Source:Pelham WE, Manos MJ, Ezzelli CE, et al. A doseranging study of a methylphenidate transdermal system in children with ADHD.
J Am Acad Child Adolesc Psychiatry.
2005
;
44
:
522
–529.

These researchers from the State University of New York at Buffalo, Cleveland Clinic Children’s Hospital, and the Medical University of South Carolina report the results of a dose-ranging study of transdermal methylphenidate (MPH). The study was supported by Noven Pharmaceuticals, the developer of this transdermal delivery system. The double-blinded, 8-day, within-subject placebo-controlled evaluation included 36 children (aged 6 to 13 years, mean=9.6 years) at 3 summer treatment sites. All children had attention deficit hyperactivity disorder (ADHD), and 58% were previously treated with stimulants. The children were mostly white (75%) and male (92%). Each day, parents applied a patch containing 1 of 3 MPH doses or placebo. Patches were worn for 15 hours. Each subsequent day a different patch was applied in random order. Over the 8-day study period, each child was exposed to each of the 4 patches on 2 separate days. Counselors and teachers completed behavioral observations in social and academic situations, with reliability assured by independent raters. Parent ratings measured behavior from 5 PM to bedtime. Adhesion of the patch, local skin irritation, vital signs, and side effects were systematically recorded.

All raters identified improved attention and activity levels in children receiving middle and high doses compared to placebo (P<.05). Teachers and parents also rated improvements in oppositional/defiant behavior. During the study, 8% of patches fell off, mainly during swimming and changing clothes, and another 8% of patches required taping. Discomfort occurred when removing the patch 5–21% of the time, and 31–37% reported erythema at the site the next morning. No severe events were reported, and the most common side effects were dose-related loss of appetite and trouble sleeping. Blood pressure and heart rate were not affected.

Dr. Schonwald has disclosed no financial relationships relevant to this commentary.
 This commentary contains discussion of an unapproved/investigative use of a commercial product/device.

Long-acting preparations of stimulants dramatically enhance treatment of the chronic and pervasive impairments caused by ADHD.1 Short-acting preparations require dosing schedules that interrupt the school day and result in shifting medication levels that may cause swings in symptoms and mood. Children with ADHD now have the option of once-a-day treatment, which often provides a smoother response that is preferred by parents.2 Several long-acting options are readily available, each with different delivery systems and response patterns.3 The MPH patch may offer yet another option for long-acting coverage of ADHD symptoms, but with even more flexibility. The transdermal delivery system may benefit children with oral sensitivities, those who are unable or unwilling to swallow pills, and those who object to the taste or feel of crushed tabs or opened caps. This route may also allow parents to remove the patch when coverage is no longer necessary rather than having to anticipate which evening or weekend events will require a short-acting tablet.

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