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Title: Practical management of cutaneous reactions to the methylphenidate transdermal system: Recommendations from a dermatology expert panel consensus meeting
Author: Warshaw, EM; Paller, AS; Fowler, JF; Zirwas, MJ
Abstract: Background: Psychostimulants remain the most-used medications for attention-deficit/hyperactivity disorder (ADHD). The methylphenidate transdermal system (NITS) is the first stimulant patch dosage formulation to be approved by the US Food and Drug Administration for the treatment of the symptoms of ADHD in children aged 6 to 12 years. The NITS patch is approved to be applied once daily to the hip and worn for 9 hours. While cutaneous reactions may occur with any formulation of medication, they are more likely with transdermal administration. Objective: The purpose of this commentary was to describe the types of cutaneous reactions that have been reported with transdermal systems in general, review the cutaneous adverse events seen in clinical trials with the NITS specifically, and provide practical management suggestions for prevention and treatment of these potential cutaneous reactions. Methods: In September 2007, a group of child psychiatrists, pediatricians, developmental pediatricians, and pediatric neurologists who treat ADHD and have had experience in their practices with NITS convened to discuss cutaneous reactions in relation to its use. Information collected from this meeting and from the clinical trials database of the sponsor was reviewed by a panel of 3 dermatologic clinical experts in contact dermatitis and I pediatric dermatologist. The panel's recommendations form the basis for this report. Conclusions: Mild to moderate erythema is a common cutaneous effect with NITS use, and is generally not a cause for discontinuation if seen in isolation. Irritant contact dermatitis is relatively common and can be reduced and treated by alternating patch application sites, moisturizing, gentle skin care, and application of topical corticosteroids at the previous patch sites if needed. Allergic contact dermatiris (ACD) and allergic contact urticaria are rare when NITS is worn as directed in the prescribing information. NITS should be discontinued if ACD is suspected.
Source: CLINICAL THERAPEUTICS
Publication Year: 2008
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