Kath Findlay The UK Adhesion Society kath.findlay@adhesions.org.uk http://www.adhesions.org.uk This email has been checked for viruses before posting.
Transdermal Fentanyl Patch. A2 Transdermal administration bypasses GI absorption. Fentanyl is currently the only opioid commercially available in a transdermal form (TDS-Fentanyl). Four patch sizes are available and provide delivery of fentanyl at 25, 50, 75, or 100 mg/hour; therefore, there is flexibility in drug dosing. The maximal recommended daily dose is 300 mg/hour. Patients requiring larger doses should be switched to an equianalgesic dose of an oral or subcutaneously administered opioid.
Each patch contains a 72-hour supply of fentanyl, which is passively absorbed through the skin over this period. Levels in plasma rise slowly over 12 to 18 hours after patch placement, and the dosage form has an elimination half-life of 21 hours. Therefore, unlike intravenous fentanyl, the transdermal administration of fentanyl is not suitable for rapid doseage. Transdermal fentanyl should be considered when patients already on opioid therapy have relatively constant pain and infrequent episodes of breakthrough pain such that rapid increases or decreases in pain intensity are not anticipated. As with other long acting analgesics, all patients should be provided with oral or parenteral rapidly acting short duration opioids to manage breakthrough pain. The most commonly reported side effects of transdermal fentanyl administration are nausea, mental clouding, and skin irritation.
-- ====================================================================Fentanyl, Duragesic®: Do not use this medicine for pain that will go away in a few days such as pain from surgery, doctor or dentist visits or any other short-lasting pain. Once the patch is applied, the medicine is slowly absorbed through your skin into the bloodstream to help control your pain. Fentanyl skin patches are for external use only. Follow the directions on the prescription label. Do not cut or damage the patch. Wash hands well. Select a clean, dry area of skin above your waist on your front or back. Do not apply the patch to oily, broken, burned, cut, or irritated skin. Use only water to clean the area. Do not use soap or alcohol because this can increase the effects of the medication. If the area is hairy, clip the hair with scissors, but do not shave it. Dry the area well before applying the patch. Take the patch out of its wrapper, and take off the protective strip over the adhesive. Do not touch the adhesive with your fingers. Press the adhesive surface to the skin and hold it for 10 to 20 seconds. Be sure the edges stick to the skin. Wash your hands at once. Apply each patch to a different area of skin to avoid irritation. If a patch comes off or causes irritation, remove it and apply a new patch to another site. Do not take the patch out of its pouch before using, and do not use a patch if the packaging or backing has been damaged. To get rid of used patches, fold the patch in half with the sticky sides together. Then, flush it down the toilet. Replace the patch every 3 days (72 hours) or as directed by your prescriber or health care professional. Federal law prohibits the transfer of fentanyl to any person other than the patient for whom it was prescribed. Do not share this medicine with anyone else, it is only for you.
Warnings and precautions:
Other pain relievers may be needed the first or two day you use the fentanyl patch, because it can take some time to start working. You should have medicine to take if you have occasional periods of "breakthrough" pain while using the fentanyl patch. Tell your doctor if fentanyl is not easing your pain.
Use exactly as directed by your doctor. If you are taking fentanyl on a regular basis, do not suddenly stop taking it. Your body becomes used to the fentanyl and when you suddenly stop taking it, you may develop a severe reaction. This DOES NOT mean you are "addicted" to fentanyl. Addiction is a behavior related to getting and using a drug for a non-medical reason. If you have pain, you have a medical reason to take pain medicine such as fentanyl to control your pain.
Avoid exposing the application site to heat sources, such as heating pads, electric blankets, heat lamps, saunas, etc. Heat can increase the amount of fentanyl released from the patch.
You can bathe or swim while using the skin patch. However, do not expose your fentanyl patch site to any source of direct heat, such as saunas or hot tubs.
You may get drowsy or dizzy when you first start taking fentanyl or change doses. Do not drive, use machinery, or do anything that needs mental alertness until you know how fentanyl affects you. Stand or sit up slowly, this reduces the risk of dizzy or fainting spells. These effects may be worse if you are an older patient. The drowsiness should decrease after taking fentanyl for a couple of days. If you have not slept because of your pain, you may sleep more the first few days your pain is controlled to catch-up on missed sleep.
Be careful taking other medicines which may also make you tired. This effect may be worse when taking these medicines with fentanyl. Alcohol can increase possible drowsiness, dizziness, and confusion and may affect your breathing. Avoid alcohol while taking fentanyl.
Fentanyl will cause constipation. Make sure to take a laxative and/or a stool softener while taking fentanyl. Try to have a bowel movement every 2-3 days, at least. If you do not have a bowel movement for 3 days or more call your prescriber or health care professional. They may recommend using an enema or suppository to help you move your bowels.
What should my health care professional know before I use fentanyl? They need to know if you have any of these conditions:
a.. diarrhea b.. head injury c.. heart disease d.. intestinal disease e.. kidney disease f.. liver disease g.. lung disease or breathing difficulties h.. seizures (convulsions) i.. an allergic or unusual reaction to fentanyl, meperidine, other medicines, adhesives, sulfites, foods, dyes, or preservatives j.. pregnant or trying to get pregnant k.. breast-feeding What other medicines can interact with fentanyl?
a.. medicines for high blood pressure b.. medicines for seizures Because fentanyl may cause drowsiness, other medications that also cause drowsiness may increase this effect of fentanyl. Some medicines that cause drowsiness are:
a.. alcohol and alcohol-containing medicines b.. barbiturates, such as phenobarbital c.. certain antidepressants or tranquilizers d.. muscle relaxants e.. certain antihistamines used in cold medicines Ask your prescriber or health care professional about other medicines that may increase the effect of fentanyl.
Side Effects: Inform you physician if you experience any of the following:
a.. itching b.. blurred vision c.. clumsiness, unsteadiness d.. constipation e.. decrease or difficulty passing urine f.. dizziness, drowsiness g.. dry mouth h.. flushing i.. headache j.. nausea/vomiting k.. pinpoint pupils l.. sweating Symptoms Requiring That You Contact Your Physician Immediately:
Rare or uncommon:
a.. breathing difficulties, wheezing b.. cold, clammy skin c.. seizures d.. slow or fast heartbeat e.. severe rash f.. unusual weakness More common:
a.. confusion b.. lightheadedness or fainting spells nervousness or restlessness
It is not the intention of UKAS to provide specific medical advice, but rather to provide users with information to better understand their diagnosed disorders. UKAS urges you to consult with a qualified medical physician, preferably with some knowledge and understanding of adhesions and their related disorders.
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