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Daytrana (Methylphenidate Transdermal) - Drug Interactions, Contraindications, Overdosage, etc

 
 



DRUG INTERACTIONS

MAO Inhibitors

Daytrana should not be used in patients being treated (currently or within the preceding two weeks) with monoamine oxidase inhibitors [ see Contraindications ].

Vasopressor Agents

Because of a possible effect on blood pressure, Daytrana should be used cautiously with pressor agents.

Hypotension Agents

Methylphenidate may decrease the effectiveness of drugs used to treat hypertension.

Coumarin Anticoagulants, Antidepressants, and Selective Serotonin Reuptake Inhibitors

Human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of coumarin anticoagulants, anticonvulsants (e.g., phenobarbital, phenytoin, primidone), and some tricyclic drugs (e.g., imipramine, clomipramine, desipramine) and selective serotonin reuptake inhibitors. Downward dose adjustments of these drugs may be required when given concomitantly with methylphenidate. It may be necessary to adjust the dosage and monitor plasma drug concentrations (or, in the case of coumarin, coagulation times), when initiating or discontinuing methylphenidate.

OVERDOSAGE

Signs and Symptoms

Signs and symptoms of acute methylphenidate overdosage, resulting principally from overstimulation of the CNS and from excessive sympathomimetic effects, may include the following: vomiting, agitation, tremors, hyperreflexia, muscle twitching, convulsions (may be followed by coma), euphoria, confusion, hallucinations, delirium, sweating, flushing, headache, hyperpyrexia, tachycardia, palpitations, cardiac arrhythmias, hypertension, mydriasis, and dryness of mucous membranes.

Recommended Treatment

Remove all patches immediately and cleanse the area(s) to remove any remaining adhesive. The continuing absorption of methylphenidate from the skin, even after removal of the patch, should be considered when treating patients with overdose. Treatment consists of appropriate supportive measures. The patient must be protected against self-injury and against external stimuli that would aggravate overstimulation already present. Intensive care must be provided to maintain adequate circulation and respiratory exchange; external cooling procedures may be required for hyperpyrexia.

Efficacy of peritoneal dialysis or extracorporeal hemodialysis for Daytrana overdosage has not been established.

Poison Control Center

As with the management of all overdosages, the possibility of multiple drug ingestion should be considered. The physician may wish to consider contacting a poison control center for up-to-date information on the management of overdosage with methylphenidate.

CONTRAINDICATIONS

Hypersensitivity to Methylphenidate

Daytrana is contraindicated in patients known to be hypersensitive to methylphenidate or other components of the product (polyester/ethylene vinyl acetate laminate film backing, acrylic adhesive, silicone adhesive, and fluoropolymer-coated polyester) [ see Description].

Agitation

Daytrana is contraindicated in patients with marked anxiety, tension, and agitation, since the drug may aggravate these symptoms.

Glaucoma

Daytrana is contraindicated in patients with glaucoma.

Tics

Daytrana is contraindicated in patients with motor tics or with a family history or diagnosis of Tourette's syndrome [ see Adverse Reactions].

Monoamine Oxidase Inhibitors

Daytrana is contraindicated during treatment with monoamine oxidase inhibitors, and also within a minimum of 14 days following discontinuation of treatment with a monoamine oxidase inhibitor (hypertensive crises may result).

DRUG ABUSE AND DEPENDENCE

Controlled Substance

Daytrana is classified as a Schedule II controlled substance by federal regulation.

Abuse

See warning containing drug abuse information [ see Boxed Warning ].

Dependence

See warning containing drug dependence information [ see Boxed Warning ].

REFERENCES

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association 1994.

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