sleep better.

The downsides:
1) It is insanely difficult to remove from the liner -I have mangled a few of them. The medication guide says to use a new one but that would mean that I'd run out early and the insurance won't do early refills a) because of the cost and b) it's a CII substance. They still seem to work even if they're a bit damaged.
2) It takes around 2 hours to kick in. I know this is normal but I work at a coffee shop where I have to clock-in at 5:30 AM and I am not about to wake up at 3:00 AM just to put a patch on.
3) The main problem: 30mg doesn't hold a torch to 80mg daily of Adderall. I am a pharmacy student so I realize that the transdermal absorbtion is 1.9 fold higher than oral d-methylphenidate but still that would mean comparing something like 60mg of methylphenidate with 80mg of amphetamine salts.

Does anyone else have this issue and, if so, what has your doctor done about it? I want to avoid pills because of the strong kick and sharp withdrawal. Does anyone wear multiple patches or use something like a total of 40mg or 60mg (two 20mg or two 30mg patches) simultaneously?

Any advice or experience shared would be greatly appreciated. :)

wifeandmom
01-24-10, 09:44 PM
When DD used Daytrana, she took a 10 mg Ritalin first thing in the morning when she put the patch on. That gave her a jump start until the patch kicked in. She never mixed patch sizes, but it's probably pretty common during titration. I know we have to jump through hoops to get more than a 30 count of any single Rx, so you would probably need to get 30 mg + 10 mg rather than 20 + 20. DD currently takes two 20 mg Adderall XR in the morning and took about a month to get our insurance to approve 60 count.

My experience was that it took a while for the absorption rate to increase, so it may be that in a few weeks you find that the 30 mg Daytrana works better than what you're seeing right now.

From http://www.druglib.com/druginfo/daytrana/pharmacology/


"When Daytrana™ was titrated to effect in the pivotal phase III clinical efficacy study, after at least 6 weeks of therapy [emphasis mine] with 9 hour wear times when applied to alternating hips, the mean peak d-methylphenidate (d-MPH) plasma concentration was 39 ng/mL with a range of 0 - 114 ng/mL. These mean peak concentrations varied inversely by age ranging from 25 ng/mL, (range 2 - 80 ng/mL) in 12 year olds, to 53 ng/mL (range 18 - 83 ng/mL) in 6 year olds.

"Daytrana™ mean peak d-MPH concentrations were approximately 1.9-fold higher than the highest observed concentrations after a once-daily oral methylphenidate formulation over a period of 7.5 to 10.5 hours, when Tmax typically occurs. These higher concentrations were observed for all children 6 - 12 years of age, both overall and when grouped by age. The Daytrana™ peak concentrations on chronic dosing were also higher than Cmaxs seen with Daytrana™ after single dosing, or 4 days of multiple dosing. With single doses of Daytrana™, peak concentrations were comparable to Cmaxs from single doses of the once daily oral MPH formulation.

"The observed exposures with Daytrana™ could not be explained by drug accumulation predicted from observed single dose pharmacokinetics and there was no evidence that clearance or rate of elimination changed between single and repeat dosing. Neither were they explainable by differences in dosing patterns between treatments, age, race, or gender. This suggests that transdermal absorption of methylphenidate may increase with chronic therapy with the methylphenidate transdermal system."

xomanadaxo
01-29-10, 10:04 PM
I recently switched from Concerta to Daytrana, too. A lot of what you wrote sounds familiar to me...especially the part about waking up! I used to take 90 mg of Concerta in the morning + 25mg Ritilan as a booster in the evening, but needed the meds to last longer so my doctor switched me to Daytrana. The 30mg patch didn't even make a dent in my ADD but my dr was hesitant to add another patch because the insurance companies can get weird with higher dosages. But, after almost wrecking the car twice in 24 hours (I was looking at Christmas lights while driving...:rolleyes:), she agreed it might be a good ieda to up the dosage. Now I'm on two 30mg patches every day. It works well for me, except since I have a fairly small frame I run out of non-irritated spots to put the patches pretty quickly and have to put them over semi-irritated skin, which can burn a lot. But all in all it's not so bad :)
Good luck!