Fentanyl adhesive sizes
12mcg/h
25mcg/h
50mcg/h
75mcg/h
100 mcg/hr
Why Charr Fentanyl Patch
Fentanyl patch Indicated for chronic pain in opioid-tolerant patients that is severe enough to require daily, round-the-clock opioid therapy for a long time and where alternative treatment options are insufficient
Stop or reduce all other extended-release opioids when starting treatment with transdermal fentanyl
25-100 mcg/hr, reapply every 72 hours until adequate analgesia is achieved
See also management
definition of opioid tolerant
Opioid-tolerant patients are those who receive, for 1 week or longer, at least 60 mg/day morphine, 25 mcg/day transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg /day PO oxymorphone, 60 mg/day hydrocodone PO, or an equal dose of another opioid
Dose Adjustments
hepatic impairment
Mild to moderate (baby spore A to B): Start with half the usual dose; Monitor closely for signs of respiratory and central nervous system depression (see WARNINGS)
Severe (Child C): Avoid use
Renal insufficiency
Also moderate to moderate: start with half the usual dose; Monitor closely for signs of respiratory and central nervous system depression (see WARNINGS)
Severe: Avoid use
Dosing considerations
Limitation of use
Because of the risks of addiction, misuse and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients with alternative treatment options (eg, non-opioid or immediate-release analgesics) Ineffective, intolerable, or may be insufficient to provide adequate pain management
Conversion of oral/intravenous opioids to transdermal fentanyl
Each transdermal system is worn continuously for up to 72 hours (see Administration)
The tables in the prescribing information cannot be used to convert from transdermal fentanyl to another opioid because conversions would overestimate the dose of a new opioid and could lead to a fatal overdose.
So calculate the 24-hour morphine dose and find the recommended initial transdermal fentanyl dose
Initiate the recommended dose and titrate the dose frequently no more than 3 days after the initial dose and every 6 days thereafter until analgesic efficacy is achieved
For patients requiring >100 mcg/hr, several transdermal regimens may be used
Stop transdermal fentanyl
Significant amounts of fentanyl continue to be absorbed by the skin for 24 hours after the patch is removed
Conversion to another opioid
Removal of a transdermal dose and titration of the new analgesic based on the patient’s report of pain until appropriate analgesia is achieved
Upon removal of the system, h17 h is required for a 50% decrease in serum fentanyl concentrations
Withdrawal symptoms are possible in some patients after conversion or dose adjustment
Not switching to another opioid
Titrate gradually, (eg, reduce dose by 50% every 6 days), closely monitoring for signs and symptoms of withdrawal
If the patient develops these signs or symptoms, raise the dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both
So don’t suddenly stop using a fentanyl patch. It is not known at what dose level transdermal administration of fentanyl can be stopped without signs and symptoms of opioid withdrawal
00 Access to naloxone for opioid overdose
Assessment of the need for naloxone at initiation and renewal of treatment
Consider prescribing naloxone
Based on the patient’s risk factors for overdose (eg, concurrent use of central nervous system depressants, history of opioid use disorder, previous opioid overdose); The presence of risk factors should not prevent proper pain management
Family members (including children) or other close contacts at risk of accidental ingestion or overdose
Consult patients and caregivers about the following:
Naloxone is also available for emergency treatment of opioid overdose
Methods vary on how to obtain naloxone as permitted by individual drug dispensing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community program)