Wednesday, August 09, 2000
Patching up illness
Pharmaceutical companies are creating medicated
patches for just about any malady or condition
By Diana Louise Carter
Rochester (N.Y.) Democrat and Chronicle
You might call it a Band-Aid solution.
Need to take medicine regularly but can't remember to do it? Slap on a patch.
Want to obey the doctor's orders but afraid the medicine will upset your delicate stomach? Put on a patch.
Tired of rubbing messy creams on your chest or back, or of holding that icepack on your aching forehead? Patches will do those things for you, too.
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PROS AND CONS
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The positives:
• Convenience of taking medication without having to remember daily dosages or swallow pills.
• Steady, constant dose.
• With transdermal types (where medicine is absorbed through the skin), the medication gets into bloodstream quickly, usually avoiding an upset stomach.
• With topical types, frees up hands and replaces messy creams.
The negatives:
• Cost is usually much higher than oral or topical medications.
• They can fall off if they get wet with sweat or in the shower, bathtub or pool.
• People with a lot of body hair might have a hard time finding a discreet, hair-free location to place patch.
• Medication or patch adhesive may irritate skin.
• Transdermal types are limited to certain medications that can pass through the skin.
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Once popular among seasick sailors and people who were trying to kick the cigarette habit, medicated patches have become available for a whole range of ailments, from migraines and wrinkles to weight loss and impotence.
Many patches, like the popular smoking-withdrawal programs, have moved from behind the prescription counter to prominent spots on drug store and supermarket shelves. All sorts of over-the-counter medications, salves and compresses have been released in patch form within the last year.
Among the new products:
• Acne cream on patches that both medicate and cover up pimples.
• Chemical cold or hot packs that can adhere to aching backs or throbbing foreheads.
• Liniments that produce chest-clearing vapors or muscle-relieving heat without all the clothes-staining goop.
While these patches are various sizes and shapes, only some qualify as transdermal, meaning that they direct medication through the skin and into the bloodstream. The others are topical, meaning they simply hold medicine or comforting temperatures against the skin.
People who make or prescribe these patches say they're popular because they're convenient.
“The patient doesn't have to think about medication as much or be as active getting (them) into their body,” says pharmacist Donald P. Reitberg, vice president of scientific affairs for the over-the-counter brands sold by Novartis Pharmaceuticals. The drug companies that Novartis absorbed pioneered patch medications, developing one for seasickness, producing the leading brand of smoking-cessation patches and popularizing estrogen-replacement patches.
Patches are particularly handy for people who are forgetful or not good at following doctor's orders.
“Obviously if you only have to use one patch every 72 hours or two times a week, chances of you doing that are greater than if you have to take a tablet three times a day,” says Stephen Coryell, pharmacist at the Center Pharmacy of the Jordan Health Center in Rochester, N.Y.
Dr. Vivian Lewis, director of reproductive endocrinology at the University of Rochester Medical Center, likes the way that synthetic estrogen metabolizes more like natural hormones when it seeps through the skin. And patients who use patches are less likely to experience stomach irritation, she notes.
Yet Lewis estimates that just 10 percent of her patients on hormone replacement therapy use patches.
One problem is that while many companies make estrogen patches, only one brand - CombiPatch, made by Aventis Pharmaceuticals - provides both estrogen and progesterone, the two hormones frequently recommended for postmenopausal women. Women who've had hysterectomies need only estrogen.
Women who need the two hormones could still use an estrogen-only patch but would need to take progesterone in pill form, too.
“Why use the patch and have to take the pill?” says Pam Wigent, a nurse practitioner at Highland Hospital in Rochester. Since some pills contain both hormones, it's just as easy to take a pill a day.
Patches can cost several times more than the same drug in pill form, and many insurance companies cover only the least expensive option.
One mid-strength patch to combat high blood pressure —
called Catapres and applied once a week — costs roughly $66 a month, says pharmacist Bill Winkowski at Twelve Corners Apothecary in Brighton, N.Y. The generic pill form, known as Clonidine, goes for about $10 a month.
The drugstore stopped carrying Catapres because few people were buying it. The lack of interest isn't just because of the money.
“It's a cosmetic thing,” Mr. Winkowski says. “The patches aren't small. These are relatively large discs. Some of them are really noticeable — silver dollar size.”
Although patches for high blood pressure, pain and heart conditions have been available for more than 20 years, doctors and pharmacists say they use them infrequently.
“I'm not sure that they're as popular as everybody thought they would be when they first came out,” Mr. Coryell says.
One exception is a high blood pressure patch used for heroin addicts in withdrawal, he adds.
A larger exception is the nicotine-withdrawal patches. Pharmacists say they remain popular because there are few alternatives. Nicotine gum is useful for some people, but gum-chewing is frowned upon in some instances.
Beyond cost, the chief complaints about patches are that they can irritate the skin or fall off. Placing the patch in a different spot each time and using adhesive tape can take care of these problems, but many people feel it's simply easier to take a pill.
Nevertheless, new patches keep coming out. Wigent notes the EMLA patch, a coin-sized, prescription-only patch that provides local pain relief in about an hour. Nurses use it to deaden the sting of inoculation for children.
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