What counseling points should be given to a patient switching from Estradot (estradiol) transdermal patches to Climara (estradiol) patches?

Switching from Estradot to Climara Patches: Key Counseling Points

When switching from Estradot to Climara patches, the most critical counseling point is the difference in application frequency: Climara is applied once weekly (every 7 days) whereas Estradot is typically changed twice weekly (every 3-4 days). 1, 2

Application Schedule Differences

• Climara patches are designed for 7-day wear, requiring only one application per week, which significantly improves convenience and compliance compared to twice-weekly changes 2, 3
• Estradot patches are changed every 3-4 days, meaning patients currently applying patches twice weekly will now only need to change once weekly 1, 3
• Maintain the same patch change day each week to establish a consistent routine and ensure continuous hormone delivery 4

Skin Tolerability and Adhesion

• Climara may cause more local skin reactions than Estradot, with studies showing higher rates of erythema (32.3% vs 21.4%) and overall skin irritation scores (0.41 vs 0.22) 3
• Monitor application sites for erythema, itching, or irritation, and rotate sites with each application to minimize cumulative skin reactions 3
• Climara's larger patch size (12.5 cm²) compared to Estradot (5 cm²) may result in slightly lower adhesion rates (82% vs 87.5% with >90% adherence), though both patches generally adhere well 3

Bioequivalence and Efficacy

• Both patches deliver equivalent estradiol exposure (similar AUC, Cmax, Cmin, and average plasma levels) when used at the same nominal dose (e.g., 50 μg/24h) 1
• Climara has a longer time to maximum concentration (Tmax) compared to Estradot, meaning estradiol levels rise more gradually but remain stable throughout the 7-day wear period 1
• Expect the same therapeutic efficacy for menopausal symptom relief, as both matrix patches provide effective and rapid control of hot flushes and other climacteric symptoms 5, 2

Application Site Recommendations

• Apply to clean, dry, intact skin on the buttock or lower abdomen, avoiding the breast area 2
• Buttock application may provide higher and more consistent absorption than abdominal sites, though both are acceptable 2
• Rotate application sites with each new patch to reduce cumulative skin irritation 3

What to Do If Patch Detaches

• If detachment occurs <48 hours since application: Apply a new patch immediately, keep the same weekly change day, and no backup contraception is needed (if using for contraception) 4
• If detachment occurs ≥48 hours since application or timing is uncertain: Apply a new patch immediately, keep the same change day, but use backup contraception for 7 days if relying on the patch for contraception 4

Common Pitfalls to Avoid

• Do not cut Climara patches into smaller pieces for dose adjustment, as this is not validated by the manufacturer and may affect drug delivery 6
• Avoid applying patches to irritated, damaged, or oily skin, as this reduces adhesion and increases local reactions 3
• Do not apply immediately after bathing or swimming; wait until skin is completely dry to optimize adhesion 3

Storage and Handling

• Store unused patches in their sealed pouches at room temperature (≤25°C); do not refrigerate 6
• Once opened, apply the patch immediately; do not store cut or opened patches 6