# Daytrana ### (methylphenidate) **[Daytrana](https://wiki.joshnp.com/books/drug-library/page/daytrana)** (methylphenidate); CII
[**Full Prescribing Information**](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2c312c31-3198-4775-91ab-294e0b4b9e7f&type=display)[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c312c31-3198-4775-91ab-294e0b4b9e7f)
--- ### **Summary** Daytrana is a long-acting methylphenidate CNS stimulant delivered as an adhesive transdermal patch worn on the hip, approved for ADHD in patients 6 to 17 years only. Dose is set by patch size and by wear time, so a parent can shorten the day by removing it early, which no oral product allows. It is also the only methylphenidate carrying a risk of permanent skin depigmentation. Schedule II; brand and generic. --- ### **Forms & Strengths** - Transdermal system (patch, hip): 10 mg/9 h, 15 mg/9 h, 20 mg/9 h, 30 mg/9 h --- ### **Dosing** - **Age:** 6-17 y/o; pediatric only - **Onset:** ~ 2 hours after application - **Duration:** through 12 hours after application, on a 9-hour wear time - **Release Profile:** continuous transdermal delivery from an adhesive matrix; no IR fraction and no bead or coat split - **Initial Dose:** 10 mg/9 h patch (12.5 cm2) once daily, including when converting from an oral methylphenidate - **Titration:** one patch size every 7 days, in the order 10, 15, 20, 30 mg/9 h - **Max Dose:** 30 mg/9 h - **Considerations:** Wear time is a second dosing variable: remove at 9 hours, or earlier for a shorter day. Never cut a patch. Heat or inflamed skin under the patch can double or triple absorption. --- ### **Pharmacology** - **Mechanism:** Blocks presynaptic dopamine and norepinephrine reuptake at DAT and NET; does not meaningfully promote catecholamine release at therapeutic doses - **Delivery / Release:** Three-layer adhesive matrix; peak plasma ~10 h single dose, ~8 h on repeat. No food effect. Absorption rises with repeat dosing over the first four weeks. - **Metabolism:** De-esterified to ritalinic acid, inactive. No CYP pathway. Half-life after removal 4 to 5 hours. - **Class Positioning:** Bypassing first pass leaves l-methylphenidate at 40% to 46% of the d-isomer instead of near zero, so conversion from an oral product restarts at the smallest patch. --- ### **Indications** - **ADHD** (ICD-10: F90.0, F90.1, F90.2, F90.8, F90.9): patients 6-17 y/o. No adult indication. --- ### **Off-Label Uses** - **Where the evidence does not support use.** - **ADHD under 6 y/o** (ICD-10: F90.x): the label records evidence against, with higher exposure and more weight loss; insufficient. (AHRQ 2024) - **Sites other than the hip:** absorption differs and is not adequately studied; insufficient. --- ### **Contraindications & Warnings** - **Boxed Warning:** Abuse, misuse, and addiction, which can lead to substance use disorder, overdose and death. - **Chemical leukoderma, specific to this product:** persistent depigmentation at, around and sometimes distant from the site. **It may be permanent.** Discontinue for good. - **Contraindicated:** - Hypersensitivity to methylphenidate or any system component, adhesives included; the reaction may be to the system, not the drug. - Concomitant MAOI, or within 14 days of stopping one. - **Contact sensitization** (0.3% of 305 children): a sensitized patient may react systemically to oral methylphenidate, and some cannot take it. - **Use with caution:** - Personal or family history of vitiligo, because of chemical leukoderma. - Structural cardiac abnormality, cardiomyopathy, serious arrhythmia or coronary disease; avoid. - Prior seizures or EEG abnormality; this label carries a Seizures warning the oral labels do not. - Pre-existing hypertension; expect a rise of 2 to 4 mmHg and 3 to 6 bpm. - Psychotic or bipolar disorder; tics or Tourette's (tic ran 7.1% versus 0%). - Hyperopia, open-angle glaucoma, or raised intraocular pressure; substance use disorder in patient or household. - **Screen before starting:** - Cardiac history, family history of sudden death or arrhythmia, and exam. - History of tics, vitiligo, eczema or adhesive reactions; inspect the hip sites. Seizure or EEG history; risk factors for mania. - Whether the household can manage a timed daily application and removal; abuse risk; baseline growth, vitals and CBC. --- ### **Drug Interactions** - **Coumarins, anticonvulsants, TCAs and SSRIs** (warfarin; phenobarbital, phenytoin, primidone): metabolism may be inhibited. Reduce their dose and monitor levels, or INR. - **MAOIs:** hypertensive crisis. Do not co-prescribe; allow 14 days after stopping. - **External heat, which behaves like an interaction:** hair dryers, heating pads, electric blankets, hot tubs and prolonged sun raise absorption more than 2-fold; inflamed skin about 3-fold. - **Antihypertensives:** effectiveness may fall; recheck blood pressure and adjust. - **Halogenated anesthetics:** sudden intraoperative pressure and rate rise. Apply no patch on the day of surgery. - **Risperidone:** a dose change either way may raise EPS risk; monitor across any change. **Serotonergic agents:** serotonin syndrome is postmarketing only here, so counsel on symptoms rather than avoid. --- ### **Administration** - **Timing:** apply to the hip 2 hours before an effect is needed; remove 9 hours later. Record both times on the carton chart. - **Wear time is a dose control:** remove earlier for a shorter day or late-day effects. - **Site:** clean, dry hip skin, not oily or irritated; avoid the waistline, alternate hips daily. - Press firmly with the palm for 30 seconds at the edges. **Never cut a patch.** Discard one whose liner tore or took adhesive with it. - **If a patch falls off,** apply a new one at a fresh site; the day still ends at 9 hours. Do not tape or re-stick a patch. - **Removal:** peel slowly; work mineral oil under a stubborn edge. **Never use acetone or nail polish remover.** - **Disposal:** used patches retain drug. Take-back site, or fold adhesive-to-adhesive and flush. A caregiver applies and removes it for children. - **Switching from an oral methylphenidate** ([Concerta](https://wiki.joshnp.com/link/11) or any other): start at 10 mg/9 h. [Xelstrym](https://wiki.joshnp.com/link/33) is a dextroamphetamine patch, not interchangeable. Do not refrigerate; store securely, preferably locked. --- ### **Side Effects** - **Common in children 6-12** (n=98 vs 85, 7 weeks): decreased appetite 25.5% vs 4.7%, insomnia 13.3% vs 4.7%, nausea 12.2% vs 2.4%, weight decreased 9.2% vs 0%, tic 7.1% vs 0%. Adolescent rates similar. Site erythema is near-universal and minor. - **Serious:** - **Chemical leukoderma,** possibly permanent, including at sites distant from the patch; and contact sensitization. Discontinue permanently for either. - Sudden death with structural cardiac disease; avoid the drug in that group. - Seizures; discontinue if one occurs. New psychosis or mania, ~0.1% pooled; consider discontinuing. - Priapism, which may require surgery, also during drug holidays. Peripheral vasculopathy including Raynaud's; reduce dose or stop. - Growth suppression: ~2 cm and 2.7 kg less over 3 years. Interrupt if growth stalls. - Acute angle closure glaucoma; new or worsening tics; angioedema and anaphylaxis; rare NMS; abnormal liver function. --- ### **Monitoring & Labs** - **Skin, for depigmentation:** examine the hips at every visit, minimum every 3 months, and ask about a pale patch anywhere on the body. Stop at the first sign. - **Skin, for sensitization:** at every visit; escalate if erythema carries edema or vesicles past 48 hours. - **Hematologic:** CBC, differential and platelets at baseline and at least annually. Labeled on Daytrana alone. - **Application and removal times:** review the chart at every visit; drift in the removal hour explains most lost effect. - **Weeks 2 to 4:** reassess tolerability at 4 weeks even without a size change; absorption rises with repeat dosing. - **Cardiovascular and growth:** blood pressure, heart rate, height, weight and BMI at baseline, each size change, and every 6 months. - **Psychiatric, tics, seizures and digits:** at every visit and size change; stop if a seizure occurs. - **Abuse and diversion:** count patches against days at each refill and check the state PDMP per state requirement. --- ### **Discontinuation & Taper** - May be stopped abruptly; the label gives no taper schedule. - **The offset is delayed.** Absorption continues from the skin depot for hours, so a patch off at 4 p.m. does not stop working at 4 p.m. - **Shortening wear time is a legitimate step-down,** and the right lever for evening insomnia rather than a smaller patch. - **Discontinue permanently for chemical leukoderma,** and stop for suspected sensitization or a seizure. - After prolonged use expect withdrawal: dysphoria, fatigue, vivid dreams, sleep change, increased appetite. Drug holidays are simply a day without a patch. --- ### **Pregnancy & Lactation** - **Pregnancy:** Human data insufficient to identify a risk. No reproduction studies with the transdermal system; oral data showed spina bifida in rabbits at 200 mg/kg/day. Stimulants reduce placental perfusion. - **Lactation:** Present in milk; infant receives 0.16% to 0.7% of the maternal weight-adjusted dose. Monitor for agitation, insomnia, poor feeding and low weight gain. (LactMed 2025) - **Milk supply:** Methylphenidate lowers prolactin; large doses may interfere before lactation is established. (LactMed 2025) - **Exposure Registry:** National Pregnancy Registry for ADHD Medications, 1-866-961-2388, [womensmentalhealth.org/adhd-medications](https://womensmentalhealth.org/adhd-medications/). --- ### **Counseling Points** - **Counsel the family on:** - **Watching for any pale or white patch of skin anywhere on the body, not only where the patch was.** It can be permanent and must be reported the day it is noticed. - Applying two hours before it is needed, and writing the removal time down. - Taking it off early being a legitimate adjustment, and that the effect does not stop when it comes off. - Redness being normal; swelling, blisters or spreading redness being a reason to call. - Alternating hips daily, off the waistline, and keeping heat off the site: no hair dryers, heating pads or long sun, which can double the dose absorbed. - Never cutting a patch; if one falls off, a fresh site, and the day still ends at 9 hours. - Removing adhesive with olive oil, never nail polish remover, and folding a used patch sticky sides together to dispose of it. - **Advise them to call for:** - Any white or pale patch of skin, at the site or anywhere else. - Swelling, blisters, or redness spreading beyond the patch edge. - Chest pain, fainting, or a racing heart that does not settle. - A seizure, new hallucinations, or new fearful thinking. - Numbness or colour change in the fingers or toes; a new or worse tic. - Weight loss over a few weeks, or a patch that has gone missing. - A painful erection lasting more than a few hours, a surgical emergency. --- ### **References** 1. DailyMed. Daytrana (methylphenidate transdermal system) prescribing information. Noven Therapeutics LLC. 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2c312c31-3198-4775-91ab-294e0b4b9e7f 2. LactMed. Methylphenidate. Drugs and Lactation Database, NICHD. 2025. https://www.ncbi.nlm.nih.gov/books/NBK501310/ 3. FDA. openFDA National Drug Code Directory, methylphenidate. 2026. https://api.fda.gov/drug/ndc.json?search=generic\_name:%22methylphenidate%22 4. AHRQ. ADHD diagnosis and treatment in children and adolescents. Comparative Effectiveness Review No. 267. 2024. https://www.ncbi.nlm.nih.gov/books/NBK602989/ 5. DEA. Drug scheduling. Methylphenidate is a Schedule II controlled substance. https://www.dea.gov/drug-information/drug-scheduling