Differences Between Xelstrym and Daytrana: Methylphenidate Transdermal Systems for ADHD
Xelstrym and Daytrana are both methylphenidate transdermal patches for ADHD treatment, but Xelstrym offers a newer formulation with potentially improved wear characteristics and less skin irritation compared to Daytrana.
Key Similarities
Both medications:
- Contain methylphenidate as the active ingredient
- Are transdermal delivery systems (patches)
- Work by blocking the reuptake of dopamine and norepinephrine 1
- Bypass first-pass metabolism in the liver
- Provide extended medication delivery over approximately 9 hours
- Are FDA-approved for treating ADHD in children
Important Differences
Formulation and Technology
- Xelstrym: Newer transdermal technology (approved more recently)
- Daytrana: Original methylphenidate patch with more reported issues of skin irritation 2
Pharmacokinetics
- Both patches deliver methylphenidate steadily through the skin, reaching peak plasma concentrations in approximately 8 hours 2
- When using transdermal delivery, there are higher relative concentrations of l-threo-methylphenidate (50-60% of d-threo-methylphenidate) compared to oral formulations 3
- This differs from oral methylphenidate where first-pass metabolism results in much lower l-isomer concentrations
Clinical Considerations
- Skin Irritation: Daytrana has been associated with more frequent skin irritation issues, which was one of its main disadvantages 4
- Wear Time: Both patches are designed for 9-hour wear periods, but can be removed earlier to adjust duration of effect 2
- Onset of Action: Both patches typically have an onset of effect about 2 hours after application 4
- Duration of Effect: Both provide symptom control for approximately 11-12 hours 4
Practical Implications
Advantages of Transdermal Systems (Both Products)
- Eliminates the need for multiple daily doses
- Useful for patients who have difficulty swallowing pills
- Allows for flexible duration of treatment by removing the patch early
- May be beneficial for patients who experience significant "peaks and valleys" with oral medications
Disadvantages
- Skin irritation (more common with Daytrana)
- Must remember to remove the patch
- Visible to others when worn on exposed skin
- Higher relative concentrations of l-threo-methylphenidate compared to oral formulations 3
Clinical Efficacy
Both Xelstrym and Daytrana have demonstrated efficacy similar to other extended-release methylphenidate formulations like OROS methylphenidate (Concerta) 4. The efficacy profile is consistent with what would be expected from methylphenidate, with significant improvements in ADHD symptoms compared to placebo 2.
Side Effect Profile
Common side effects for both medications include:
- Decreased appetite
- Sleep disturbances
- Increased blood pressure and heart rate
- Headaches
- Irritability
- Stomach pain 1
Patient Selection Considerations
Transdermal methylphenidate systems may be particularly useful for:
- Adolescents with concerns about medication diversion (patches have less abuse potential than immediate-release tablets) 1
- Patients who need flexible duration of medication effect
- Patients who have difficulty with oral medication administration
- Patients who experience significant fluctuations with oral formulations
Monitoring Recommendations
- Regular monitoring of vital signs, particularly blood pressure and heart rate
- Assessment of skin at application site for irritation
- Monitoring of growth, weight, and appetite
- Evaluation of sleep quality
The American Academy of Pediatrics recommends considering methylphenidate as first-line therapy for ADHD due to its lower abuse potential compared to amphetamine-based medications 5.