Fentanyl Transdermal System

A to Z Drug Facts

 Action A potent, short-acting, rapid-onset opiate agonist that relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting, and increased bladder tone.

 Indications Management of chronic pain refractory to less potent agents.

 Contraindications Hypersensitivity to fentanyl or adhesives.

 Route/Dosage

PATIENTS WHO HAVE NOT TAKEN ANOTHER OPIATE CHRONICALLY (ADULTS): Give lowest dose (25 mcg/hr) initially. ELDERLY PATIENTS: May need reduced dose. PATIENTS WHO HAVE RECEIVED ANOTHER OPIATE CHRONICALLY (ADULTS): Calculate dose based on previous day's opiate requirement. Maximum pain relief does not occur until 24 hr after application; a short-acting opiate may be needed for breakthrough pain. Initial dose can be increased after 3 days. Further dosage increases should occur at not less than 6-day intervals. Patches should be replaced every 3 days; some patients require new patch every 2 days.

 Interactions

Amiodarone: Profound bradycardia, sinus arrest, and hypotension may occur. Barbiturate anesthetics, other CNS depressants: May have additive effects. Dosage of fentanyl required will be less than usual.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypotension; orthostatic hypotension; hypertension; bradycardia; tachycardia; chest pain. CNS: Lightheadedness; dizziness; sedation; disorientation; incoordination; headache; hallucinations; euphoria; depression; seizures. DERM: Sweating; pruritus; urticaria; exfoliative dermatitis. GI: Nausea; vomiting; constipation; abdominal pain; diarrhea; dyspepsia; dry mouth. GU: Urinary retention or hesitancy. RESP: Laryngospasm; depression of cough reflex; dyspnea; hypoventilation. OTHER: Tolerance; psychological and physical dependence with chronic use.

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Do not use in children < 12 years, or < 18 years who weigh < 50 kg. Special risk patients: Use with caution in elderly patients or patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume or circulatory shock. Exposure to external heat: Direct contact with heating pads, electric blankets, saunas, or hot tubs could increase fentanyl absorption. Fever: May increase absorption of fentanyl; monitor for adverse reactions. Renal or hepatic impairment: Use with caution since fentanyl is renally and hepatically excreted.

 Administration/Storage

• Select dry, flat surface on chest or back for application. If excessive body hair is present, clip hair in affected area. Do not shave.
• Avoid applying to any irritated body area.
• After removing wrap, apply to skin using firm pressure for about 20 seconds. Be certain that edges are sealed. If gel accidentally comes in contact with skin, wash area with water.
• Remove after 72 hr; fold adhesive side in on itself and discard in toilet.
• Rotate application sites.
• If patch becomes loose, reinforce edges with tape. Do not completely cover patch with another occlusive dressing.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess respiratory rate, heart rate, and BP prior to administration and frequently during therapy, especially after dosage adjustment. Report significant alterations to physician.
• Assess pain type and intensity prior to administration and 24 hr after administration. Assess need for intermittent short-term analgesia until adequate pain control is achieved.
• Reassess 72 hr after administration to determine effectiveness of initial dose, and after every dosage adjustment.
• Assess for signs of developing tolerance.
• Monitor GI, urinary, and bowel function.
• Take precautions to prevent falls, especially with initial dosages.
• If adverse reactions occur, remove patch and notify physician. Continue to monitor patient frequently for at least 12 hours.
• Assure that naloxone and intubation/airway management equipment are available.

 Patient/Family Education

• Inform patient that maximal effect is not achieved for 3 days after initial application, and that supplemental analgesia may be needed.
• Instruct patient to self-monitor effectiveness of medication regularly and to report any significant change. Inform patient that tolerance may develop.
• Advise patient that patches are generally changed every 3 days, but that in some cases a change every 2 days is more effective.
• Explain adverse reactions, and identify signs and symptoms that should be reported. Inform patient that adverse reactions can persist for several hours after removal of patch.
• Explain measures to reduce constipation if present.
• Instruct patient to avoid driving or other potentially hazardous activities unless tolerant to the effects of the drug.
• Caution patient to avoid intake of alcoholic beverages or other CNS depressants.
• Explain potential for tolerance and abuse.
• Inform patient that withdrawal symptoms may be experienced when drug is discontinued and not to discontinue unless advised by physician.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts