Class: Opioid Analgesic. C-II
Dosage Forms. Transdermal Patch: 12 mcg/h, 25 mcg/h, 50 mcg/h, 75 mcg/h, 100 mcg/h
Common FDA Label Indication, Dosing, and Titration.
1. Pain, chronic (moderate to severe), Adults and Children older than 2 y: opioid tolerant, which cannot be managed by other means in opioid-tolerant patients, transdermal fentanyl dosage based on the patient’s current 24-h oral morphine requirement; replace patch q72h; may replace patch q48h in patients not achieving adequate analgesia
Off-Label Uses. None
MOA. Fentanyl is a phenylpiperidine opioid agonist with predominant effects on the mu opioid receptor and is about 50-100 times more potent as an analgesic than morphine.
Drug Characteristics: Fentanyl Transdermal
Medication Safety Issues: Fentanyl Transdermal
Drug Interactions: Fentanyl Transdermal
Adverse Reactions: Fentanyl Transdermal
Efficacy Monitoring Parameters. Relief of pain.
Toxicity Monitoring Parameters. Severe skin rash, excessive drowsiness, decreased breathing, severe constipation, chest pain, inability to urinate, constipation.
Key Patient Counseling Points. Use a stool softener and/or laxative for preventing constipation. May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants. Apply to clean, dry skin. Skin breaks may increase absorption. Remove old patch when new patch applied. Febrile patients may have increased absorption. Monitor carefully.
Clinical Pearls. Use caution in elderly, appear more sensitive to the effects. Tolerance and physical dependence may occur with chronic use, avoid abrupt discontinuation. Significant addiction potential, care with storage and disposal. In an REMs program, provide medication guide. Life-threatening respiratory depression may develop in opioid-naive patients. Substantial differences exist in the pharmacokinetic profile of fentanyl products. Do not convert patients on an mcg-per-mcg basis from one fentanyl product to another fentanyl product; the substitution of one fentanyl product for another fentanyl product may result in a fatal overdose.