Magazine article Behavioral Healthcare Executive

A New Way to Deliver Psychiatric Meds

Magazine article Behavioral Healthcare Executive

A New Way to Deliver Psychiatric Meds

Article excerpt

Psychiatric pharmacotherapy traditionally has involved pills, liquids, and shots. Prescribers now can add skin patches to that list.

Earlier this year the FDA approved the iransdcrnial delivery (i.e., through the skin) of two psychiatric drugs:

* EMSAM was approved for treatment of major depressive disorder in adults. EMSAM delivers selegiline, a monoamine oxidase inhibitor (MAOI), transdermally (figure 1).

* Daytrana was approved for treatment of ADHD. Daytrana is a once-a-day transdermal treatment using methylphenidate, a central nervous system stimulant (figure 2).

While these are the first approved transdermal applications of psychiatric drugs, medications have been delivered transdermally for more than two decades, including antimotion sickness and smoking-cessation drugs. According to the Institute for Safe Medication Practices, an estimated 12 million people worldwide use medicated patches for a variety of ailments, involving more than 30 different drugs.

Transdermal delivery of psychiatric medications will be useful in patients who will not or cannot swallow pills, notes Joseph Biederman, MD, chief of the clinical and research program in pediatric psychopharmacology at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School.

Commenting on Daytrana, Dr. Biederman notes that "From the time you take the patch off, the effect lasts about two hours, so if you want an eight-hour effect, you can take it off after six hours." Thus, patients and their caregivers can decide how long they want to keep the patch on, depending on a patient's needs on a particular day. A new patch is used every day.

"Daytrana offers true all-day therapy," asserts Noven Pharmaceuticals Vice-President Joseph Jones (Noven manufactures Daytrana for Shire, plc). "It's not the only product that provides all-day therapy, but no pill provides the same level of dosing flexibility." Since therapy can bediscontinucd as early as needed by removing the patch, Jones explains, Daytrana offers an advantage that pills don't.

In addition, says Andrew Adesman, MD, chief of development and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, New York, Daytrana should appeal to some parents, who can apply the patch in the morning and remove it in the late afternoon or early evening.

With EMSAM, medication is absorbed over an extended period, which minimizes exposure to the digestive system, notes Bristol-Myers Squibb spokesman Craig Stoltz (Bristol-Myers Squibb and Somerset Pharmaceuticalsdeveloped EMSAM). This is important because MAOI antidepressants inhibit intestinal enzymes needed to break down tyramine, which is found in some foods and beverages such as tap beer and aged cheese, Large amounts of tyramine absorbed systemically can lead to a sudden increase in blood pressure and may require immediate medical attention. For those reasons, patients taking MAOIs for major depression are advised to avoid foods and beverages high in tyramine. While no tyramine dietary modifications are required at EMSAM'sstartingand target dose of 6 mg/24 hours, they are needed for EMSAM's 9 mg/24 hours and 12 mg/24 hours doses.

Concerns

Transdermal patches do have theirdownsides. For example, Daytrana's onset of action is not very rapid, notes Dr. Adesman. Daytrana generally requires two liours to take effect, compared with only 30 to 45 illimites for most oral ADHD medications. It also turns out, he adds, that there is a fair amount of variability in children's absorption rates. …

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