Covers still being applied without the clonidine patch

Clonidine is a medicine used to treat high blood pressure (hypertension). It is available as a medicine patch (clonidine transdermal system [Catapres-TTS]) in various doses (Catapres-TTS-1 [0.1 mg/day], Catapres-TTS-2 [0.2 mg/day], and Catapres-TTS-3 [0.3 mg/day]). This medicine is packaged in a carton containing individually labeled pouches of 4 clonidine patches and 4 adhesive covers (Figure 1). The adhesive cover does not contain any medicine and should be applied directly over the clonidine patch only if the patch begins to separate from the skin.

ISMP and the US Food and Drug Administration (FDA) continue to receive error reports about patients and caregivers who apply only the adhesive cover to the skin, without the clonidine medicine patch. Because there is no medicine in the cover, the error has led to uncontrolled blood pressure. The cover is larger than the clonidine patch, which makes it difficult to confirm that the patch is under the cover. While the pouches that hold the patches are labeled, the patches themselves are not labeled with the drug name. Also, the adhesive cover does not state that it does not contain any medicine. 

clonidine patch.FDA

Here’s what you can do: If you or a family member are prescribed a clonidine patch, talk to your healthcare provider and pharmacist about how to correctly use and apply the medicine. Read the Patient Instructions, found in the carton, before using the clonidine patch. Remember the following:

  • The clonidine transdermal system is packaged in a carton that contains both clonidine patches and adhesive covers. 
  • The adhesive cover does not contain any medicine.
  • Only apply the adhesive cover if the clonidine patch begins to loosen from the skin after application during the 7-day period; if used, place the adhesive cover directly over the patch.
  • If you have any questions, contact your healthcare provider or your pharmacist.

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