Transdermal Patch experiences?

[Pat]

(This seems like the right forum to ask in, I apologize if it's not.)

I'm in a tussle with the insurance company over my meds. The Endo and I worked out a plan that included estradiol in gel form because I tend to exercise regularly and work up a sweat. The insurance company wants me to switch to a transdermal patch. At this point I can totally prove that the gel works for me, but they say they will only cover the gel if I try the patch and it fails. (Insert snarky comment about requiring medicine to fail...)

The few people I know who have used the patch told me it tends to fall off easily but I thought I'd ask a wider audience for their view.

Comments?

[tgirlamc]

Hi Jennie!... First congrats on this step forward!.... I avoided the patches because, like you, I exercise a lot and had friends who recounted to me tales of uneven dosing due to sweating, showering, bad adhesion etc...but on the other hand, I know others who also exercise a lot and have had zero issues.... it's sad the insurance companies have to be combative on the issue but there are always hoops that must be jumped through along this path and this is just another of those... I'd say, give them an honest try and see what happens!... Enjoy the ride!!!

Take Care,

Ashley

[Joan_CD]

Jennie I've used Vivelle Dot patches for several years now and rarely have a problem. I do a three mile walk every day, shower with it on and even take an occasional bath and they don't fall off. Before I put them on I make sure the area is free of oil with alcohol and shave the area (I place them in the lower abdominal area).

[I Am Paula]

I've used estradot for 3 1/2 years, and I've only had two come off. Maybe it has something to do with skin oiliness?

[Suzanne F]

I have worn the patches for a year and a half and I have had one come off. I am a runner and have had no issues with sweating causing them to come off.
Suzanne

[Jennifer-GWN]

I was totally opposite of Suzanne... Tried patches for a few months... Cursed them regularly. I'm oily sweaty for workouts and shower often... They quickly were replace by injections.

[Eryn]

I'm happy with patches. I use Mylan twice-a-week patches which is the generic for Vivelle Dot. I prep my skin with 91% alcohol and the patches stick just fine.

I was not happy with once-a-week patches. They were larger and did not stick as well.

If I couldn't do patches, my first choice for an alternative would be injections.

[Cindia]

if you have to use patches and have an issue with them coming off you should be able to get a product called Tegaderm to use over them. Ask your pharmacist about them.

Don't know of anyone that used them for the estrogen patches but had a couple patients use them with the fentanyl pain patches.

Tonya

[Emma Beth]

I've been using the Mylan week long patches for the past month.

The first one I had a minor issue with it staying on at first.

But now I don't have an issue. Once they adhere, they stay on pretty good. I tried them on my lower abdomen and had more issues with them staying there because of sweat. I started applying them to my upper buttocks and they work better there for me.

I was told by my Endo's supervisor, when I expressed a concern about fluctuations in my hormone levels with the patch and he suggested that when I put on my new patch, leave the old one on for the next day before taking it off. There is usually a little left in them before they are actually finished. The new one takes about a day to begin working.

[MarieTS]

I have the gel, there was an out-of-pocket contribution but now that's no longer the case so I am not complaining. :-)

[RylieM]

Jennie I've used Vivelle Dot patches for several years now and rarely have a problem. I do a three mile walk every day, shower with it on and even take an occasional bath and they don't fall off. Before I put them on I make sure the area is free of oil with alcohol and shave the area (I place them in the lower abdominal area).

I have worn the patches for a year and a half and I have had one come off. I am a runner and have had no issues with sweating causing them to come off.
Suzanne

if you have to use patches and have an issue with them coming off you should be able to get a product called Tegaderm to use over them. Ask your pharmacist about them.

Don't know of anyone that used them for the estrogen patches but had a couple patients use them with the fentanyl pain patches.

Tonya

Thank you all my doctor temporarily turn me down for estrogen at my last appointment but she did mention she plans to start me on patches because I have a history of transient ischemic attacks or mini strokes meaning i'm at a higher than normal chance to have a real one. I was worried because I sweat alot I workout a ton by riding my mountain bike on ave 10 miles a day and 100 miles a week and I don't take it easy my ave speed on the streets 20 max 40 offroad a bit different my current bike setup is a 1x10 with a 36 t chainring and 11-36 cassette setup to date I have never gone past my 7th gear and usually I do take hills around my 3rd or 4th gear at least on road off road my 10th gear does get a workout. Besides that I also swim alot altho I do plan on buying alot of medical tape just incase.

[Emma Beth]

Rylie, that's an impressive set up on your bike and how you use it.

Personally I prefer Fixie. I do mostly road work with it, but I can take it light off road. The only thing I can say about Fixie is that there is nothing like having the bike itself train you for a smooth peddling technique.

When you are going down hill and have no choice to keep pedaling when you want to coast and your back side is bouncing on the saddle painfully, you learn very fast.

[RylieM]

Im a semi amuter cross country racer but also use my bike for my daily commute to and from work and pretty much where ever else I need to go. I say semi only because I dont compete for standing ect I really only do 1 race a year altho it is a officially sanctioned race for a new england race circuit so I can say that I am a racer. I do it more for fun but if I place well and earn a prize then all the better.

[Pat]

Thanks everyone. I guess I still have mixed feelings on this. I hadn't even considered the dose variation over time from a patch. I'm getting excellent results from the gel and don't feel like messing that up. I'll put it into arbitration saying I'm unwilling to let a successful treatment be sidelined while waiting for an alternative to fail and if I end up having to pay for the gel out of pocket, I'll do that.

The advice on bikes... I'll file it for later.

[Starling]

I have a related question, which is: is there a difference between the way gel and the patch are handled by the liver? I thought transdermal applications were less challenging to that organ.

Lallie

[Pat]

That's my understanding as well. I think the patch and gel are virtually the same in terms of liver impact and that's part of the selection process the endo went through. Injections should also be liver-friendly. In fact, I think anything that is not oral bypasses the liver issue.

[OCCarly]

I've been on Climara patches now for almost four months. My endo has me change the patch every three days. I have my own swimming pool, and I swim daily and sometimes shower twice a day. I have had a few patches start to fall off at the end of the third day, but not from water or sweat -- the greater danger is that they your clothing will stick to the gumming around the edges and start to pull them off -- and then water will start to get under them and they will work loose. So if you go with the patches, be careful where you put them and how you dress over them. And if you sweat heavily now, don't worry. After a few months on estrogen, that won't be a problem any more.

[KellyTG]

Yeah Cindia the Tegaderm works pretty good. I would suggest to OGCarly that she use alcohol swabs on the area prior to applying the Climara patch to dry skin. Another suggestion is to buy these from Ebay because they are much cheaper than your local drug store. I used these patches off and on for a year and switched to injections due to the adhesion issues.

[Eryn]

I just use 91% isopropyl alcohol on a folded piece of toilet tissue. Cheap and effective way to ensure good adhesion.

[Kate T]

Do you guys have access to slow release intradermal pellets in the US? I was on patches initially but found them to be a real pain after a while and switched to the pellets. But I don't know if they are available in the US. That would be my go to delivery system once dose was established and you were stable (which my understanding is you are Jennie??).

[Emma Beth]

Kate, I think they may be.

But, they may not be readily available everywhere.

I'm going through the VA Health Care System and I was told by both my Endos that they do not offer those through the VA at this time. The VA only offers the oral pills, patches (Three day and week long patches), and injections only.

I can't speak as to elsewhere though. I'm sure someone else may chime in about that.

[Kate T]

It's possible they may not be in WPATH SOC guidelines either to be honest. They can get pretty high E2 levels. My endo is very experienced (he does most of the girls and guys on eastern seaboard Oz and has done for over 20 years) so I trust him with it. They are private here as well. I paid about AU$300 for mine. On the up side I've had mine in for over 12 months and I'm stil E2 +++ maximal GG cycle levels and T is non existent even though I haven't had orchi. Sort of starts to look like a reasonably priced option as I approach 15 months with them in at only AU$20 per month compared to AU$24 per month for Estrodot scripts on our subsidised PBS.

[Frances]

No one reacts the same way to the different methods, and no particular method is better. It depends on the person.

I have been using Estradot patches for almost 10 years. My absorbs the estradiol just fine. I put them on after a shower, and I clean the area of soap residue with rubbing alcohol. They stay on without any problems.

[Pat]

Just to put a cap on this: I agreed to try a month on the patch with the proviso I could switch back if I had any problems. And the result is that there were no problems at all. The patches, made by a company called Sandoz, are tiny (about an inch long, half an inch high) -- much smaller than the ones I had seen my friends use. The recommended placement is on the side of the abdomen and it's easy to find a spot there that isn't going to get a lot of clothing friction. They stick like limpets. I haven't had so much as an edge lift while wearing them even when exercising heavily. I'll have to wait for the blood work in a couple of months to know how well I'm absorbing from them but the changes I've been experiencing haven't slowed at all so I'm assuming they're working great. So I'm happy; my insurance company is happy and I'll find out in a while if the doctor's happy.

If anyone else has reservation about patch .vs. gel, my experience has been that the patch is OK.

[Jeri Ann]

Hey Jennie,

I intended to respond to your question about patches when it first started but I forgot. I hope it's not too late. I switched to patches for a while and never had one come off. They did, however, make my breasts extremely sore. Even the bounce produced from walking was very uncomfortable. Being concerned with the possible side effects and effectiveness of HRT I have done injections for the past sixteen months.
Hope this helps.

Jeri