Critical assessment of the methylphenidate transdermal system

Introduction of the methylphenidate transdermal system (MTS) provides a different way of delivery for the most widely prescribed agent used to treat attention-deficit hyperactivity disorder (ADHD). The MTS delivery system provides good absorption of the active ingredient. Maximal plasma concentration of methylphenidate occurs from seven to nine hours after patch placement. Onset of action in pharmacodynamic studies has been registered at the two-hour mark after patch placement. As a result of the transdermal delivery system, the effect of first-pass metabolism is greatly diminished. Removal of the patch is associated with a biexponential decrease in methylphenidate levels. Recommended placement of the MTS is on a patient's hip, with a suggested application time of nine hours. Efficacy was demonstrated at all time points measured in ADHD, from 2-12 hours. Most adverse events reported were mild to moderate in severity; the most frequent adverse events reported were disturbances in sleep and appetite.