Fentanyl (transdermal)

Overview

Fentanyl is a narcotic medication, which can be administered via a skin patch. Commonly used after surgery, this medication relieves pain by targeting the central nervous system.

Applied by a healthcare provider, this medication is generally applied to the upper outer arm or chest while in a hospital or healthcare center. Fentanyl is prescribed mainly for the management of moderate to severe pain that cannot be treated using other means, including non-steroidal analgesics, immediate release opioids or opioid combination medications.

This medication is a narcotic and may cause mental or physical dependence. If stopped suddenly, adverse side effects can happen. When used under close supervision of the prescribing physician, addiction is not likely to occur.

In addition to its medical effects, Fentanyl may also alter a patient's mood or cause intense drowsiness.

Because exposure to heat may lead to accidental overdose, this medication should be stored away from heat sources and anyone using this medication should avoid activities which could lead to elevated body temperature.

Conditions Treated

  • Moderate to Severe Long-Term Pain

Type Of Medicine

  • Opioid Analgesic

Side Effects

Side effects have been known to occur with the use of the Fentanyl patch. Along with the relief of pain, this medication is known to cause mood alteration, feelings of euphoria, drowsiness and dysphoria. Fentanyl affects the coughing reflex and constricts the patient's pupils. This medication may cause nausea or vomiting.

Because Fentanyl causes a slower gastrointestinal transit time, it can lead to constipation. It may also lead to a sense of urinary urgency.

Reddening or irritation of the skin at the application site might occur, especially within 6 hours after removal of the Fentanyl skin patch.

As with any narcotic medication, Fentanyl can lead to dependency, so should only be used under the direct supervision of a physician.

Additional side effects associated with Fentanyl include:

  • Blurry vision
  • Chest pain
  • Convulsions
  • Difficulty urinating
  • Dizziness
  • Dry mouth
  • Increased thirst
  • Loss of appetite
  • Mood swings
  • Muscle cramps
  • Pale skin
  • Rapid Breathing
  • Sore throat
  • Sunken eyes
  • Tightness in the chest
  • Ulcers or sores in the mouth
  • Unusual fatigue
  • Wrinkled skin

These are only some of the side effects of Fentanyl, and any unusual symptoms should be reported to a medical professional.

Dosage

As with any medication, Fentanyl should only be used by the person it is prescribed to. This medication is available as an extended release patch or as a device assisted patch for adults and children over the age of two. The patch is generally applied to the chest or upper arm by a healthcare provider. The dose of Fentanyl prescribed will vary from patient to patient.

For patients using the skin patch for chronic pain, one patch is applied to the skin and left there for 72 hours. The dosage may be adjusted by a physician during treatment.

The dose required for effective treatment may be considerably different between patients. The recommended dose is between 25 and 100 mcg per hour via a patch applied every three days. Dosage may be delivered between 12 and 100 mcg per hour.

A standard dose of Fentanyl is equivalent to 360 mg per day of oral morphine, according to the manufacturer.

If the patch is not worn or changed and a missed dose occurs, it should be reapplied when it is time to administer the new patch. Extra patches should not be applied if a dose is missed. Unless ordered to do otherwise by a physician, the Fentanyl patch should not be used at home or outside of a hospital setting.

This medication should not be taken for any longer than prescribed by a physician. A complete medication guide is available with prescription and any questions should be referred to the prescribing physician or a pharmacist.

Other forms of Fentanyl, including oral, injection, nasal spray and sublingual options are available. These may not be appropriate if continuous treatment is required. Doses are not equivalent between varied formulations. For example, a 25 mg oral dose does not equal a 25 mg dose via a patch. Increasing doses provide increased relief, and this medication does not plateau at a certain dosage level.

Major Drug Interactions

Taking another drug, herb or nutritional supplement, whether over the counter or prescription, along with Fentanyl could lead to serious drug interactions. The prescribing physician should be informed of any medications currently being taken by the patient to prevent drug interactions.

Other Central Nervous System Depressants, such as opioids, sedatives, muscle relaxants, tranquilizers, hypnotics or general anesthetics can lead to severe medical issues, including coma. If these medications must be used together, the dose of one or the other should be reduced significantly.

Antipsychotics, such as Thorazine and Stelazine should not be used with Fentanyl, unless ordered by a physician.

Alcohol and illicit drugs may interact with Fentanyl.

Some antihistamines, such as dipehnhydramine, may interact with Fenanyl and cause a decreased heart rate.

Certain antibiotics, heart or blood pressure medications and antifungal medications may interact with Fentanyl, as may medications used to treat HIV or AIDS.

Potentially fatal respiratory distress could occur when Fentanyl is used with CYP3A4 inhibitors, including but not limited to Ritonavir, Clarithromycin, Fluconazole and Verapamil.

This medication should not be used along with Amifampridine, Naltrexone or Mifepristone.

The use of Fentanyl along with Josamycin or Spiramycin may increase the risk of certain side effects, and the dosage of one or both medications may be reduced during treatment.

Fentanyl, in any form, should never be mixed with sleeping aids or tranquilizers, unless specifically ordered by a doctor. Doing so could lead to death.

More than 900 drugs are known to interact with Fentanyl in some way.

The prescribing physician may prohibit the consumption of certain foods while the Fentanyl patch is being used. A change of diet may be necessary during treatment to avoid interactions.

Fentanyl may interact with grapefruit juice. The consumption of any grapefruit product while taking Fentanyl is not recommended, as it may increase the level of the medication found in the blood, leading to accidental overdose. In some cases, this interaction could be life threatening.

Patients should consult with their physician before taking vitamins and Fentanyl concurrently.

Warnings

The Fentanyl patch should only be used under the direct supervision of a physician. It is generally administered in a hospital setting.

This medication should only be taken by the person it is prescribed to. If Fentanyl is taken by someone to whom it is not prescribed, serious side effects and even death could occur. Fentanyl is a powerful pain medication with a high potential for abuse. As such, it should be stored securely and the prescribing physician contacted immediately if this medication is lost or stolen.

A doctor should be informed of any allergies, including those to other medications, foods, preservatives or dyes.

Fentanyl may be prescribed to children, but the safety of this medication has not been established for children under the age of two.

This medication is safe for use by geriatric patients, however, since this age group is more susceptible to drowsiness and age-related problems in the lungs, the dosage may be adjusted for older patients.

Certain medical problems can affect the use of Fentanyl. It is important that the patient discuss their complete medical history with the prescribing physician before taking this medication. Patients with a history of drug or alcohol abuse should weigh the pros and cons of taking this medication with the prescribing physician before it is administered.

Patients with a history of any of the following medical conditions should consult with a physician before taking this medication:

  • Brain tumors
  • Bradyarrhythmia
  • Chronic obstructive pulmonary disease
  • Depression
  • Drug or alcohol dependence or abuse
  • Gallbladder disease (such as gallstones)
  • Head injury
  • Heart conditions
  • Hypotension (low blood pressure)
  • Kidney disease
  • Liver disease
  • Low oxygen levels or breathing problems
  • Pancreatitis
  • Seizures
  • Weakened immune system

This medication should not be taken longer than a physician has ordered.

The Fentanyl skin patch is only indicated for use in patients who are tolerant to opioids. If oral opioids have never been used previously to manage pain, this medication should be prescribed with caution.

Like other narcotic medications, Fentanyl skin patches may cause urinary urgency in some patients, and difficulty with urination with other patients.

In some cases, Fentanyl may cause fainting.

Using a Fentanyl patch or any opioid analgesics, could worsen or prolong cases of infectious diarrhea. Because this could lead to dehydration and other serious side effects, Fentanyl should be used with care by patients who are experiencing diarrhea, particularly when accompanied by a high fever and blood or pus in the stool.

A nurse or other trained health care professional will administer this medication while the patient is in the hospital. This patch should be removed before a patient leaves the hospital. Patients should not leave the hospital with a Fentanyl patch on their skin. This medication will only work when applied correctly.

A Fentanyl skin patch should not be applied to skin that is irritated or injured. This medication should not be ingested, chewed or swallowed. The patch should never be placed in or around the mouth.

This medication is packaged in a sealed pouch. The patch should not be removed from the sealed pouch until it is time to apply it.

Anyone handling this medication should avoid any contact with the adhesive surface of the patch. If the medication does come in contact with the hand, the skin should immediately be rinsed with clear water. Soap or other cleansers should not be applied.

Special care should be taken not to tear or damage the patch in any way. A damaged patch may allow the medication to pass through the skin too quickly, resulting in an overdose.

The Fentanyl patch should be attached to a dry, flat area of skin on the chest, upper arm or back. This medication should be applied in an area that is not extremely oily and is free of cuts, scars, burns or skin irritation. The patch will remain in place better if applied to a portion of the skin that has little or no hair. If this medication must be attached to an area with hair, it may be clipped first with scissors but the area should not be shaved. Fentanyl should not be applied to any area that has received radiation therapy.

If the area of application must be cleaned prior to application, only plain water should be used. No soaps, detergents, lotions, cleansers or products containing alcohol should be used.

The liner covering the adhesive portion of the skin patch should be removed before application. The patch should be placed firmly in place, using the palm of the hand for no less than 30 seconds. The entire adhesive surface should be attached to the skin, with emphasis on the areas around the edges.

If the skin patch loosens, the edges may be taped with first aid tape. If the patch falls off after application, it should be thrown away and a new patch applied to a different area.

If more than one patch is required at once, the patches should be placed far enough apart that the edges to not touch or overlap.

The Fentanyl patch should be removed after 72 hours or as directed by a physician. If another patch is applied, it should be on a different place on the body. At least 3 days should pass before a patch is applied to an area where it has already been attached.

For children or anyone with decreased mental alertness, this patch should be placed on the upper back to prevent the patch from being removed and/or being placed in the mouth.

Fentanyl passes through the skin a little bit at a time. Because a certain amount of the medication must accumulate on the skin before this medication can be absorbed, it can take up to 24 hours for the first dose to work. The prescribing physician may adjust the dose during the first few weeks of treatment to determine which dose works best for the patient. Even if the patient feels that the medication is not working, the dose should not be increased without first consulting the prescribing physician.

An oral narcotic may be indicated to reduce pain during the first few days of treatment with the Fentanyl patch. Any other narcotic described should be taken as directed. Taking more than one narcotic at one time may increase the chances of serious side effects.

The Fentanyl patch contains a high concentration of an opioid substance that has the highest potential for abuse and the associated risk of a fatal overdose.

This medication should only be prescribed to patients who have already received treatment with an opioid and demonstrated tolerance. Those who are not considered opioid-tolerant may suffer life-threatening hypoventilation.

Because peak concentrations of this medication usually occur between 20 and 72 hours after placement of the patch, patents should be closely monitored during this time, particularly if they are at high risk.

Fentanyl can lead to respiratory depression.

The Fentanyl patch may be abused in a similar way to opioids, legal or illicit. The risk of abuse should be considered when this medication is prescribed, administered or dispensed.

Those with a family or personal history of substance abuse, including alcohol or drug addiction, or those with mental illness may have an increased risk of opioid abuse. Patients should discuss the risk of opioid abuse or addiction with the prescribing physician. Consistent monitoring should occur for patients at high risk for misuse or addiction.

Following prolonged use, or if physical dependency is suspected, withdrawal of opiate therapy practices should be followed and the medication reduced using a dosage-tapering schedule. Abrupt stopping of Fentanyl can lead to serious withdrawal symptoms in both children and adults.

The Fentanyl patch is only indicated for use on intact skin. This medication should not be used if the pouch that it comes in has a broken seal or if the patch is cut, damaged or appears tampered with.

This patch should not be applied near external heat sources such as lamps, heating pads, hot tubs or electric blankets. Patients wearing a Fentanyl patch should avoid taking hot baths and showers, or sunbathing. The amount of Fentanyl released may increase due to increased temperature, resulting in an overdose. Patients who develop a fever or increased body temperature should be closely monitored while taking this medication and the dose may be adjusted as necessary.

Serious medical problems and even death have occurred in people who were accidentally exposed to Fentanyl. Accidental exposure can occur when the medication is transferred from adult to child while hugging or by exposure to a caregiver's skin while applying medication or removing the patch.

Using a Fentanyl patch in any way other than indicated can lead to serious medical problems or death.

Fentanyl could be sought out by those who abuse drugs and the sale of this medication can result in criminal prosecution. Because it can be used in a similar way to illicit drugs, it should be prescribed with care. Concerns regarding abuse or addiction should not prevent the use of this medication for appropriate pain management, when indicated by a physician.

A professional licensing board or state controlled substance authority may be contacted for instructions on the prevention and detection of respiratory depression. This condition may occur at any time during the use of this medication, but the highest risk is 24-72 hours prior to initiation of therapy or after a dose increase.

The patient should be observed during treatment for signs of respiratory distress. Signs of respiratory depression caused by opioids include a reduced urge to breath and decreased respiration rates, often causing a sighing pattern of breathing. Serious and life-threatening respiratory depression has occurred, even in patients who are using Fentanyl as directed. Proper dosage and administration of this medication is essential for avoiding life threatening effects. Overestimating the proper dose can lead to overdose, even with the first dose of this medication.

Some foods may interact with Fentanyl. A change in diet may be indicated during the course of treatment, based on a physician's instructions. In particular, grapefruit juice may increase the level of Fentanyl in a patient's blood.

While taking Fentanyl, patients should avoid eating grapefruit or consuming grapefruit juice. An alternative citrus beverage may be consumed. Adverse effects have occurred even when grapefruit juice is not consumed at the same time that a Fentanyl patch is used. If a product containing grapefruit is consumed during treatment, medical treatment should be sought. In some cases, life-threatening overdoses may occur from the consumption of grapefruit products while taking Fentanyl or similar opioid medications.

Patients with chronic obstructive pulmonary disease, or cor pulmanole, should use caution when taking the Fentanyl patch. The lowest appropriate dose of this medication should be prescribed or treatment with a non-opioid pain medication considered.

Those with previous head injuries and increased intracranial pressure should use this medication with caution.

Patients with Addison's disease may be at increased risk for respiratory depression while using Fentanyl.

The Fentanyl skin patch may exacerbate certain effects of hypothyroidism, including lethargy, depression and constipation. Those with uncontrolled hypothyroidism may be prescribed Fentanyl in a lower dose. Using Fentanyl by patients with hypothyroidism may also increase the risk of respiratory depression and other serious side effects.

Those with seizure disorders may experience worsened seizures while using this medication, especially at a high dose. This medication should be used cautiously by those who are predisposed to seizures.

Patches should always be kept out of the reach of children, whether used or new. A considerable amount of the active medication may remain in the patch, even after it is used and discarded. Accidental or deliberate application or ingestion of this medication by a child could result in death.

The Fentanyl patch should be used with caution for patients with cardiac disease.

Because no significant information exists on the use of this medication in patients with impaired renal or hepatic function, it should be used with caution if prescribed.

The Fentanyl patch can cause spasm of the sphincter of Oddi, so patients with pancreatitis should use this medication with caution.

After a period of time, patients may develop a tolerance to this medication, reducing its effect over time. Tolerance may affect the desirable and undesirable results of this medication and may occur at different rates for different individuals.

Physical dependence may occur with the use of this medication, so stopping suddenly may result in adverse side effects, some of which are severe. Withdrawal symptoms include restlessness, insomnia, perspiration, chills, irritability, anxiety, weakness, abdominal cramps, nausea, vomiting, diarrhea, increased heart rate or high blood pressure. Unless specifically ordered to do so by a physician, patients should not immediately stop using this medication.

This medication often impairs the physical or mental capabilities of patients. Performing tasks that require concentration, such as driving a car or operating machinery should not be completed while taking Fentanyl.

CYP45 inducers can speed the metabolism of Fentanyl, which can cause accidental overdose.

Patients and their caregivers should be provided with a medical guide when prescribed this medication. This medical guide may be updated each time that it is dispensed. Patients should be told that this medication contains Fentanyl, a medication that is similar to morphine, methadone and oxycodone.

The skin should be cleaned with clear water and completely dried prior to application of the patch.

This patch should not be folded.

Patients should not adjust the patch without the supervision of a healthcare professional.

While the patch is applied, patients should avoid the use of heating pads, electric blankets, saunas tanning lamps or heated water beds.

If a patch accidentally falls off and sticks to the skin of another person, they should take it off immediately, rinse the area with clear water and seek immediate medical care.

Any unused patches should be disposed of as directed by a physician.

Women who are pregnant, nursing or planning to becoming pregnant, should speak to their physician before taking this medication. When used while pregnant, this medication can cause dependency in unborn children. This can lead to life-threatening withdrawal symptoms once the baby is born. Babies born on this or any other habit forming medication may require several weeks of medical treatment to successfully withdraw from this medication.

Because Fentanyl passes across the placenta, it is not recommended for pain relief during labor and delivery. This medication is excreted in breast milk and is not recommended for use in nursing women due to risk to the infant.

The Fentanyl patch may burn skin if worn during an MRI. The patch should be removed before undergoing this or similar medical tests.

A medical professional should be contacted immediately if a patient using Fentanyl believes that they have a fever.

No more than one patch should be used at a time, unless specifically ordered by a physician.

A Fentanyl patch should not be removed before being worn for three continuous days, unless the patient is told to do so by the prescribing physician.

If the dose taken does not control pain, the prescribing physician should be consulted. The patch should not be removed, even in this case.

Special care should be given when engaging in any activity that may increase the body temperature, such as excessive walking or other exercise or exposure to the sun or warm temperatures (such as a steamy bathroom). An increase in body temperature can lead to an accidental overdose.

Consumption of alcohol or the use of over-the-counter medications that may contain alcohol is while using Fentanyl is not recommended. Alcohol can lead to accidental overdose and may be fatal.

Patients who experience constipation, vomiting, headache, abdominal pain, dizziness, itching, redness, or a rash while taking Fentanyl should seek medical care, particularly if these symptoms are severe.

Emergency medical care should be sought for patients who have trouble breathing, an increased heartbeat, chest pain, swelling of the face, throat or tongue, excessive drowsiness or lightheadedness, especially when changing positions.

A Fentanyl patch should not be used by patients who are not opioid-tolerant or to manage acute or intermittent pain. This medication is not indicated for use following minor out-patient or day surgeries.

If adequate respiratory monitoring equipment or resuscitative equipment is not available, those with a history of respiratory issues should not be prescribed this medication.

This medication should not be prescribed to patients with severe or acute bronchial asthma or who are suspected of having paralytic ileus.

This medication can be easily transmitted to others who come in contact with the adhesive portion of the patch or the area where it was applied, before the area is washed. This could lead to adverse effects and accidental overdose.

In the case of an accidental overdose, the patient should seek emergency medical attention or contact the Poison Help line at 1-800-222-1222. An overdose of Fentanyl can lead to death, especially when experienced by a child. Symptoms of an overdose include slowed breathing and/or heart rate, muscle weakness, clammy skin and fainting.

Major drug interactions have happened with the use of the Fentanyl patch. The prescribing physician should be informed of any medications, herbs or nutritional supplements are being taken. This medication may also be affected by the consumption of certain foods.

The Fentanyl patch should not be used by those allergic to Fentanyl.

Those with severe breathing problems, a blockage in the digestive tract, or those already being treated with a similar narcotic pain medication should not take the Fentanyl patch.

Some adverse skin reactions may occur once the patch is removed, including sensitively and redness around the application site.

Certain antibiotics, antifungals, blood pressure medications or drugs that treat HIV or AIDS may interact with Fentanyl. Certain medications that interact with Fentanyl can lead to serotonin syndrome. Patients that take medication for depression, Parkinson's disease, or migraine headaches should consult with their physician before taking this medication.

Any other around-the-clock opioid medications should be discontinued once Fentanyl is prescribed.

Before undergoing any medical treatment, the physician in charge should be informed that the patient is using a Fentanyl skin patch.

Storage

Fentanyl patches should be stored at room temperature, away from sources of heat, moisture and direct light. This medication should not be frozen.

This medication should be kept out of the reach of children and pets.

It is particularly important to store this medication away from any sources of heat. Exposure to heat may cause the effective medication in this patch to be absorbed more quickly, which may lead to an accidental overdose. Storing this medication near heat sources, such as heating pads, lamps or in steamy rooms, like bathrooms, is not recommended.

Outdated or unused medication should be disposed of as indicated by a physician or medical facility. When disposing of a used patch, it should be folded inward, so that the sticky side is inside, and less likely to cause accidental exposure. If the patch has been used, the liner covering of the adhesive portion of the patch should be removed before it is folded in half. The patch, or the protective liner should not be flushed down the toilet. In most cases, a healthcare provider should dispose of this medication.

This medication can lead to serious effects if taken by children, pets or adults who have never taken narcotic pain medications. It should always be kept in a secure location. Direct contact with unwashed application sites can lead to accidental exposure to the medication.

Summary

Fentanyl patches are used to manage moderate to severe pain, generally in a hospital setting for patients with long term pain from conditions such as cancer. Because it is a long-acting (around-the-clock) opioid medication, Fentanyl can lead to abuse or addiction. It should be prescribed with care to those with a history of abuse of alcohol or illicit drug abuse. This medication should not be used while taking other opioid medications, unless specifically indicated by the prescribing physician.

This medication is typically applied to the upper arm, chest or back by a healthcare professional. It targets the central nervous system and is commonly used after surgery or when round-the-clock pain management is required. The Fentanyl patch is not for short term treatment of mild or occasional pain.

The Fentanyl patch should be kept out of the reach of children and pets. Accidental exposure via the adhesive portion of the patch can lead to serious health concerns and even death. This medication should not be used if the patient has a breathing problem, blockage in the stomach or intestines or by those who are currently being treated with a similar opioid medication.

Heat sources should be avoided when using this medication. Increased levels of Fentanyl may be absorbed through the skin when the body temperature is increased.

Fentanyl can cause extreme drowsiness. It should not be used while driving or operating heavy machinery.

Women who are pregnant, nursing or planning to become pregnant should not use this medication, unless indicated by a physician. Fentanyl is known to cause dependence in unborn children, who may require specialized medical intervention after birth. This medication is excreted through breast milk.

This medication is not indicated for use by children under the age of two.