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Emsam: What Happens When You Cut The Patch?


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#1 In_Remission_Starlite

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Posted 16 July 2008 - 09:21 AM

Has anyone cut the Ensam patch to adjust the dose? The patch is designed to give a dose over 24 hours so if it's cut in half does it give you half the dose over 24 hours or the full dose but over half the time (12 hours)? My pharmacist wasn't sure- she said she didn't think I would get any drug at all- it would just be "lost", which makes no sense. Where would it go? The way the patch is designed it doesn't ooze out of some capule or something. Obviously I would get something- just not sure what.

Anyone have any experience or knowlege with that?



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#2 Serpens

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Posted 16 July 2008 - 11:07 AM

Has anyone cut the Ensam patch to adjust the dose? The patch is designed to give a dose over 24 hours so if it's cut in half does it give you half the dose over 24 hours or the full dose but over half the time (12 hours)? My pharmacist wasn't sure- she said she didn't think I would get any drug at all- it would just be "lost", which makes no sense. Where would it go? The way the patch is designed it doesn't ooze out of some capule or something. Obviously I would get something- just not sure what.

Anyone have any experience or knowlege with that?


You get approximately half the dose. According to my pDoc, this is safe to do, and he has basically all his Emsam patients cut a 12mg/24 patch in half to offset the gargantuan price of the drug. I've been cutting them in half for three months, and haven't noticed any change in efficacy vs the 6mg/24 patches. I can't say for certain that you'll have the same success, but it stands to reason that you should.
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#3 In_Remission_EndOfRope

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Posted 27 August 2008 - 09:42 AM

My doc explained that the med is in the glue. Patching is something like occluding a topical ointment. To taper my dose, he says to overlap the patches. This is great, as long as he gives me samples to sticker myself with. It is so hard (on my bod anyway) to find a big enough area following the correct placement guide that is free from hair... scars... bruises... blemishes... The patches really irritate even the smallest imperfections on my skin & seem to draw everything toward the surface.

#4 medi

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Posted 24 September 2008 - 09:40 AM

Has anyone cut the Ensam patch to adjust the dose? The patch is designed to give a dose over 24 hours so if it's cut in half does it give you half the dose over 24 hours or the full dose but over half the time (12 hours)? My pharmacist wasn't sure- she said she didn't think I would get any drug at all- it would just be "lost", which makes no sense. Where would it go? The way the patch is designed it doesn't ooze out of some capule or something. Obviously I would get something- just not sure what.

Anyone have any experience or knowlege with that?


You get approximately half the dose. According to my pDoc, this is safe to do, and he has basically all his Emsam patients cut a 12mg/24 patch in half to offset the gargantuan price of the drug. I've been cutting them in half for three months, and haven't noticed any change in efficacy vs the 6mg/24 patches. I can't say for certain that you'll have the same success, but it stands to reason that you should.


I was told cutting the patch works, but the challenge is to have it stick completely. It's bad enough when it's not cut! I was on those luxury items for months. No more ADs for me.
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Dx Axis 1: BD II. Had been diagnosed with MDD. Am sometimes also diagnosed with PTSD.
Has undergone ECT in 2008.
Current Meds: Lithium 600 mg, Synthroid 75 mcg, Inderal 80 mgs, Ativan 2 mg or more, as needed, Zolpidem.
Have had experience with: Tricyclics (useless back then), Paxil, Celexa & Lexapro ( the three caused jitteriness&/or mixed states), Wellbutrin (also jitteriness, more severe), MAOI-B (Emsam patch)(hypomania, fun, but no way I could sit at my desk and think), Neurontin (innocuous), Depakote (too much weight gain, hair loss, sleepiness, lack of energy, and no noticeable benefit), Topamax (I'll only cite the suicidality obsession as of 75 mgs....), Lamictal (no benefit), Zyprexa (heart palpitations and shortness of breath at only 2.5 mgs), Abilify 2 mgs (serious GI pain), Calcium Channel Blockers (weak --- verrrry).


#5 Serpens

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Posted 24 September 2008 - 06:13 PM

I was told cutting the patch works, but the challenge is to have it stick completely. It's bad enough when it's not cut! I was on those luxury items for months. No more ADs for me.


I haven't had a problem with adherence really. It wrinkles a little, but I sweat like some sort freak of nature and have never had it come loose.
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#6 rex

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Posted 25 September 2008 - 02:39 PM

Haven't had any problem with adhesion, even when cutting the patch. Just keep fingers away from the adhesive side. I usually alternate between shoulder areas, since it produces blisters on my chest.
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#7 In_Remission_MJS

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Posted 07 June 2009 - 10:16 AM

I regularly use samples and that usually means cutting them. When I went from 6 to 9 to 12 I cut patches to use every last one of them. The drug is too expensive to waste even a single one.

I wish I could say I haven't had a problem with adherence. I've had patches fall off by morning and others so sticky they actually pull off skin. I've had actual sores around the edges where I'd had patches. I'm not overly hairy but I do shave the areas where I place the patches to minimize the pain of removal.

I alternate between my hips and upper arm every other box and my left and right side daily. I found that if I stuck with just my hips or arms I would start developing excruciation muscle pains in the respective limb.

If EMSAM wasn't working for me I would want to move on to something else but the oral alternative will definitely have much worse side effects as I've not suffered from any of the dietary issues whatsoever. I did watch my diet at first but have since returned to my typical diet.

#8 Serpens

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Posted 08 June 2009 - 12:26 AM

Here's a spot to try, unless you've got particularly hairy shoulders. Right over the right or left shoulderblade. Run your fingers over the top of your shoulder and down your back until you feel the bulge to the shoulderblade. That's where you want to put it. Wipe the site down with one of those alcohol prep pads, then wipe over that with a towel so it's dry. Stick the patch on. Never had a problem with one falling off unless it doesn't get on right at first.
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#9 gigantor

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Posted 19 October 2012 - 09:35 AM

I cut a 6mg patch in half when I first started (with the guidance of my pdoc) since 6mg felt too high. 3mg wasn't strong enough so I applied the other half. Bad idea. It didn't feel like I was simply getting 6mg but like I was getting the dose in stereo. I felt like I was being blasted so I removed both halves and applied an intact 6mg patch. Not sure if dose timing had anything to do with it or if it somehow truly acted like two patches at once with its delivery system.
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#10 aerialiste

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Posted 22 October 2012 - 04:32 AM

My former genius pdoc said it was fine to cut patches; I did so for years (both tapering on/off, and using higher-dose patches for a lower dose) and as far as I could tell, there was never any loss of efficacy. Suspect this is just the pharmaceutical company being [insert epithet basically meaning "silly rascals"] but in this as in all things crazymed, YMMV.
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Experience with: Elavil, Prozac, Zoloft, Celexa, Wellbutrin, Remeron, Effexor, Zyprexa, Lamictal, Lithobid, Emsam, Abilify, Seroquel, Deplin, Cymbalta, Trazodone, Risperdal, Saphris, Rozerem, Lunesta, Ambien, Valium, Xanax, Ativan, Klonopin.

#11 gigantor

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Posted 22 August 2013 - 09:13 PM

I'm still on the regular 6mg patch and feel as wonderful as ever. I have middle-of-the-night insomnia which is pretty intense in itself but I've accepted it and work around it. It's a small price to pay for the entire rest of my body, mind, spirit, and life that this medication has given me back.

To those here saying that they cut the patch and it doesn't stay on well, are you first cleaning the area with alcohol? I do this and my patch never comes off at all. Does your patch not stay on because of cutting or do you think that alcohol and applying to a relatively hairless area would work for you?

I ask because I'm considering cutting 12 mg patches.


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#12 AllinMyHead

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Posted 21 April 2014 - 12:10 PM

Hi Gigantor, my pdoc just gave me an Rx for 6 mg patches and advised me to cut them in half, so I'll start with 3 mg. I'm curious, were you able to stay on the 6 mg dose or did you eventually need to increase to 9 mg? 

 

Thank you!


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Current Rx: Remeron (Mirtazapine - Organon brand, 30 mg qhs), Lamictal (100 mg qhs), Clonazepam, (1.5 mg qhs), Trazodone (.25 mg qhs) Levothyroxine (1.37 mg, am)

Current OTC: Multivitamin (food based with a lots of stuff I assume is good for me), Vitamin D3 (1000 UI), Fish oil gel capsules 

 

Non med treatments: rTMS (1 six week round), ECT (10 RUL Ultrabrief)  

Past meds: Emsam TD, Remeron ( x2), Abilify, Seroquel, Risperdal, Welbutrin, Cymbalta, Zoloft, Prozac, Dextromethamphetimine, Adderall, Strattera. 

 

"Against the assault of laughter nothing can stand." -Mark Twain

 



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