Dotti 0.0375 mg/day twice-weekly patches are currently difficult to obtain. During this shortage, a prescriber may consider one of the following options for an individual patient:
- Temporarily authorizing one-half of a Dotti 0.075 mg/day patch twice weekly;
- Changing the patient to once-daily estradiol gel in a prescriber-selected strength; or
- Locating an intact 0.0375 mg/day patch at another pharmacy.
These are different treatment pathways. Skippack Pharmacy cannot automatically change a patient’s product, strength, dosage form, or directions without prescriber authorization.
Temporary half-patch option
Some prescribers may consider authorizing one-half of a Dotti 0.075 mg/day patch for selected patients. Cutting a Dotti patch is an off-label use that is not included in the manufacturer’s approved instructions. The FDA-approved prescribing information does not provide instructions or data regarding dose delivery, adhesion, stability, storage, or performance after a Dotti patch is cut. It should not be assumed to be identical to using an intact Dotti 0.0375 mg/day patch, and it may not be appropriate for every patient.
Once-daily estradiol gel option
A prescriber may instead consider changing the patient to estradiol gel. Estradiol gel is a different medication-delivery system with different strengths, application instructions, and dosing frequency. There is no FDA-established conversion showing that a particular gel strength is equivalent to the Dotti 0.0375 mg/day patch. Skippack Pharmacy currently has access, subject to continued wholesaler availability, to the following estradiol gel 0.1% single-dose packets:
- Estradiol gel 0.25 mg/0.25 g
- Estradiol gel 0.5 mg/0.5 g
- Estradiol gel 0.75 mg/0.75 g
The patient’s prescriber must determine whether estradiol gel is appropriate and select the strength based on the reason for treatment, medical history, previous response to estrogen, symptoms, treatment goals, and clinical judgment.
Prescriber authorization is required
Skippack Pharmacy cannot automatically:
- Substitute the Dotti 0.075 mg/day patch;
- Change the patient’s directions to one-half patch;
- Change the patient from a patch to a gel; or
- Select an estradiol gel strength for the patient.
The prescriber may send Skippack Pharmacy a new prescription or contact the pharmacy to provide documented authorization for the selected product, strength, and directions.
Do not purchase, cut, apply, or change how you use your medication based only on the information on this page. Wait until your prescriber has authorized the change and Skippack Pharmacy has dispensed the medication with patient-specific instructions.
These are temporary shortage options—not permanent guarantees
Our team continues to check availability for intact Dotti 0.0375 mg/day patches and other potential alternatives. Availability of the Dotti 0.075 mg/day patch and estradiol gel may also change. If intact Dotti 0.0375 mg/day patches become reliably available again, the patient and prescriber may choose to reevaluate the temporary treatment plan.
Options to discuss with your prescriber:
Ask About the Temporary Half-Patch Approach
Contact your prescriber and ask whether this temporary option is appropriate for you.
-
- Your prescriber may approve or decline the option based on your individual treatment plan.
- If approved, your prescriber may send us a new prescription or call Skippack Pharmacy with verbal authorization for the change.
- Do not cut or use the 0.075 mg/day patch until we have received your prescriber’s authorization and provided your instructions.
Ask About Once-Daily Estradiol Gel
Skippack Pharmacy may be able to obtain estradiol gel in 0.25 mg, 0.5 mg, and 0.75 mg single-dose packets.
There is no exact established conversion between the Dotti 0.0375 mg/day patch and one specific gel strength. Your prescriber must determine:
- Whether estradiol gel is appropriate for the reason you are receiving estrogen;
- Which gel strength should be prescribed;
- When you should stop using the patch and begin using the gel;
- Whether any other hormone medications should be continued or adjusted; and
- When your response to the new product should be reevaluated.
If gel is selected, your prescriber may send Skippack Pharmacy a new prescription with the chosen strength and directions.
Skippack Pharmacy cannot select the gel strength or automatically change your patch prescription.
Look for an Intact 0.0375 mg/day Patch
If you prefer to continue using a complete, intact 0.0375 mg/day patch, you may need to locate another pharmacy that currently has it available.
Confirm availability with the receiving pharmacy first because inventory can change quickly. When permitted, the receiving pharmacy may contact Skippack Pharmacy to request a transfer of eligible remaining refills. In some circumstances, your prescriber may need to send a new prescription.
Patient FAQ
Why am I receiving this notification if I was already approved through the estradiol shortage form?
Estradiol patch availability changes frequently, sometimes from day to day. Our team continues to monitor inventory and work to maintain access to all strengths.
At this time, we have an adequate supply of several other estradiol patch strengths. However, Dotti 0.0375 mg/day remains especially difficult to obtain across the market. You are receiving this notification so you know what to expect before your next refill and can review the options currently available.
Previous approval through our shortage form does not guarantee that the same product or strength will remain available for future fills.
PATCH - Why are you offering a 0.075 mg/day patch instead?
Dotti 0.0375 mg/day patches are currently difficult to obtain. We presently have limited access to Dotti 0.075 mg/day patches, which may provide a temporary option when divided evenly in half with your prescriber’s approval. Availability can change quickly and is not guaranteed.
PATCH - Does one-half of a 0.075 mg/day patch provide the same dose as an intact 0.0375 mg/day patch?
The Dotti prescribing information describes proportional differences in patch surface area and states that the composition per unit area is identical. Based on that information, a prescriber may determine that using one-half of the 0.075 mg/day patch is a reasonable temporary option for an individual patient.
However, the manufacturer has not evaluated or guaranteed the dose delivery, adhesion, stability, or performance of a cut Dotti patch. It should not be assumed to be identical to using an intact 0.0375 mg/day patch. This option may be used only when specifically authorized by the patient’s prescriber and dispensed with individualized pharmacy instructions.
PATCH - Can I cut my patch without contacting my doctor?
No. Do not change your dose or cut the patch on your own. Cutting Dotti is an off-label, temporary option we identified to help address the current shortage, but it may not be appropriate for every patient.
Your prescriber must decide whether to approve this option. If approved, the prescriber may send Skippack Pharmacy a new prescription or call us with verbal authorization for the change. We cannot automatically change the strength or directions without that approval.
PATCH - Does this apply to all Dotti strengths?
No. This page addresses the current availability problem involving the 0.0375 mg/day strength and the specific temporary Dotti 0.075 mg/day half-patch approach described here.
Do not cut a patch of another strength or change how you use any estradiol product unless your prescriber has authorized the change and Skippack Pharmacy has provided product-specific instructions.
PATCH - Will my application schedule change?
The schedule must follow the directions on the newly authorized prescription label. Do not assume that your existing directions remain unchanged.
PATCH - Does my prescriber have to approve the half-patch option?
Yes. Your prescriber may approve the option, decline it, or recommend a different treatment plan. Skippack Pharmacy is making patients and prescribers aware of this temporary possibility because of the current supply issue, but we cannot determine that it is appropriate for every patient.
PATCH - I am willing to use another brand of estradiol 0.0375 mg/day patches. Can you obtain a different brand or generic?
At this time, we are unable to obtain a brand-name or generic estradiol patch in the 0.0375 mg/day strength through our available suppliers.
Our current supplier access is limited across multiple products in this strength. Availability can change, and we will continue checking for any 0.0375 mg/day product that becomes available.
PATCH - Can I cut another brand of estradiol patch?
Do not cut any estradiol patch unless your prescriber has specifically authorized it and your pharmacist has confirmed the instructions for the exact product being dispensed.
Patch construction, labeling, adhesion, and storage requirements may differ by manufacturer. The information on this page relates only to the specific Dotti product and shortage situation described here and should not be applied to another brand, strength, or transdermal product.
PATCH - How should I cut, store, and apply it?
If your prescriber approves this option, Skippack Pharmacy will provide specific patient instructions. Follow those directions exactly. Do not cut another brand or type of patch unless a pharmacist confirms it may be cut.
GEL - Is estradiol gel another possible option?
Yes. A prescriber may consider changing an appropriate patient from the unavailable Dotti patch to once-daily estradiol gel.
Estradiol gel is not the same dosage form as a patch, and the change requires a new prescription or documented prescriber authorization.
GEL - What estradiol gel strengths can Skippack Pharmacy obtain?
Subject to continued availability, Skippack Pharmacy may be able to obtain:
- Estradiol gel 0.25 mg/0.25 g
- Estradiol gel 0.5 mg/0.5 g
- Estradiol gel 0.75 mg/0.75 g
Each strength is supplied in individual single-dose packets.
GEL - Which gel strength is equal to my Dotti 0.0375 mg/day patch?
There is no exact FDA-established conversion identifying one of these gel strengths as equivalent to the Dotti 0.0375 mg/day patch.
For its labeled indication, the estradiol gel prescribing information starts therapy at 0.25 mg once daily and permits adjustment based on clinical need. This labeled starting dose should not be interpreted as a direct conversion from Dotti 0.0375 mg/day.
The number on a Dotti patch represents its nominal estradiol delivery rate per day. The number on the gel packet represents the amount of estradiol contained in the gel being applied. These numbers should not be compared milligram-for-milligram.
Your prescriber must select the gel strength based on your individual treatment needs and response.
GEL - Is the 0.75 mg gel automatically the closest replacement?
No. Skippack Pharmacy is not identifying the 0.75 mg, 0.5 mg, or 0.25 mg packet as the automatic replacement for every patient taking Dotti 0.0375 mg/day.
A prescriber may choose any clinically appropriate strength or recommend a different treatment option.
GEL - How often is estradiol gel applied, and where?
Estradiol gel is generally applied once daily to the right or left upper thigh, alternating thighs each day.
Apply the entire contents of the prescribed packet in a thin layer over an area approximately 5 by 7 inches, or about the size of two palm prints. Allow it to dry before dressing, wash your hands afterward, and do not wash the application site for at least one hour. Do not apply it to the face, breasts, irritated skin, or in or around the vagina.
Do not allow another person to touch the application area for at least one hour after application. After the gel has dried, cover the application site with clothing.
Estradiol gel contains alcohol and is flammable. Avoid fire, flame, or smoking until the gel has completely dried.
GEL - Is estradiol gel appropriate for every patient taking Dotti?
Not necessarily.
Dotti has several labeled uses. The estradiol gel products discussed on this page are specifically labeled for moderate to severe vasomotor symptoms, such as menopausal hot flashes.
If Dotti was prescribed for vaginal symptoms, hypoestrogenism, osteoporosis prevention, or another reason, the prescriber must determine whether estradiol gel is an appropriate alternative.
GEL - Can Skippack Pharmacy choose the gel strength for me?
No. Selecting a gel strength is a clinical treatment decision that must be made by your prescriber.
Skippack Pharmacy can provide the prescriber with information about the products and strengths currently available, but we cannot determine which strength is appropriate for an individual patient.
GEL - Should I continue my progesterone or other hormone medication?
Continue all other medications exactly as prescribed unless your healthcare provider changes them.
Changing the estrogen product does not automatically change the directions for progesterone or another hormone medication. Your prescriber should review your complete hormone-therapy plan.
I found another pharmacy that has the 0.0375 mg/day patch in stock. What should I do?
That is great news! Our goal during this shortage is not to profit from a difficult situation—it is to help our patients and community maintain access to their medication.
Please ask the pharmacy that has the patch in stock to call Skippack Pharmacy. When permitted, we will transfer the remaining refills on your prescription directly to them.
Because inventory can change quickly, we recommend confirming that the pharmacy still has the medication available before requesting the transfer.
Will I need to do this with every refill?
Hopefully not. Our goal is to resume filling Dotti 0.0375 mg/day patches as usual as soon as we can reliably source them.
However, availability can change quickly, and we cannot guarantee when this strength will be consistently available. We will review the available options with each refill and let you know if any additional action is needed.
Do you know when the 0.0375 mg/day patch will be back in stock?
Unfortunately, we do not have a confirmed restock date. Supply changes frequently, and availability is not guaranteed.
If this shortage page remains active, it means our access to the 0.0375 mg/day patch remains limited or inconsistent. We will update or remove this notice when we can reliably resume filling the medication.
Prescriber Information
Option 1: Temporary Dotti Half-Patch Approach
Dotti Construction:
- The labeled three-layer system includes an adhesive formulation containing estradiol.
- The prescribing information states that the composition of the systems per unit area is identical.
- The 0.0375 and 0.075 mg/day systems have labeled active surface areas of 2.83 cm² and 5.66 cm², respectively.
Providing Prescriber Authorization:
If clinically appropriate, the prescriber may authorize this temporary change by:
• Sending Skippack Pharmacy a new prescription for Dotti 0.075 mg/day with directions to use one-half patch; or
• Calling Skippack Pharmacy and providing verbal authorization for the strength and direction change.
The prescriber determines the final product, dose, directions, quantity, refills, duration, and clinical appropriateness. Skippack Pharmacy will document the authorization and provide the patient with product-specific instructions.
Example directions: “Apply one-half of one Dotti 0.075 mg/day patch to the skin twice weekly.”
Option 2: Once-Daily Estradiol Gel
Estradiol gel may be considered as a separate treatment option for an appropriate patient. It should not be presented as a direct or automatically equivalent substitution for Dotti 0.0375 mg/day.
The available gel product is labeled for moderate to severe vasomotor symptoms due to menopause. Dotti has additional labeled indications; therefore, the prescriber should confirm that the gel is appropriate for the patient’s treatment indication.
Products currently accessible through Skippack Pharmacy, subject to availability:
- Estradiol gel 0.1%, 0.25 mg/0.25 g, 30 single-dose packets
- Estradiol gel 0.1%, 0.5 mg/0.5 g, 30 single-dose packets
- Estradiol gel 0.1%, 0.75 mg/0.75 g, 30 single-dose packets
There is no FDA-established conversion between Dotti 0.0375 mg/day and a particular estradiol gel packet strength. The prescriber should select the strength and adjust treatment based on the patient’s indication, prior estrogen exposure, symptom control, tolerability and clinical response.
Example prescription format:
Estradiol gel 0.1%, ___ mg/___ g single-dose packets
Apply the entire contents of one packet to the right or left upper thigh once daily, alternating thighs.
Quantity: 30 packets
Refills: Prescriber discretion
The prescriber determines the final product, strength, directions, transition timing, quantity, refills, treatment duration and clinical appropriateness.
What authorization is needed?
For the temporary half-patch approach: If clinically appropriate, send a prescription for Dotti 0.075 mg/day with clear directions to apply one-half patch twice weekly, or contact Skippack Pharmacy to provide authorization for the strength and direction change.
For estradiol gel: Send a prescription identifying the selected gel strength, application directions, quantity and refills. Skippack Pharmacy cannot select the gel strength or automatically convert the existing patch prescription.
The prescriber remains responsible for determining the product, strength, schedule, duration and clinical appropriateness for the individual patient.
What supports the dose-by-area rationale?
Dotti contains estradiol within its adhesive layer. The prescribing information lists progressively larger active surface areas and estradiol contents for higher strengths and states that the composition per unit area is identical. Because the 0.0375 mg/day and 0.075 mg/day systems have proportional active surface areas and identical composition per unit area, a prescriber may infer that halving the active surface area could approximate the nominal delivery rate of the 0.0375 mg/day system. This is a clinical inference, not a manufacturer-approved conversion or labeled instruction.
Are all estradiol patches interchangeable or suitable for cutting?
No. Patch designs differ. This information is specific to the Dotti drug-in-adhesive system and should not be generalized to reservoir patches, other manufacturers, or other transdermal products.
What counseling limitation should be considered?
The Dotti label directs storage in the protective pouch and application immediately after removal. Storage and performance of a cut portion have not been specifically guaranteed by the manufacturer. Patients should receive and follow the pharmacy’s product-specific instructions.
Important Notice:
This page provides general information about temporary options that a patient’s prescriber may consider during the Dotti 0.0375 mg/day shortage. It is not an individualized treatment recommendation.
Use of one-half of a Dotti 0.075 mg/day patch is off-label. The FDA-approved prescribing information does not provide instructions or data regarding dose delivery, adhesion, stability, storage, or performance after a Dotti patch is cut.
Estradiol gel is a different medication-delivery system with different strengths, application instructions, labeled indications and dosing frequency. There is no FDA-established conversion demonstrating that a particular estradiol gel strength is equivalent to the Dotti 0.0375 mg/day patch.
Skippack Pharmacy does not recommend that every patient cut a patch or change to estradiol gel. The patient’s prescriber must determine whether either option is clinically appropriate and must authorize the product, strength and directions before dispensing.
Patients should not cut a patch, change products, select a gel strength or alter their medication schedule without patient-specific instructions from their prescriber and pharmacist.