- To Change Your Mind - Details Matter
Daytrana Tips: The ADD Patch System Works
Non Med Options for ADD Treatment: Controversy
June 7, 2007ADHD/ADD: The Cerebellum Deserves Attention
June 10, 2007Daytrana, the “Dermatologist,” and Everyday ADD practice:
Advanced skin insights from the front, -or how Bag Balm can make summer fun.
- Bag Balm Appiications!
This will be a fun post for a Saturday morning here in the US, some tips that will help with the interesting and clinically useful Daytrana patch. If you use it, this note will make it easier to use it effectively. Full disclosure: I do teach other psychs and docs how to use the drug, do get paid for that teaching, – but wouldn't speak for Daytrana if I didn't realize a specific first line ADD indication for the drug in my office practice.
First, let's review our CorePsych mission basics: here we are, beginning a series about non-med alternatives for ADD, but we all know the meds often work well if we use them correctly. As I have reported numerous times, meds absolutely become a problem if they are used without careful titration and full awareness of comorbid conditions from subtle bowel problems, to genetic challenges with specific metabolic pathways.
The Daytrana patch is an interesting delivery system that is absorbed through the skin, does not have to be swallowed, and has the considerable benefit of using it for whatever duration you wish during the day. The other meds often require some manipulation during the summer. After adjusting the dose during the school year they and now want to sleep in, or don't want to use with the PM dose because they have no homework. But challenging behaviors may persist.
Transdermal Daytrana can solve many of those summer adjustment problems, simply because you can put it on and take it off when you want to.
About Summer Meds: My criteria for summer meds is simple: best to stay on an even lower dose to manage behavior and social issues. If no such issues arise and they wish for a break [are predominantly inattentive] I don't argue with stopping.
What is a real problem: Parents who come back to restart meds way too late the next school year when Tommy is already in the academic tank in December. They waited too long to reassess behavior, for whatever reason, and the child suffers. Their “summer break experiment” creates an almost irreversible problem later that year. Very bad spot for Tommy. Worst case scenario, and sadly too often: “It's April doc, can we restart meds to save this school year?” Poor kid looks like a train hit him.
So Daytrana can solve some of those problems for the summer because you don't have to run around worrying about dosage time. Put it on and then take it off when you want to, period [doesn't have to be on “9 hrs”]. So let's review those tips:
With all that preamble, here is the useful, fun part:
Very few rashes occur as a side effect with Daytrana, but at times we do see some uncomfortable redness with the patch, especially with the skin sensitive crowd. So here are a couple of…
Tips for using Daytrana.
- Keep it in the refrigerator, the backing comes off more easily.
- In spite of what the company says, it works well if cut – and starting with a lower dose [e.g.1/2] is often helpful with folks sensitive to other oral meds. We don't have to cookie cut [standardize] treatment for everyone, we can use our imagination clinically- but get with the right dose the right patch size and stay with it.
- Adjustment of dosage can best be accomplished by watching the PPT [post patch time, my own acronym]: if it's effectiveness is gone 1hr after removal the dose is too low. Shoot for 3-4 hr PPT and all will be right with the dose.
- If a rash occurs there are three fun-and-easy solutions for the skin reddening [erythema]
- For the girls with skin complaints consider Calmoseptine, it's a girl thing: Pink, with cooling methol, zinc oxide, and calamine, this is just the ticket and can be a fun end to a long day in the pool. Your pediatrician or psych can get samples at 800.800.3405 [no financial connections]
- For the guys, a different, fun thing: the agrarian solution: Bag Balm [no financial connection] at your local drug or feed and seed store, for cows with chapped teats in Vermont. I'll bet you can see why this might be a guy bonding thing – see the happy picture at the top of this post.
- The least complicated and easily available is your friend and mine, recently written up in the New York Times for its medical usefulness, olive oil. I bet you have some in the pantry right now. Smooth it on at the end of the day. It's almost too easy.
Each of these three solutions can help make this summer and the next year easier and can provide some fun for the treatment team.
Back to non-med ADD treatments next post…
Related articles
- Treating ADHD With a Skin Patch (everydayhealth.com)
31 Comments
My son was doing the 10 mg patch for about 4 months until it was recalled. Our pharmacist said that there were still some 15mg available so we called our dr and she agreed he could go up on dosage. Since starting the 15mg he has been seeing bugs that are not there. His teacher says he flinches because he thinks he is seeing things. He has become obsessed and terrified that bugs are getting on him. We didnt have this reaction with the 10mg. The problem is that the 10mg wont become available until at least August 2016. I tried cutting the 15mg in half this morning to see what that would do. Im not sure if this is the medicine causing these hallucinations or what is going on. Any ideas?
Amanda,
From what your report, without an examination, but speaking from experience only, it isn’t the medication, but rather the med dosage. Under the direction of your doc cutting the 15 into thirds would give you your 10mg target dosage. If problems continue with that dose the problem then trickles down to two: 1. It is the wrong medication, period, for genetic metabolic reasons or, more likely, 2. It’s very sensitive dosage problem encouraged by non-genetic metabolic issues, and presents as his narrow Therapeutic Window – Video Here: http://corepsych.com/tw
Hope this helps,
cp
I recently had to cut one of my oldest son’s patches in half to use for my younger son who is also adhd and prescribed half the dose of my oldest son’s same medication. The manufacturer was having problems getting the medications to the pharmacies in our area and I didn’t want him to go without. The school called me and said that cutting it releases more medication than necessary but I’m not sure if that is true. I’ve done this twice before without problems. Any advice?
Nichole,
Not a problem from our experience in this office, and with others around the country who regularly cut patches to titrate dose correctly and effectively.
cp
Hi!
I really appreciate you taking the time to answer all the quedtions submitted! I have read lots of info on the internet and you seem to have the best and easiest explanations for a lot of wuestions I have had. So thank you for that!
My kids have started on Daytrana 15 and 20 mg. We love it! It keeps them more even throughout the day, instead of the ups and downs we’ve experienced with oral medications. My son is on the 15mg, and also takes 2mg of tennex. Daytrana controls the impulses and hyperactivity, tennex helps with slowing his mind to help focus. He previously took tennex 2mg and quillivant xr 8mg, and metabolized thru it in about 5 hrs. It was great because it worked quickly, but wore off early in the day. Daytrana is great because it lasts longer in the day, but takes 2-3hrs to start working. Could we use a small dose of quillivant instead of ritalin (since they are similar drugs)first thing, until the patch starts working?
Also, do you know anything about warming the patch to help quicken the initial start of the medicine? I’ve read that warming it with either a heating pad or hot water bottle can increase the medication delivered. (I know the manufacturer says no, but they also say no to cutting it)
Kathi,
Only warming I’ve heard about is just to make it comfortable in the winter going on. Many mothers do go in and paste it on in the AM before the child wakens to get that early start. The fact that it takes 2-3 hr to start may mean talking to your doc about going up just a bit. Thank you,
cp
My daughter was diagnosed with ADHD last year. We have tried several meds over the past year, but the Daytrana patch has worked the best with the least amount of side effects. With our doctors permission, we are only using the patch as needed this summer, and planned to continue every day in the Fall. Whenever we use it this summer, she complains of terrible itchiness. She begs us not to put it on because it itches so bad. Do you think she developed an allergy to the adhesive? And if so, anything we can do to control it?
Melissa,
Your most important question that arises out of deeper consideration for the variables at play: why is she having all of these problems with every medication. My guess is that she very likely suffers with immunity issues that present as differing challenges with each of the meds in question – and the adhesive reaction is but one different example of and underlying immunity/gut/metabolism disarray that lurks below the surface. For more info take a look at this GI Video Series first: http://corepsych.com/gi – Then ask her to do the Transit Time Test to further evaluate possible GI changes: http://corepsych.com/ttt only 69 cents, can’t afford to not do it.
With these superficial inquiries you will begin to consider other contributory problems… then you need even more precision with tests like these – starting with the IgG on this second page: http://corepsych.com/tests14
Hope this helps,
cp
My 12 year old son has been on the 10 mg Daytrana patch for a few months now after being on Adderal ER 15 mg for 3 years with the last year literally refusing to take his medicine. I love the patch because I can put it on him at 6 a.m. before I leave for work and by the time he starts school at 8:30 a.m. it’s working. The only issue I am having is, now that it’s warming up outside I am having a difficult time taking the back off the patch. The box says that I can’t store them in the refrigerator, so how can I keep them from overheating before my son is able to use them?
Kelly,
Try this: Store in fridge, not freezer, and let it warm up to room temp whilst shower and breakfast takes place. Should not be a problem. Cooling does not interfere with the effectiveness of the MPH product, only the delivery system whilst still cold. Please let us know if this covers the dilemma.
cp
Dr. Parker,
I am on Ritalin and am interested in to Daytrana patch. I also plan to go on a trial of Anafranil for OCD and some depression issues. I noticed that Anafranil says it has compications with meds blocking 2d6 and Ritalin does this. This may be a question with an obvious answer but I was wondering if Daytrana blocks 2D6 given that it is a transdermal patch? I am sorry if that is a stupid question but I do not know much about this topic. Thank you
Jay,
Anafranil is a 2D6 substrate and as such can be blocked by any 2D6 blocker. See this article for details on pathways – http://www.medscape.com/viewarticle/462703_5 | My take, without the reference here by my side, is that Cozza and Armstrong in their drug interaction book documented an inhibition of 2D6, a blocking of 2D6 by MPH products. I would watch carefully for an interaction. None of these are entirely predictable – “always” – because of the polymorphisms of 2D6 in the first place. But I would register concern and slow watchfulness, and yes Daytrana, as an MPH, would cause the same problems irregardless of the patch delivery system.
Heavy article!
cp
Sorry to dig up such an old article but I am hoping you may be able to assist.
My son (age 6 – 1st grade) has been on the Daytrana patch (20mg) for just about a week now to manage his ADHD, previously had tried Adderal, Ritalin LA and Medadate over the last 1.5yr, but he was very against oral medications and we had/have high hopes for the Daytrana as the delivery method is much preferred. I have been talking with his teacher to keep track of how well things are working, it seems that in the morning between 8-11:30 there’s not much of a noticeable improvement, after lunch time things start to kick in and by the time I pick him up after school the patch seems to be working great. After doing some research today I’ve found that it takes 2 hours for the patch to start working, he usually has it put on around 7am, is there anyway to increase the effectiveness of the patch earlier in the day? Besides simply waking him up earlier and getting it on sooner. He wakes up and showers at 6:45 and has it put on immediately after his shower. Would really like to be able to keep him on the patch as it’s made medicating much less stressful for him, but as most of the academics in class are done in the early morning hours he’s missing out on a lot of school work and is distracting to the class.
Danielle,
Several thoughts:
1. Grind up an immediate release Ritalin, either 5 or 10 as your medical team find works best, between two spoons and mix w apple sauce for the AM.
2. If the DOE, discussed in this video series here – http://bit.ly/7PMdrops, is insufficient he does need an increase in Daytrana dose.
3. Use the patch in the PM same as in the AM. The dose is right if, after removing he has about 2-3 hr of PPT [Post Patch Time] remaining from the medication effect.
These ideas would be the easiest for most folks subject to your doc working w you on the IR form.
cp
My son recently started Daytrana. He was on 10 mg for 5 weeks. His grades improved tremendously but still could not focus in class and was interfering with his learning. The doc increased to 20 mg. He complains that he is sleepy(same complaint with 10mg also). He is inattentive ADD. Is the 20 too much? How does the bowel movements relate to the medicine? Isn’t the medicine a stimulant, why does it make him feel sleepy? I’m confused.
Cathy,
Sorry, too little info for me to even remotely speculate. If he had a drowsy reaction to 10 mg he likely is not metabolizing it well, with consequent relative toxicity, and [deep speculation] a slow bowel w bulletproof liver. SEARCH bulletproof liver here and look at this playlist on YouTube: http://bit.ly/dosevids
cp
Thank you so much for your quick reply. My son is in attentive ADD. He is not hyperactive at all. He just “checks out” and when he checks back in he has missed all of the instruction. A home, when you ask him a question you have to make sure he repeats it back to you otherwise you will get an answer that is not intended because he really isn’t paying attention. We noticed in K, spoke about it in first grade, and in second. I knew he would need an intervention because as the content gets harder he won’t be able to handle it. He started on Daytrana 10mg for 5 weeks. I didn’t tell the teacher because I wanted to see if there were any noticeable changes. She never mentioned anything. There were the same complaints of lack of attention except his grades had improved dramatically. He did well and didn’t notice any major changes except loss of appetite for lunch and couldn’t fall asleep at night. (Although even before any meds he had trouble falling asleep.) He ate a good breakfast and dinner. We still had the same complaints from school about not paying attention or able to keep up and falling behind in math(which is latest part of school day.) he did mention that he felt sleepy after lunch but I contributed it to not being able to fall asleep so naturally he is tired. After consulting with the doctor and with the concerns in school, we decided to increase it for 5 weeks and reevaluate. He has been on the 20 mg for two days and he has completely lost his appetite all day and is expressing major sleepiness after lunch(he doesn’t eat but his scheduled lunchtime.) in addition, he isn’t having regular bowel movements which we contributed to his lack of appetite. As his mom, I don’t like the 20 already. Should we go to 15 or back to 10? We saw some positive changes with 10. Does the dosage determine the length of time it works? It doesn’t seem so. I watched the video and read the link you sent. It’s concerning. I just don’t want to mess up my son. I want him to be and feel successful and he was hating school in 3rd grade already with such a long road ahead. Any advice is greatly appreciated.
Cathy,
The background noise is there – he very likely has some metabolic problems associated. Unpredictable outcomes result. Testing would be helpful vs added speculation. Testing beats speculation everyday. Do the Transit Time test, even though he’s not eating well, – it might be instructive and encourage more deliberate assessments. I leave specifics to you and your doc.
cp
My 8yo daughter takes 15mg Vyvanse, 1mg Intuniv (new med, one week ago), and 150mg Zoloft (Mood Disorder NOS). The Zoloft has helped with mood issues, but the Vyvanse dose is not high enough to properly address impulse, focus, & hyperactivity. Unfortunately when we increase the Vyvanse the mood issues come rushing back. She grows terribly agitated, irritable, and aggressive. (Same happened with Focalin). We can’t find that “see-saw” balance you teach about.
Is it possible that the Daytrana patch would affect her differently since it is absorbed through the skin and not taken orally?
Thanks much
CBak
CBak,
Daytrana might work, but if she’s on 15 Vyvanse it’s likely true that you are already working w a very narrow window and a metabolic problem. See this video playlist [and the one following on the channel]:
ADHD Meds Problems – Mind and Gut: http://bit.ly/mindgut
ADHD Meds & Allergies – Milk and Wheat: http://bit.ly/mawimmun
With that investigation you’ll find yourself much further along the Understanding Path.
cp
Right Cathy, no prob, many cut it every day.
cp
Hi there:
We’re taking my daughter to the doc tomorrow. She’s currently on 2 mg. Intuniv. It worked great for about a month. Same thing with the 1mg, which is why we increased to 2mg. Now the school is back to saying she is very disruptive and agitated. We are seeing agitation at home too. She just can’t slow down. She tries to slow down, but you can just “see” her struggling to calm herself. She now requires constant redirection to stay on task at school. Morning routines are getting tough again too. Intuniv has become a placebo. We are considering the patch since it has the flexibility of taking it off. Was wondering what the beginning dosage should be? She is primarily hyper and impulsive. 6 yrs old. 44 pounds. Thanks for your blog.
Brandy,
From the research, and from personal office experience it appears that you have reached the commonly experienced plateau of ‘not enough’ – most of the children tested arrived at a dose of 3 or 4 mg as the final dose. I would pursue the next level as your/her response was initially positive, leaving me with an encouraged feeling that going up to the recommended dose could prove helpful. But this is a call for you and your doc in the office there, not a recommendation with no personal review from the Internet.
The Daytrana patch is a good alternative, not used as often as it could be, with a good 12 hr DOE after you find out exactly when to take it off as it relates to bedtime and PPT as documented in this post. Titration is important with any of these ADHD meds, and informed patience will get you there.
cp
Dr. Parker, Daytrana is my son’s second med. to try since diagnosed with ADD. He started with Vavanse 10mg which made him very tired and actually fell asleep within 2hrs of taking the med.
His Dr. decided to try Daytrana 10mg. This is his 5th day in a row using the patches. However, he seems attentive and “with it” for about 3-4 hrs after putting the patch on. He gets very tired and grumpy about 4 hrs after the med. has been applied. He suddenly feels like sleeping or resting. The second half of the patch resembles the same problem with the Vyvanse. What could this mean? Maybe the 10mg is not strong enough or too strong?
Thank you for your help.
Jennifer
Jennifer-
This situation requires more questions to clarify issues than we have time for here – but a few superficial thoughts are in order:
First as a general rule you are outlining the problems we see every day: too much or too little – or simply wrong med.
1. His reaction to the Vyvanse is quite ‘atypical,’ could be attributed to some genetic metabolic challenge [if it is the top of the window], as the tiredness is frequently associated with slightly too much – especially if it occurs at the outset. More likely that the Vyvanse dose is insufficient based upon the later ‘onset of tiredness,’ – and before I stopped the Vyvanse I would work with your doc to try a higher dose.
2. But, then, when he takes the MPH product he again shows similar symptoms, – indicating, again, some challenge with dopamine in the system generally. This latter observation encourages looking more carefully into the depression possibility, as dopamine very characteristically down-regulates serotonin = cranky and bitter. Further this Daytrana [an MPH], with the delay in onset later in the day, indicates the dose is likely insufficient – and bear in mind these points are not mutually exclusive. [He could have too little and a comorbid depression as well.
3. May sound silly, but I would also ask very pointedly about his bowel habits. Slowing bowel with longer transit times almost always have unpredictable outcomes.
This is one that really must be solved by more careful questioning from the outset, even before the meds are started, then carefully working with each med in the context of some of the parameters suggested here.
Your doc will appreciate your understanding that the titration process is the key after the completed diagnosis – considering every other contributory aspect, as any additional diagnostic challenges often create issues.
cp
Thanks for the reassurance, Dr. Parker. This week I cut my 7yo son’s 10mg patch in half, considering the same logic you mention regarding dosing via size (I’d noticed the 15mg patches are that much larger.) The smaller dose took the edge off of his mild impulsive behavior, still affords him the focus he needs, without any of the sad, down mood swings. Thank you so much for taking the time to write.
Robert,
BTW: one quick further aside – this is another example of the fact that I am so conservative, working on precision, that I appear to be oddly liberal!
cp
Robert,
Cutting it is off label, but does nothing to interfere with the delivery system. The patch is cut at the manufacturer – and each patch is increased in mg by simply cutting a larger patch… so they cut it at the outset, why can’t we cut it out here?
Office experience with mothers who are very concerned about the specifics of careful titration regularly confirm: no problem.
The bottom line: Cutting prevents overdose which brings much more profound reactivity problems, – thus this post.
Thanks,
cp
I am confused because Dr. Parker’s is the only opinion I have found that says cutting the Daytrana patch to administer a lower dosage is not a problem. Every single other web mention of cutting the patch discusses how doing so will compromise the delivery system and risk overdose. Why the discrepancy??? HELP!
Robert
Sally,
It’s interesting how some people are simply MPH [methylphenidate] metabolizers, and some can use AMP [amphetamine] products better. The additional variable: those improved delivery systems.
Daytrana and Vyvanse both characteristically have the longest durations of effectiveness with the interesting flexibility of use.
Thanks for your note,
Chuck
We love the Daytrana Patch!It has made an incredible difference in my child.He had been on Adderall for 8 years.It was time for a change,and we got it. He is much calmer,more focused,NO MELTDOWNS!!!