Are Patches Better Than Pills?

It all started with a motion-sickness patch in 1982. Today you can slap on a patch to avoid pregnancy, stop smoking or treat pain. Soon Canadians may see patches for attention deficit hyperactivity disorder and diabetes.

What’s The Point?

“For some people it is the convenience of putting on a patch,” says Barry Power, director of practice development at the Canadian Pharmacists Association. “It may simply be easier than remembering to take pills a few times a day.”

You just stick it on—sometimes as infrequently as once a week—and you’re done. You get the same drug, through a different delivery system. And in certain cases, there are fewer side effects.

Here’s what’s currently available in Canada:

Pain Relief

Drug name: Duragesic (fentanyl)
What it does: Prescription-only Duragesic relieves constant pain such as that of cancer patients.
How it compares: A 72-hour Duragesic patch was as effective as intravenous morphine in one study. It may cause less constipation and may be less sedating.
Who should avoid it: People with mild, intermittent or short-term pain. Anyone with acute or severe asthma. Those with a history of depression or drug or alcohol abuse are at greater risk of opioid addiction.
Side effects/warnings: Constipation, nausea, vomiting, tiredness, and, in rare cases, slowed breathing. As with most patches, mild tingling or redness may occur at the patch site, and if you’re allergic to the pill form of a drug, you’ll be allergic to the patch form. There have been Canadian reports of deaths involving misuse and abuse of Duragesic. Additional side effects may occur. Consult your doctor and the package insert for more information. There is currently a warning from Health Canada about dosage and the use of this patch.

Birth Control

Drug Name: Evra (norelgestromin/ ethinyl estradiol)
What it does: Prevents pregnancy in 99 percent of cases when used correctly. It delivers the hormones estrogen and pro­gestin, preventing ovulation.
How it compares: It’s as effective as the Pill. The U.S. version exposes women to 60 percent more estrogen than the Pill, increasing the risk of side effects. The Canadian patch has less estrogen than the U.S. patch, but Health Canada is reviewing the U.S. studies on side effects. Both the patch and the Pill may cause blood clots and hypertension.
Who should avoid it: Smokers, especially those over 35, and women with a history of blood clots, certain heart or liver conditions, migraines with visual aura or very high blood pressure.
Side effects/warnings: Skin irritation, nausea, headache, cramps. These generally resolve in the first or second month. Tell your doctor about any prescription, nonprescription or herbal medicines you’re taking. Certain antibiotics, cholesterol-lowering drugs and other medications may interfere with effectiveness. Additional side effects may occur. Consult your doctor and the package insert for more information.

Nicotine Replacement

Drug name: Prostep, Habitrol, NicoDerm (nicotine)
What it does: Delivers nicotine to help reduce withdrawal symptoms when quitting smoking.
How it compares: Since you may chew up to 20 pieces of NR gum per day, a patch is easier on your jaw—and stomach. Zyban, a pill that’s been proven helpful, has been linked to depression and suicidal thoughts. The patch has not.
Who should avoid it: Pregnant or breastfeeding women; people with heart disease (unless you have a doctor’s okay).
Side effects/warnings: Increased heart rate, irritability, sleep dis­turbance, nightmares, headaches, dizziness, upset stomach. Never smoke while using the nicotine patch. Tell your doctor if you use caffeine, acetaminophen or vitamins, or if you’ve had heart, thyroid or skin problems. Additional side effects may occur. Consult your doctor and the package insert for more information. Additional side effects may occur. Consult your doctor and the package insert for more information.

Chest Pain

Drug Name: Nitro-Dur,Transderm-Nitro, Trinipatch, Minitran (nitroglycerine)
What it does: Relaxes blood vessels, increasing oxygen and blood flow to the heart.
How it compares: It’s as effective as a long-acting pill in preventing angina, but neither will help in an acute attack. Your doctor may also prescribe short-acting pills to treat sudden attacks.
Who should avoid it: Anyone with low blood pressure, severe anemia, recent stroke or head injury, or taking long-acting nitroglycerine. Men on erectile-dysfunction drugs.
Side effects/warnings: Headache, light-headedness. Inform your doctor about any drugs you’re taking, especially beta blockers, calcium-channel blockers, erectile-dysfunction drugs or acetylsalicylic acid. Additional side effects may occur. Consult your doctor and the package insert for more information.

Menopause

Drug Name: Climara, Estraderm, Estradot (estradiol)
What it does: These estrogen-only patches relieve hot flashes. They may also prevent osteoporosis.
How it compares: The patch is easier on the liver than the pill. A com­bination estrogen/pro­gestin patch is also available and is best for women who have not had a hysterectomy.
Who should avoid it: Women with a history of breast cancer or blood clots. Those who have not had a hysterectomy should avoid estrogen-only patches, which can increase their risk of endometrial cancer.
Side effects/warnings: Breast tenderness, nausea, swelling, vision problems. Smokers are at increased risk of blood clots. Many drugs, alcohol, caffeine, vitamin C and herbal products can affect how the patch works, so tell your doctor if you use them. Additional side effects may occur. Consult your doctor and the package insert for more information.

Alzheimers

Drug Name: Exelon Patch (Rivastigmine Transdermal Patch)
What it does: Exelon is not a cure for Alzheimer’s disease as it does not affect the underlying degenerative process of the disease. It’s expected to reduce the breakdown of acetylcholine, a chemical thought to be important for learning. People with Alzheimer's disease have lower brain levels of acetylcholine.
How it compares: Test subject reported using the Exelon in a patch instead of pills simplified use and cut the drug's side effect of nausea and vomiting.
Who should avoid it: There are many other drugs that can interact with rivastigmine so you tell your doctors about all the prescription and over-the-counter medications before taking the drug. Anyone with a heart rhythm disorder (slow heartbeats), an enlarged prostate, urination problems, asthma, obstructive pulmonary disease, or a seizure disorder such as epilepsy should consult their doctor first.
Side effects/warnings: Nausea, vomiting, diarrhea, decreased appetite, dizziness, abdominal pain (stomach pain), urinary tract infections, weakness, fatigue, insomnia, vertigo.