Abstract
This is an update to the 2010 article published in Hospital Pharmacy on safety concerns involving transdermal patches and magnetic resonance imaging (MRI). Since publication of the original article, new brand and generic transdermal medications have become available and notable changes regarding the presence or absence of metallic content among existing transdermal formulations occurred. To update the tables within the article, Food and Drug Administration (FDA)-approved transdermal medications through October 2020 were researched in order to determine metallic content and procedures for reapplication after MRI, if applicable. Readers should consult the prescribing information or manufacturer for the most current information on use of transdermal medications in the MRI setting. Of note, manufacturers have not evaluated the use of transdermal products while patients undergo a MRI scan.
Keywords: drug information, adverse drug reactions, medicaiton safety
Introduction
This is an update to the 2010 article published in Hospital Pharmacy on safety concerns involving transdermal patches and magnetic resonance imaging (MRI). 1 Since publication of the original article, new brand and generic transdermal medications have become available and notable changes regarding the presence or absence of metallic content among existing transdermal formulations occurred. To update the tables (Tables 1 and 2), Food and Drug Administration (FDA)-approved transdermal medications through October 2020 were researched in order to determine metallic content and procedures for reapplication after MRI, if applicable. Newly approved transdermal medications were identified by consulting the FDA Novel Drug Approvals Web site 2 and the CenterWatch Web site 3 while generics were identified through a search of the FDA Orange Book Web site. 4
Table 1.
| Generic name | Trade name | Manufacturer | Metal component |
|---|---|---|---|
| Asenapine | Secuado | Noven Pharmaceuticals | No |
| Buprenorphine | Butrans | Purdue Pharma | No a |
| Generic | Teva Pharmaceuticals | No | |
| Generic | Amneal Pharmaceuticals | No b | |
| Capsaicin | Qutenza | Averitas Pharma | No |
| Clonidine | Catapres TTS | Boehringer Ingelheim | Yes (aluminum) |
| Generic | Actavis Pharma | Yes (aluminum) | |
| Generic | Aveva Drug Delivery Systems Inc | Yes (aluminum) | |
| Generic | Mayne Pharma | Yes (aluminum) | |
| Generic | Mylan | No | |
| Diclofenac | Flector | Pfizer | Yes (dihydroxyaluminoacetate) |
| Estradiol | Alora | Allergan | No |
| Climara | Bayer | No | |
| Menostar | Bayer | No | |
| Minivelle | Noven Pharmaceuticals | No | |
| Vivelle-Dot | Novartis | No | |
| Dotti | Amneal Pharmaceuticals | No | |
| Generic | Mylan | No | |
| Estradiol/levonorgestrel | Climara Pro | Bayer | No |
| Estradiol/norethindrone | CombiPatch | Noven Pharmaceuticals | No |
| Ethinyl estradiol/levonorgestrel | Twirla | Agile Therapeutics, Inc. | No |
| Ethinyl estradiol/norelgestromin | Xulane | Mylan | Insufficient information to determine metallic content; consider removal of patch prior to MRI |
| Fentanyl | Duragesic | Janssen Pharmaceuticals | No |
| Generic | 3M Drug Delivery | No | |
| Generic | Apotex | No | |
| Generic | Mylan | No | |
| Generic | SpecGx LLC | No | |
| Granisetron | Sancuso | Kyowa Kirin | No |
| Lidocaine | Lidoderm | Teikoku Pharma USA | Insufficient information to determine metallic content; consider removal of patch prior to MRI |
| ZTlido | Scilex Pharmaceuticals | No | |
| Generic | Actavis Laboratories | No | |
| Generic | Mylan | No | |
| Generic | Rhodes Pharmaceuticals | No | |
| Lidocaine/tetracaine | Synera | Galen Specialty Pharma | Yes (iron powder) |
| Menthol/methylsalicylate* | SalonPas | Hisamitsu Pharmaceutical Co. | No |
| Methylphenidate | Daytrana | Noven Pharmaceuticals | No |
| Nicotine* | Habitrol | Dr. Reddys Laboratories | Insufficient information to determine metallic content; manufacturer recommends removal of patch prior to MRI |
| Nicoderm CQ | GSK Consumer Healthcare | Yes (aluminum) | |
| Generic | Apotex | No | |
| Nitroglycerin | Nitro-Dur | Ingenus Pharmaceuticals | Insufficient information to determine metallic content; consider removal of patch prior to MRI |
| Generic | Mylan Technologies | No | |
| Generic | Hercon Pharmaceutical | Insufficient information to determine metallic content; consider removal of patch prior to MRI | |
| Oxybutynin | Oxytrol | Allergan | No |
| Oxytrol for Women* | Allergan | No | |
| Rivastigmine | Exelon | Novartis | Yes (trace metals and metal ions) |
| Generic | Alvogen | Yes (aluminum) | |
| Generic | Amneal Pharmaceuticals | No | |
| Generic | Breckenridge Pharmaceuticals | No | |
| Generic | Mylan Technologies | No | |
| Generic | Zydus | Insufficient information to determine metallic content; consider removal of patch prior to MRI | |
| Rotigotine | Neupro | UCB Inc. | Yes (aluminum) |
| Scopolamine | Transderm Scop | GlaxoSmithKline | Yes (aluminum) |
| Generic | Mylan Technologies Inc. | No | |
| Generic | Perrigo Pharmaceuticals | Yes (aluminum) | |
| Selegiline | Emsam | Somerset Pharmaceuticals | No |
| Testosterone | Androderm | Allergan | Yes (aluminum) |
Note. *Over-the-counter product.
Although the Butrans® Transdermal System, when properly applied to a patient’s skin, does not contain metallic foil, the manufacturer was aware of at least 1 post-marketing report from a patient who reported a burn under the system after an MRI scan (Purdue written communication. June 21, 2019).
Although verbal communication with a medical information representative confirmed that the patch does not contain metallic components, the manufacturer recommended removal of the patch prior to MRI.
Table 2.
Recommended Reapplication Instructions for Transdermal Patches after Removal for MRI.10-13,15,26,33,38,41,42,44,46,49,50,54-56,58,60
| Patch brand name | Reapply original patch? | Apply new patch? |
|---|---|---|
| Androderm (testosterone)* | Information on reapplication is lacking | Information on reapplication is lacking |
| Catapres TTS (clonidine) and generic from Actavis Pharma, Aveva Drug Delivery Systems Inc, or Mayne Pharma | No | Yes, to a new skin site |
| Exelon (rivastigmine) and rivastigmine generic from Alvogen and Zydus | No | Yes, to a new skin site |
| Flector (diclofenac)* | Information on reapplication is lacking | Information on reapplication is lacking |
| Habitrol (nicotine)* | Information on reapplication is lacking | Information on reapplication is lacking |
| Lidoderm (lidocaine)* | Information on reapplication is lacking | Information on reapplication is lacking |
| Neupro (rotigotine) | No | Yes, to a new skin site |
| Nicoderm CQ (nicotine) | Yes, to the same or different skin site | Yes, to the same or a new skin site |
| Nitro-Dur (nitroglycerin) and generic from Hercon Pharmaceutical* | Information on reapplication is lacking | Information on reapplication is lacking |
| Synera (Lidocaine/tetracaine) | Information on reapplication is lacking | Yes |
| Transderm Scop (scopolamine) and generic from Perrigo Pharmaceuticals* | Information on reapplication is lacking | Information on reapplication is lacking |
| Xulane (ethinyl estradiol/norelgestromin) | Yes, if removed for less than 1 day | Yes, if removed for more than 1 day or unknown timeframe, apply a new patch and start a new 4-weeks cycle. |
Note. *For transdermal products lacking information on reapplication of the original and new patch, please contact the prescriber for further instruction. In most cases, application of a new patch at a new site after MRI would be a reasonable course of action in order to avoid the potential for a medication error where a necessary patch is inadvertently not reapplied.
The primary data source for each medication was the most recent prescribing information. If pertinent data were not located within this source, then the medical information department of the respective manufacturer was contacted. The representative was asked to email the authors any available supporting information regarding transdermal patch administration and MRI if available. Although every effort has been made to ensure the accuracy and completeness of the information presented in the tables, the reader is advised that the authors, Hospital Pharmacy, or SAGE cannot be held responsible for the currency of the information, for any errors or omissions, or for any consequences that may arise. The reader should consult the prescribing information or manufacturer for the most-up-date information. Prudent clinical practice involves cautious use of transdermal medications during MRI scans and consultation with, and adherence to, institutional MRI protocols. Of note, manufacturers have not evaluated the use of transdermal products while patients undergo a MRI scan.
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iD: Michael Gabay 
https://orcid.org/0000-0002-8864-0146
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