1. Transdermal Delivery Systems

2. Advantages of Transdermal Delivery Systems Reasonably constant dosage can be maintained (as opposed to peaks and valleys associated with oral dosage) First pass metabolism in the liver and GI tract is avoided Reduced need for active administration (some patches can last 7 days) The patch is noninvasive and dosage can be stopped by removal Easy to apply and to monitor

3. Oral versus Transdermal EE = Ethinyl Estradiol

4. Limitations of Transdermal Delivery Systems Skin structure poses a barrier on the mw of the drug (< 500 Da) Usually reserved for drugs which are extremely potent (thus requiring a dosage of only a few mg). –The largest daily dose of a drug from a patch is the nicotine patch, with delivers a daily dose of only 21 mg.

6. The drug must traverse three layers, the stratum cornium, the epidermis, and the dermis. Of these, the toughest barrier is the stratum corneum, which consists of 10-25 layers of keratinized cells.

7. The stratum corneum is the outermost layer of the epidermis and is composed mainly of dead cells that lack nuclei. These are sloughed off during the day and replaced by new cells from the stratum germinativum.

8. In the stratum corneum is a high proportion of keratin, an insoluble protein, with a high proportion of disulfide bridges (from cysteine), and also a high level of glycine and alanine residues that allow strong H-bonds to neighboring amino acids.

9. Types of patches: definitions Liner: Protects the drug during storage and is removed prior to use Drug Adhesive: Serves to bind the components of the patch to the skin Membrane: Controls the release of the drug from the reservoir in certain types of patches Backing: Protects the patch from the outer environment.

10. Drug in Adhesive Patches A system in which the drug is incorporated directly into the adhesive, rather than into a separate layer. Usually used for smaller molecular weight compounds. These can be either a single layer or multi- layer. Sometimes referred to as the “matrix type patch”

11. Film Backing Drug/Adhesive Layer Protective Liner (removed prior to use) skin Schematic Drawing of the Matrix (Drug-in-Adhesive) type of patch.

12. Drug in Adhesive Patches Can Also Have Additional Layers to Regulate Rate of Drug Delivery Link

13. Reservoir Patches The reservoir system has a drug layer that is separate from the adhesive.

14. Film Backing Drug Layer Protective Peel Strip (removed prior to use) skin Schematic Drawing of the Reservoir type of patch. Rate-controlling Membrane Contact Adhesive

15. http://molinterv.aspetjournals.org/cgi/reprin t/4/6/308http://molinterv.aspetjournals.org/cgi/reprin t/4/6/308 Article illustrating two types of patches can be found at:

16. What kind of drugs can be incorporated into a patch? Compounds with low logP will not diffuse into skin lipids However, compounds with high logP also have difficulties, this time associated with their diffusion out of the stratum corneum. The accepted range of logP values is between 1 and 3.

17. Products on the market, or in development include: Clonidine Works as an agonist of adrenaline at the presynaptic  2 adrenergic Product name = Catapres-TTS ® used to treat hypertension

18. Ethinylestradiol (EO) and norelgestromin (N) Product name = Ortho-Evra ® Used for Contraception Type of patch = Drug-in-Adhesive Frequency of application = weekly

19. Fentanyl Product Name = Duragesic ® Used for: Analgesia Type of Patch = Drug-in-Adhesive Frequency of Application = Weekly

20. Lidocaine Product Name = Lidoderm ® Used for: analgesia of postherpetic neuralgia (PHN), a painful condition caused by the varicella zoster virus (herpes zoster = shingles)

21. Lidoderm Patch Type of Patch = Reservoir Frequency of Application = Daily

22. Nicotine Product name = Habitrol ®, Nicoderm – CQ ®, Nicotrol ®, Prostep ® Used for: Smoking cessation Frequency of administration = Daily

23. Nitroglycerin Works by producing nitric oxide (NO), which then acts as a vasodilator Product Names = Nitro-Dur ®, Transderm-Nitro ® Used for: Angina Type of Patch = Nitro-Dur is Drug-in-adhesive Nitrodisc is reservoir Frequency of administration = Daily

24. Estradiol Product Name = Alora ®, Climara ®, Esclim ®, Estraderm ®, FemPatch ®, Vivelle ®, Vivelle-DOT ® Used for: Hormone replacement Type of Patch: Drug-in-adhesive Frequency of application = weekly

25. Estradiol + Norethindrone Product name = CombiPatch ® Used for: Hormone Replacement

26. Oxybutynin Works as competitive antagonist of the muscarinic acetycholine receptor Product name = Oxytrol ® Used for: Overactive bladder (antispasmodic) Type of Patch: Drug-in-adhesive Frequency of application = twice a week

27. Scopolamine Works as competitive antagonist of acetylcholine at the muscarinic receptor Product Name = Transderm Scop ® Used for: Motion Sickness

28. Testosterone Product Names = Androderm ®, Testoderm TTS ®, Testoderm ® Used for: Hypogonadism

29. Lidocaine + Epinephrine Product name = Lidosite Used for: Dermal anesthesia Type of Patch = Reservoir, iontophoretic. Epinephrine acts as vasoconstrictor, thus prolonging the duration of action of lidocaine (by delaying resorption) at the site

30. Iontophoretic Patches Iontophoretic patches use a tiny electrical current to promote flow of the drug (usually charged) through the skin.

31. Iontophoretic Patches

35. Microneedles Patches Microneedles patches are currently being explored as mechanisms to deliver vaccines and larger macromolecules.

36. Transdermal Vaccine Technology LINK

37. The microneedle technology can result in more effective contact of the vaccine with the antigen-presenting Langerhans cells The needles can be fabricated to be long enough to penetrate the stratum corneum, but short enough to not come into contact with nerve endings. LINK

38. Assigned Reading Scheindlin Stanley Transdermal drug delivery: PAST, PRESENT, FUTURE. Molecular interventions (2004), 4(6), 308-12 (see link in presentation). Prausnitz, Mark R.; Langer, Robert. Transdermal drug delivery. Nature Biotechnology (2008), 26(11), 1261- 1268 LinkLink Sieg, A.; Wascotte, V. Diagnostic and therapeutic applications of iontophoresis. Journal of Drug Targeting, (2009); 17(9): 690-700. Graduate Students Only: Subedi, R. K. et al. Recent Advances in Transdermal Drug Delivery. Archives of Pharmal Research (2010), 33(3): 339-351.

39. Homework Questions 1.List the advantages of administering drugs via trandermal drug delivery systems, over administering medications orally. 2.Use diagrams to illustrate the differences between a drug-in-adhesive patch and a reservoir patch 3.List the limitations on the types of drugs which can be administered by first-generation transdermal delivery systems. Explain why much of the drug is wasted, and how this is commercially feasible. 4.Draw the structures of the following drugs and circle the functionalities capable of ionization at biological pH. Redraw each structure, showing the predominant charge state at pH = 7.4 (blood pH): Fentanyl, Lidocaine. 5.Explain how second and third generation transdermal devices differ from first generation and provide examples of each that are in clinical trials. 6.Explain how transdermal delivery of vaccines might elucidate a greater immune response than conventional methods.