Skin pretreatment and the use of transdermal clonidine

Article Abstract:

Clonidine is a drug used to treat high blood pressure; it works by acting on the alpha receptors for adrenalin. The drug may be taken by mouth, but many patients prefer the transdermal patch. A transdermal clonidine patch is applied to the skin and slowly releases clonidine; the drug is absorbed through the skin and is carried to the blood stream. The patch is worn for seven days, freeing the patient from taking pills regularly. Unfortunately, the patch can cause inflammation and itching of the skin in many patients. The skin may also darken in response to the patch. This side effect seems to be associated with sex and race; white women experience skin problems most frequently, at a rate of about 34 percent. About 18 percent of white men develop skin problems using the patch. In contrast, the patch causes skin problems in only 14 percent of black women, and 8 percent of black men. Many physicians have tried applying a 0.5 percent hydrocortisone cream to the skin prior to placing the patch to decrease the likelihood of inflammation and itching. However, the effectiveness of this technique has not been established by careful study, nor is it known whether the cream interferes with the diffusion of the clonidine into the skin. Therefore, a study with 10 hypertensive patients was undertaken to evaluate the effectiveness of the hydrocortisone cream. The study was of the crossover type, in which the patients moved from one experimental group to another after a suitable period. After the results were tabulated, it became clear that the hydrocortisone cream had an effect on the rate of entry of clonidine into the body. Treatment with hydrocortisone resulted in more rapid movement of clonidine into the skin and higher drug levels in the blood, thereby increasing the dose. However, even with this increase, the amount of clonidine in the blood was within the limits considered appropriate for treating hypertension. The hydrocortisone cream had no apparent effect on the control of the blood pressure, which was achieved in the 10 patients. However, the hydrocortisone cream did have a significant effect on the skin symptoms, and patients experienced less itching and inflammation after pretreatment of the skin with hydrocortisone cream prior to the application of the patch. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Complications and side effects, Contact dermatitis

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Improving compliance in an inner-city hypertensive patient population

Article Abstract:

High blood pressure (hypertension) has been called a silent disease because it causes no symptoms. Only after decades of high blood pressure do the arteries, kidneys, and other structures succumb to the cumulative effects of hypertension. At this point, the consequences are often irreparable. Unfortunately, it is often difficult to convince patients to take medication when they feel perfectly healthy. Patient compliance is likely to be especially inadequate among inner city residents, who are generally poorer and less educated than the average patient. Social, economic, and ethnic factors all contribute to poor patient compliance to prescribed antihypertensive medication in the inner city. In one clinic in New York City, the Harlem Hospital Center High Blood Pressure Program, the drop-out rate of patients reached 50 percent. More patients followed their prescribed treatments poorly than well. Many modifications were instituted at the clinic to improve the likelihood of good patient compliance. These included expansion of hours of the clinic and the involvement of nurse-therapists in patient following-up and health counselling. These and other efforts improved patient compliance. It become clear that simple treatment regimens were more likely to be followed than were more complex ones, and every effort was made to keep treatment as simple as possible within the constraints of good medical care. For example, a medication taken once a day is more likely to be taken than one that requires doses four times a day. In recent years, a new option has become available. The drug clonidine may be administered through a transdermal patch. This patch adheres to the skin and is worn for a week. During that time, the drug leaks out slowly and is absorbed into the skin. A preliminary study of this treatment method for hypertension in 20 inner city residents revealed that patients were enthusiastic about this type of treatment and hypertension was better controlled using this method. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, African Americans

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Therapeutic adherence in the elderly: transdermal clonidine compared to oral verapamil for hypertension

Article Abstract:

Patient compliance is always a problem that must be considered in the practice of medicine. Unfortunately, the problem is especially serious in treating high blood pressure (hypertension), since patients with hypertension often feel fine and have little immediate motivation to take pills. Some medications can be administered by transdermal patch, which may be a good method for improving patient compliance. The transdermal patch is stuck onto the skin; this bandage-like device leaks drug into the skin at a very slow rate and the drug can then be carried away by the blood. The antihypertensive drug clonidine is available in a transdermal patch that can be effective for a week. A study was conducted to compare the compliance of patients using the transdermal patch with that of patients taking oral doses of verapamil, another antihypertensive drug. All 58 patients participating in the study were 60 or over and had mild hypertension. The patients were randomly assigned to receive either oral verapamil or the clonidine patch; the clonidine group also received placebo pills and the verapamil group also received dummy patches. Blood pressure declined significantly for both groups. The systolic blood pressure (pressure at the highest point of the pulse) declined from an average of 148 to 135 for the clonidine group and from 156 to 148 for the verapamil group. Patient compliance was virtually complete for the patches. However, neither the clonidine group nor the verapamil group took their pills regularly, which was determined by pill-counting. Fewer than 27 percent of the patients taking verapamil and fewer than 88 percent of the patients taking clonidine had the right number of pills. A significant fraction of the patients had too few pills. The side effects of the two different treatment methods in the present study were comparable, but the patients expressed greater satisfaction with the transdermal patch than with the pills. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Verapamil

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