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fentanyl transdermal
generic
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about ER opioid use and how to mitigate associated risks; reserve ER forms for patients with inadequate tx alternatives; not indicated for prn analgesic use; proper dosing and titration essential to decr. respiratory depression risk
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Accidental Exposure
accidental exposure to even one dose, especially by children, can result in fatal fentanyl overdose; death from overdose has occurred in children and adults who were accidentally exposed to transdermal fentanyl; instruct patients about strict adherence to proper patch handling and disposal
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Opioid Analgesic REMS
providers are strongly encouraged to complete risk evaluation and mitigation strategy (REMS)-compliant education program, counsel patients and/or caregivers with each Rx on serious risks, safe use, and importance of reading medication guide
CYP450 3A4 Interaction
concomitant use with CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. fentanyl concentration which may incr. or prolong adverse effects including potentially fatal respiratory depression; monitor patients receiving any concomitant CYP450 3A4 inhibitor or inducer
Avoid Heat Exposure
patients should avoid exposure of application site/surrounding area to external heat sources; exposure to direct external heat sources such as heating pads, electric blankets, heat/tanning lamps, sunbathing, hot baths, saunas, hot tubs, and heated water beds may incr. fentanyl absorption and has resulted in fatal overdose
Adult Dosing .
Dosage forms: PATCH: 12 mcg per hour, 25 mcg per hour, 37.5 mcg per hour, 50 mcg per hour, 62.5 mcg per hour, 75 mcg per hour, 87.5 mcg per hour, 100 mcg per hour
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental exposure
- [strength clarification]
- Info: 12 mcg patch actually delivers 12.5 mcg per hour; order this patch strength as fentanyl transdermal 12 mcg per hour to avoid misinterpretation as 125 mcg per hour
pain, severe chronic
- [individualize patch dose q72h]
- Start: individualize dose based on current opioid intake, see pkg insert for conversion tables; may adjust dose 3 days after tx start, then no more frequently than q6 days; Info: for opioid-tolerant patients only; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in patients 65 yo and older; some patients may require q48h dosing; do not alter/cut patch; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; drug effects may persist >24h after patch removal; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- mild-moderate impairment: decr. usual start dose by 50%; severe impairment: avoid use
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: decr. usual start dose by 50%; severe impairment: avoid use
Peds Dosing .
- Dosage forms: PATCH: 12 mcg per hour, 25 mcg per hour, 37.5 mcg per hour, 50 mcg per hour, 62.5 mcg per hour, 75 mcg per hour, 87.5 mcg per hour, 100 mcg per hour
Special Note
- [prescribing info]
- Info: consider prescribing opioid overdose reversal agent (e.g., naloxone, nalmefene), especially if risk of opioid overdose or accidental exposure
- [strength clarification]
- Info: 12 mcg patch actually delivers 12.5 mcg per hour; order this patch strength as fentanyl transdermal 12 mcg per hour to avoid misinterpretation as 125 mcg per hour
pain, severe chronic
- [2 yo and older]
- Dose: individualize patch dose q72h; Start: individualize dose based on current opioid intake, see pkg insert for conversion tables; may adjust dose 3 days after tx start, then no more frequently than q6 days; Info: for opioid-tolerant patients only; use lowest effective dose, shortest effective tx duration; do not alter/cut patch; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; drug effects may persist >24h after patch removal; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- mild-moderate impairment: decr. usual start dose by 50%; severe impairment: avoid use
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: decr. usual start dose by 50%; severe impairment: avoid use