Daytrana

(methylphenidate)

Forms/Strengths

•  Patch: 10 mg/9 hours, 15 mg/9 hours, 20 mg/9 hours, 30 mg/9 hours

Dosing

• Age: ≥ 6 y/o
• Onset: Approximately 2 hours after application
• Duration: 9-hour wear time; continuous release for 9-12 hours
• Considerations: Apply the patch to the hip area (alternating sites) 2 hours before the effect is needed. The patch may be removed earlier if shorter duration is desired or if late-day side effects occur. Monitor for skin rash or sensitivity. Discard patches appropriately.
• Initial Dose: 10 mg patch applied daily
• Titration: 5 mg every 3 - 7 days
• Max Dose: 30 mg/day

Quick Facts

• Blocks dopamine/norepinephrine reuptake; improves focus and attention
• Transdermal patch delivers controlled methylphenidate absorption; bypasses gastrointestinal metabolism
• Apply to a clean, dry, non-irritated area on the hip
• Avoid exposure to external heat sources
• Monitor for skin reactions and psychiatric symptoms
• Common side effects: skin irritation, decreased appetite, insomnia, headache

Indications

•  ADHD (ICD-10: F90.0)

Off-Label Uses

•  N/A

How to Take

• Apply the patch once daily in the morning to clean, dry skin.
• Preferred application sites: hip area (alternating sides daily).
• Press firmly for 30 seconds to ensure proper adhesion.
• Wear the patch for 9 hours unless otherwise directed.
• Avoid cutting the patch, as this may alter drug release.
• Dispose of used patches by folding them in half and flushing or placing in a secure disposal container.
  

Side Effects

•  Common: Decreased appetite, insomnia, nausea, vomiting, weight loss, tics, affect lability, anorexia.
• Serious: Cardiac issues, increased blood pressure, psychiatric reactions, seizures, priapism, peripheral vasculopathy, chemical leukoderma, contact sensitization

Monitoring / Labs

• Cardiovascular: Baseline and routine monitoring of heart rate and blood pressure.
• Growth in Pediatrics: Regular monitoring of height and weight to detect growth suppression.
• Psychiatric Symptoms: Observe for mood changes, anxiety, or psychosis.
• Abuse Potential: Monitor for misuse or diversion.

Education

• When to Call the Doctor:

  • Severe mood changes, aggression, or suicidal thoughts.
  • Chest pain, rapid heartbeat, shortness of breath (cardiovascular concerns).
  • Uncontrolled movements, tics, or worsening anxiety.
  • Signs of skin reactions (severe redness, swelling, blistering).
  • Numbness, coldness, or color changes in fingers or toes (circulatory issues).
  • Unexplained weight loss or delayed growth in pediatric patients.

• Safety Tips:

  • Monitor blood pressure and heart rate, especially in patients with cardiovascular risk.
  • Use caution in patients with anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
  • Avoid heat exposure (e.g., hot showers, heating pads, strenuous exercise) as it may increase drug absorption.
  • Ensure adequate hydration and nutrition, as appetite suppression is common.
  • If patch falls off, replace with a new one but remove at the usual time.

• Parent Tips for Pediatric Patients:

  • Monitor for skin irritation; rotate application sites to prevent reactions.
  • Encourage a nutrient-dense diet to counteract appetite suppression.
  • Administer in the morning before school for optimal effect.
  • Monitor school performance and behavioral changes.
  • Communicate regularly with teachers and caregivers about medication effects.

Additional Information

• Contraindications:

  • Hypersensitivity to methylphenidate or formulation components.
  • Use within 14 days of MAOI therapy (risk of hypertensive crisis).
  • Symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma.
  • History of substance use disorder, unless benefits outweigh risks.

• Pregnancy:

  • Category C; use only if benefits outweigh risks.
  • May cause neonatal withdrawal symptoms or low birth weight.

• Lactation:

  • Excreted in breast milk; not recommended due to potential infant exposure.

• Drug Interactions:

  • Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase serotonin syndrome risk.
  • Acidifying agents (e.g., ascorbic acid) may reduce drug absorption.
  • Alkalinizing agents (e.g., sodium bicarbonate) may increase methylphenidate levels.
  • May potentiate hypertensive effects of certain medications (e.g., decongestants, beta-agonists).