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How to apply a fentanyl patch

We have a script to apply 1/2 a fentanyl 25 mcg patch. The patient’s insurance won’t pay for the 12 mcg patch. We are instructed to tell the patient to just remove 1/2 the adhesive backing and leave the other half covered, so only one-half of the patch will be sticking to the skin. The patient has never had this before.

Has anyone ever seen this before?

BidingMyTime

Lost Shaker Of Salt
  • Sep 27, 2017
  • #2

No, I’ve never seen that done. That is going to give very rough, approximated dosing, at best. And what happens when the other half comes off when the passing is tossing and turning in their sleep, and then they either get the full dose if it sticks to their skin, or no dose if it sticks to their sheet? If the dosing isn’t super critical for this particular patient. and they were allergic to every other pain medication (as if), then maybe, people do weird stuff to work with limited insurance coverage.

But, I would imagine in the vast majority of real-life scenarios, then either the full 25mcg patch should be used (back off on their IR pain medications), or their current ER pain medication dose should be upped in stead.

Abby Atwood

Full Member
  • Sep 27, 2017
  • #3

Sine Cura

Membership Revoked
  • Sep 27, 2017
  • #4

This is dumb. Do not fill it.

BTW, the “breakthrough” regimen is ALWAYS filled in tandem with the long-acting regimen, every time, without fail, like clockwork.

owlegrad

Uncontrollable Sarcasm Machine
  • Sep 27, 2017
  • #5

mnoble

Full Member
  • Sep 27, 2017
  • #6

Aren’t most brands of fentanyl patches matrix, not reservoir, now? Could just cut it since matrix patches dose is proportional to area of patch. Obviously the responsible thing is still just get the 12’s approved.

CetiAlphaFive

Full Member
  • Sep 27, 2017
  • #7

We have a script to apply 1/2 a fentanyl 25 mcg patch. The patient’s insurance won’t pay for the 12 mcg patch. We are instructed to tell the patient to just remove 1/2 the adhesive backing and leave the other half covered, so only one-half of the patch will be sticking to the skin. The patient has never had this before.

Has anyone ever seen this before?

mnoble

Full Member
  • Sep 27, 2017
  • #8

Abby Atwood

Full Member
  • Sep 27, 2017
  • #9

Okay but it delivers 12.5 mcg/hr

Addendum: This is just to clarify in case there is actual confusion out there. The 12 mcg patch is actually a 12.5 mcg patch. The box reads 12 mcg vs 12.5 mcg to prevent med errors. Package insert clarifies that the patent is receiving a 12.5 mcg/hr dose.

Rockinacoustic

Full Member
  • Sep 27, 2017
  • #10

Anyone who is okay dispensing this needs to retroactively fail pharmaceutics.

The prescriber’s office can call and get the authorization for the 12mcg/hr patch.

maria1oh

Full Member
  • Sep 27, 2017
  • #11

ldiot

Full Member
  • Sep 27, 2017
  • #12

lord999

Full Member
  • Sep 27, 2017
  • #13

Guess that physician hasn’t figured out Fick’s law yet. What a bonehead.

General observation: You should never (and yes, never) cut a transdermal patch as it really does affect drug delivery in really unpredictable ways. Open your Ansel’s for why, but there’s some real controversy over the years over the effectiveness of transdermals on different skin thicknesses much less cutting the system open. However, it is possibly safe to cut certain topical patches that only have epidermal or up to dermal release (so lidocaine and other topical pain relief may be cut given the package insert instructions) as there is no systemic release and that the drug does not well up.

And @idiot, I hope you’re recovered some sanity and morale from being overexposed to drinking from the UF firehose.

owlegrad

Uncontrollable Sarcasm Machine
  • Sep 28, 2017
  • #14

Guess that physician hasn’t figured out Fick’s law yet. What a bonehead.

General observation: You should never (and yes, never) cut a transdermal patch as it really does affect drug delivery in really unpredictable ways. Open your Ansel’s for why, but there’s some real controversy over the years over the effectiveness of transdermals on different skin thicknesses much less cutting the system open. However, it is possibly safe to cut certain topical patches that only have epidermal or up to dermal release (so lidocaine and other topical pain relief may be cut given the package insert instructions) as there is no systemic release and that the drug does not well up.

And @idiot, I hope you’re recovered some sanity and morale from being overexposed to drinking from the UF firehose.

Learn how to apply and remove a transdermal patch. Transdermal patch application is easy, but as the nurse you must know how to properly remove and apply a patch. This tutorial will cover the application of a Fentanyl transdermal patch.

What are transdermal patches? They are medicated sticky, adhesive patches wore on the skin. The adhesive backing on the patch that sticks to the skin contains medication that is continuously delivered via the skin to the bloodstream. Many different types of medications can be ordered via the transdermal route. One of these medications are Fentanyl.

How to apply a fentanyl patch

What is Fentanyl? It is an opioid pain medication used to treat severe pain. Patients who use transdermal Fentanyl patches are opioid tolerant, meaning they experience chronic, severe pain that cannot be controlled with oral opioid medications. Therefore, the transdermal patch can deliver continuous amounts of Fentanyl to help manage the patient’s pain. These patches are not for patients who have never taken oral opioid medications (these patches usually contain high doses of Fentanyl and can be too strong for patients who have never taken Fentanyl, which can lead to severe side effects), acute pain such as post-op or surgical related etc.

Nurse’s Role with a Transdermal Patch of Fentanyl:

When administering a new patch, ALWAYS remove the previous patch before applying the new one.

ALWAYS wear gloves when removing and applying a Fentanyl patch! Why? To prevent becoming contaminated with the drug.

ALWAYS have another nurse witness you disposing of the old Fentanyl patch and dispose according to your hospital’s protocol. Every employer has specific guidelines for how this is done.

Never apply a new transdermal patch on the same site (always rotate sites), broken or irritated skin, or on hair (it will not stick).

Sites to place a transdermal patch include: upper arm, chest, or back. If the patient is confused, place the patch on a site where the patient cannot easily pull it off.

Always time, date, and initial the patch.

When applying a new patch, assess the patient for adverse side effects:

  • Respiratory depression
  • Hypotension
  • Decreased mental status (lethargic, confused etc.)
  • Pain rating and it’s location

You may have to reinforce the patch with a tegaderm or tape to keep it from falling off, especially if the patient is sweaty, has oily skin, or it is located on an area that experiences a lot of friction.

Always chart where you place the patch so when the next dose is due the next nurse knows where to find the patch.

Video Demonstration on Transdermal Patch Application

Steps on How to Remove a Transdermal Patch

How to apply a fentanyl patch

  1. Note in the chart where the last nurse charted the location of the previous patch
  2. Wash hands and don gloves
  3. Remove patch from skin and fold it sticky side to sticky side

How to apply a fentanyl patch

  1. Dispose per hospital protocol with another nurse as a witness
  2. Clean site with warm water to remove any residue or dead skin cells from the site
  3. Doff gloves and wash hands

Steps on How to Apply a Transdermal Patch

  1. Perform the patient’s 5 Rights:
  • Right patient
  • Right drug
  • Right dose
  • Right route
  • Right time

2. Check the packaging (make sure it is not torn or expired)

3. Open new patch: don’t use scissors because you can mistakenly cut the patch

4. Date, time, and initial the patch (the patch still has the protective backing so do this on the opposite side)

How to apply a fentanyl patch

5. Wash hands and don gloves

6. Pick a new site to place the patch and make sure skin is clean, intact, and free from hair. If hair is present, trim it (don’t shave it), and if the skin is dirty cleanse it with warm water only (not soap or lotions…this can prevent it from sticking).

7. Carefully take off one side of the back and stick it to the skin and then take off the other side of the backing.

How to apply a fentanyl patch

8. Firm press down the patch for at least 15 to 20 seconds (make sure it has no bumps, folds, or bubbles). You may have to reinforce it with extra tape.

How to apply a fentanyl patch

9. Chart location of the patch so the next nurse who removes it knows where it is.

How to apply a fentanyl patch

In my practice as a clinical pharmacist, I see the use of fentanyl patches on pretty much a daily basis. I’ve seen numerous mistakes with fentanyl patches and wanted to put together a list of 5 dangerous mistakes. In no particular order:

1. Fentanyl patches are extremely potent. Many healthcare professionals don’t realize how strong a fentanyl patch is. Opioid conversions are never perfect, but conservatively, a total daily dose of oral morphine 45-60 mg is approximately equivalent to fentanyl 25 mcg patch. Because of this, I’ve seen numerous cases of inappropriately high starting doses, especially in the elderly population.

2. Lost or missing patches should scare you. Fentanyl as mentioned above, is extremely potent. There is significant risk of children/pets getting access to a used patch. Take a lost or missing patch very seriously. Simply do a google search of fentanyl patch deaths and you’ll understand what I’m talking about. Flushing of used patches is recommended per ISMP.

3. Fentanyl patches are meant for chronic pain. I’ve seen orders numerous times for fentanyl patches from the ED or primary providers for the treatment of acute pain. You are not helping patients relieve their acute pain. With an onset of action that takes hours to days once applied, a patient can be in pain for a long period of time before the drug begins having an effect.

4. Delayed withdrawal. Fentanyl patches basically create a deposit of drug being slowly absorbed through the skin. I remember a case where a patient was on a chronic higher dose (100 mcg) and the patch was discontinued in the ED without any follow up or supplemental opioids. Long story short, they ended up having withdrawal symptoms, but not until hours after they were discharged. (Remember slow onset as well as slow elimination and offset)

5. Drug diversion. Whether at home, or in healthcare settings, I’ve dealt with numerous cases of drug diversion. These cases even go to the point of diverters removing used patches from dementia patients.

Looking for more real world clinical pearls? Check out the 30 medication mistakes I see in my everyday practice as a clinical pharmacist – a free resource for subscribers.

Fentanyl is a drug that can be extremely dangerous when applied wrongly on an individual. At least five cases have been reported that involves the wrong application of the drug.

  • Fentanyl comes in various forms; one among them is the transdermal skin patch which is applied externally.
  • To know the exact portion of the application, an individual must ask for a licensed medical professional’s consultation.
  • Since the drug causes addiction when abused, a valid prescription must always be sought for. Fentanyl also comes in the form of an injectable intravenous. However, unlike the skin patch, the needle has to be inserted at the right place.
  • Consultations must be requested, prescriptions must be sought for, and proper instructions must be obediently followed.

Cases that Show wrong application and exceeding dosage than prescribed are extremely fatal.

  • One was a 35-year-old male who died at home. The dead body was found by his own wife. The man did not have any history of drug abuse and addiction. However, his life had abruptly ended with the wrong dosage of Fentanyl.
  • A 38-year-old individual who used Fentanyl for unknown reasons. The family claimed that this individual had a history of drug abuse, but was at that time being treated.
  • A 42-year-old individual used it to end her life. The act of committing suicide is should never be an option regardless of how bad the situation is.If the individual needs help, a professional help should be sought for.
  • The last case was someone who was found by the mother who discovered a needle and a tube with Fentanyl.

While this drug performs as an analgesic, it should not be made as a tool for addiction, abuse, and suicide.

Using this for the wrong reasons may lead to sedation, euphoria, respiratory depression, and death on high doses. It can be used to treat painful sensations, since it is originally designed as an opiate to relieve chronic pain. However, once concentration exceeds, it can lead to disastrous effects on one’s health.

When the drug has effectively relieved them from pain, other life srtuggles’ almost immediately will depend on them taking the drug for some relief. However, with the cases mentioned, it is never a good idea to abuse it whatever is the purpose. Particularly for first time users, in the similar manner with the first case, consultations must be sought first and foremost.

It would also be vital to remove the tool that serves as the drug’s vessel the moment the necessary dosage has been reached. It takes time to complete the dosage, but when it is overdosed, the drug can be detrimental to one’s health. An example would be the span of time the transdermal skin patch has stayed on the external portion where it is attached. When it exceeds the necessary span of time, it eventually becomes toxic.

It would not hurt to find alternative drugs for pain. Ask for those that are less likely to lead to harmful effects that Fentanyl brings.

Description: Potent opioid analgesic in a topical patch lasting 72 hours (on specialist advice some patients may require the patch to be changed every 48 hours).

Preparations

Format

Dose

Examples

12, 25, 37 . 5, 50, 75,100 micrograms/hour

Matrifen®, Fencino®, Mezolar®, Osmanil®, Opiodur®, Yemex®, Mylafent®, Victanyl®

25, 50, 75,100 micrograms/hour

  • It is recommended that patients should ideally stay on the same formulation and should not switch between a matrix and a reservoir patch. Consult local guidance for preferred brand.

Indications

  • Second line opioid for moderate to severe opioid responsive pain.
  • Pain must be stable.
  • Oral and subcutaneous routes are not suitable.
  • Patient unable to tolerate morphine/ diamorphine due to persistent side effects.
  • Compliance is poor, but supervised patch application is possible.

Cautions

  • Fentanyl is a potent opioid analgesic; check the dose conversion carefully. 100 to 150 times more potent than oral morphine.
  • A 25micrograms/hour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
  • Frail or elderly patients may need lower doses and slower titration.
  • Heat/pyrexia increases the absorption of fentanyl and can cause toxicity. Avoid direct contact with heat (for example hot water bottle, heat pad). Showering is possible as the patches are waterproof, but patients should avoid soaking in a hot bath, sauna or sunbathing. If the patient has a persistent temperature of 39 ◦ C, the patch dose may need reviewed – use anti-pyretic measures. : dose reduction may be needed in severe liver disease. : no initial dose reduction. May accumulate gradually over time. Monitor patient and reduce dose. Fentanyl is not usually removed by dialysis.

Drug interactions

  • Hepatic metabolism is reduced by grapefruit juice and a number of medications (for example fluconazole, clarithromycin , erythromycin ): check British National Formulary (BNF).
  • Alcohol and CNS depressants increase side effects.
  • Anticonvulsants may reduce its effect. Refer to BNF.
  • Manufacturers warn of a risk of serotonin toxicity when fentanyl is used in combination with other serotonergic drugs.

Side effects

  • Similar to other opioids (dizziness, sedation, delirium) but less constipation and possibly less nausea.
  • If signs of opioid toxicity (for example sedation, delirium), remove the patch and seek advice. Fentanyl will be released from the site for up to 24 hours. Monitor the patient for 24 to 48 hours.
  • Naloxone (in small titrated doses) is only needed for life-threatening respiratory depression (refer to Naloxone guideline).
  • An allergic reaction to the patch adhesive can occur – consider switching brand of patch, change opioid or consider one to two doses of a 50micrograms to 100micrograms beclometasone dipropionate inhaler on to site prior to application of patch.

Dose and Administration

Starting a fentanyl patch

  • Do not start at end of life.
  • Choose a suitable patch – matrix patch allows titration in smaller increments.
  • Calculate the dose of fentanyl from the conversion chart given here or seek advice. Patch strengths can be combined to provide an appropriate dose.
  • Patches are licensed for dose initiation and titration.
  • Make sure the patient takes another regular opioid for the first 12 hours after the patch is first applied to allow the fentanyl to reach therapeutic levels (refer to Switching opioid to fentanyl patch table below).
  • An immediate release opioid (for example oral morphine or morphine SC) must be available 1-2 hourly, as required, for breakthrough pain or to treat any opioid withdrawal symptoms (diarrhoea, abdominal pain, nausea, sweating). These can occur during the fentanyl initiation period due to the variable time to reach steady state. The correct 4 hourly equivalent dose should be used.
  • Fentanyl is often less constipating than morphine; half dose of any laxative and titrate.

Switching opioid to fentanyl patch

How to apply a fentanyl patch

Current opioid

Switching procedure

Immediate release (quick acting) morphine or oxycodone

Apply patch; continue the immediate release opioid 4 hourly for the next 12 hours.

Modified release (long acting) 12 hourly morphine or oxycodone

Apply patch when the last dose of a 12 hourly, modified release opioid is given.

Subcutaneous infusion of morphine, diamorphine, oxycodone or alfentanil

Apply the patch and continue the infusion for the next 8 to 12 hours, then stop the infusion.

Adjusting the fentanyl patch dose

  • Review the fentanyl patch dose after 72 hours; drug levels will be at steady state.
  • If the patient shows signs of opioid toxicity (drowsiness, confusion), reduce the dose and reassess the pain. Seek advice.
  • If the patient still has pain which is opioid responsive, titrate the fentanyl dose in 12micrograms to 25 micrograms/hour increments depending on the patch strength in use. Remember to include the breakthrough doses used. It will take 12 to 24 hours for the new dose to take effect so give breakthrough analgesia at the correct dose, as required. If there is a significant increase in the number of breakthrough doses required seek specialist advice.

Fentanyl patches in the last days of life

  • Continue the fentanyl patch, changing it every 72 hours.
  • If a new, opioid responsive pain develops, use subcutaneous morphine as required for breakthrough pain. Use the conversion chart to calculate the dose of morphine. If the patient is known to be renally impaired alfentanil may be a more appropriate choice (eGFR<30ml/min – refer to Renal Palliative Care – Last Days of Life guideline).
  • After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a SC infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch.

Switching a fentanyl patch

  • If switching from a fentanyl patch to any other strong opioid by any other route, specialist palliative care advice should be sought.

Dose Conversions

  • All opioid dose conversions are approximate.
  • Patients should be monitored closely so that the dose can be adjusted if necessary.
  • Manufacturers of the various formulations of fentanyl have issued different recommendations for dose conversion, as have drug regulatory bodies.
  • Fentanyl is approximately 100 to 150 times more potent than oral morphine; the table below provides a guide to dose conversions, but if in doubt seek advice.

24 hour oral morphine dose

Fentanyl patch dose (micrograms per hour)

Immediate release oral morphine (1)
Suggested breakthrough dose (refer to guidance in dose and administration above)

Fentanyl is a potent synthetic opioid that is used to treat persistent, chronic pain. Transdermal fentanyl patches attach to the skin to deliver round-the-clock pain treatment. They are typically reserved for people with cancer, terminal illnesses, or chronic pain.

It cannot be understated. Fentanyl is one of the most potent opioid analgesic drugs in the world. It is 50-100 times stronger than heroin. Fentanyl should only be taken under careful medical supervision and prescription. Misusing fentanyl can be fatal. Overdose deaths related to fentanyl were up a staggering 45% in 2017, accounting for more than 28,000 deaths alone.

This article provides an overview of how transdermal fentanyl patches work and highlights the risks and side effects of using fentanyl patches.

Fentanyl Patches

Brand names for fentanyl patches include Duragesic, Matrifen, and Tilofyl. Each patch lasts for approximately 72 hours. Transdermal patches deliver constant, potent opioid medication that is absorbed via the skin. The patches come in four different, transparent sizes beginning at 2.75 mg of fentanyl up to 11.0 mg of fentanyl. The largest application is about four square inches.

Transdermal fentanyl patches include four layers that regulate the delivery of fentanyl in a complex mechanism.

  1. The first layer is a silicon adhesive that attaches directly to the skin.
  2. The second layer is an ethylene-based membrane that controls the rate of fentanyl delivery.
  3. The third layer contains the fentanyl drug and dipropylene glycol mixed with cellulose that allows the fentanyl to be absorbed by the skin.
  4. The fourth layer is a protective, backing sheet of foil that protects fentanyl from leaking out of the controlled, patch membrane.

Fentanyl patches are a sort-of last resort pain management system after other approaches have not worked. They are only prescribed if someone is already opioid-dependent as a result of taking at least 60 mg of morphine, 30 mg of oxycodone, or 8 mg of hydromorphone daily. The risk of a fentanyl overdose is significantly higher for someone who is not already opioid-dependent.

Side Effects of Fentanyl Transdermal Systems

Fentanyl patches are only prescribed to a particular patient who needs relief from moderate to severe, persistent pain that other methods have proven to be ineffective. Some of the side effects of fentanyl patches can range from mild to severe. These symptoms include:

  • Constipation
  • Sleepiness
  • Skin Rash and Irritation

The delivery system can feel like it is burning skin. Other people report intense nausea and vomiting due to the high potency of the drug.

Sleepiness seems like a mild side effect; however, it can be an indicator that the dose of fentanyl is too high. If this is the case, a doctor needs to be contacted immediately. If someone is overly sleepy or has trouble keeping their eyes open while using a fentanyl patch, this can be a serious risk of opioid overdose.

Signs of Fentanyl Overdose

A fentanyl overdose can occur even with the use of doctor-prescribed transdermal fentanyl patches. It is good practice to educate friends and family members for what is called the opioid overdose triad. The overdose triad consists of three key symptoms of onset opiate overdose:

  1. pinpoint pupils
  2. unconsciousness
  3. respiratory depression

Once the overdose process reaches respiratory depression, when someone’s breathing becomes shallow and then stops completely, overdose can become fatal. It can be prudent to keep a prescription of Narcan available in case of emergency.

Narcan, the life-saving emergency opioid overdose medication, delivers naloxone through the nostrils. It instantly alleviates the respiratory depression effects of opioid overdose. We addressed how Narcan works on fentanyl overdoses in greater detail in a previous post.

Children and Fentanyl

Because fentanyl patches are worn and then discarded, young children can be in particular danger. Children being accidentally exposed to fentanyl by incidental exposure by improper storage and disposal have forced the FDA to issue a warning for all fentanyl patients. It is important to store all patches safely out of reach from children. The FDA also suggests fentanyl patches be discarded separately from household trash where children or pets cannot get into it.

Patches can look like stickers or Band-Aids to young children. With their curious minds and desire to mimic their parents, a child may place a patch on their lower back or touch it with their fingers. Even after 72-hour use, there are still traces of the drug left on the adhesive that can cause an overdose in young children.

Store fentanyl in locked rooms or cabinets to ensure children cannot gain access to medication drawers. Take the trash out regularly. It is also good practice to place an adhesive covering over the patch to make sure that no one can accidentally be exposed to the opioid side. While wearing a fentanyl patch, check that the patch is still attached to your skin throughout the day as they can come loose sometimes.

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I really don’t recommend you even try fentanyl with zero opiate tolerance, you are just asking to OD. The dosage is ridiculously low.

But to answer your question, you said it’s a 25mcg/h patch so that patch contains 2.5mg total. I’m not sure what a dosage is for someone with no tolerance, or any tolerance really. I tried finding, best I could find was like

250-500mcg for having no or low tolerance, but don’t take it from me without someone else posting to confirm.

I do believe you can cut it into appropriate dosage though and then eat or take it sublingually.

Again though, I REALLY suggest you just throw it away or give it away or something else, it’s extremely dangerous to take fentanyl without any opiate tolerance. Also, the high is supposed to be sub par compared to other opiates, with little to no euphoria.

Swimmingdancer

Bluelight Crew
  • Mar 5, 2013
  • #3

You can’t just cut it, it’s a gel patch isn’t it?? It’s impossible to dose those accurately.

2.5mg (the total amount contained in the patch) is a very unsafe amount of fentanyl for someone with no opioid tolerance. Half the patch is still a lot and could be unsafe. Reliable opioid conversion data for buccal fentanyl (where you put it in your mouth/cheek) or sublingual (under the tongue) is lacking. It is even less known how strong chewing a random amount of a fentanyl patch would be! I STRONGLY advise you to NOT chew this patch. The best conversion I’ve seen is that around 200mcg of buccal fentanyl should probably equal around 10mg oral morphine (which would be a safe dose for morphine). But how would you know how much of a patch is 200mcg and how much is actually going to be absorbed (since a patch is not designed for buccal/sublingual use)?

The safest way to use it would be to not use it at all, the second safest would be to apply it on the skin as it’s designed to be.

hatrix

Bluelighter
  • Mar 5, 2013
  • #4

I think applying on the skin might still be risky. I think that people can still OD even using the 50mcg/h patch as its supposed to be taken because of tolerance.

I’m not completely positive though. My best advice is just avoid using it, its too risky.

Bluelighter
  • Mar 5, 2013
  • #5

Swimmingdancer

Bluelight Crew
  • Mar 5, 2013
  • #6

I think applying on the skin might still be risky. I think that people can still OD even using the 50mcg/h patch as its supposed to be taken because of tolerance.

I’m not completely positive though. My best advice is just avoid using it, its too risky.

Yes, you’re correct that the 50mcg/hr patch should only be used by people with tolerance. The 25mcg/hr patch is supposed to be roughly equivalent to around 60-120mg of oral morphine spread out over the course of 24hrs, so I think you may be right that someone with no tolerance to opioids at all and little to no experience probably shouldn’t even risk applying it to their skin.

In general, even putting patches on your skin can be dangerous because the way it deposits in your skin it slowly builds up and if you start thinking “whoa this is way too strong” removing it isn’t going to help because there will still be fentanyl in your skin that is absorbing into your system. I really think people with no opioid tolerance shouldn’t mess with fentanyl. But I do think applying a 25mcg/hr patch to the skin would be WAY safer than chewing some random amount of a patch.

Accidental exposure to medication is a leading cause of poisoning in children. Young children, in particular, have died or become seriously ill after being exposed to a skin patch containing fentanyl, a powerful opioid pain reliever. If you suspect that a child has been exposed to a fentanyl patch, call 911 and seek emergency medical help immediately.

The U.S. Food and Drug Administration urges parents and caregivers to take precautions and make sure that these patches are stored, used, and disposed of properly. Below are some ways to reduce the risk of exposure and safely dispose of these patches, and what to do if a child is exposed to a fentanyl patch.

Children Can Overdose on Fentanyl Patches

The fentanyl transdermal system, which is available as a generic product and marketed under the brand name Duragesic, is a patch prescribed by health care providers to be applied to the skin. The patch treats opioid-tolerant patients who need daily, round-the-clock, long-term pain medicine by releasing fentanyl through the skin over the course of the treatment. The patch is generally replaced every three days.

Children can overdose on new and used fentanyl patches by putting them in their mouth or sticking the patches on their skin. This can cause death by slowing the child’s breathing and decreasing the levels of oxygen in their blood.

The FDA has warned, and continues to warn, patients, caregivers, and health care professionals about the dangers of accidental exposure to the fentanyl patch, and the need to properly store and dispose of the product.

In addition, the FDA recommends that patients and caregivers talk to their health care providers about having naloxone on hand. Naloxone is a life-saving drug that, when sprayed into the nose or injected, can quickly reverse the powerful effects of opioids, including fentanyl, during an overdose. Naloxone can be given to children and anyone who may have been exposed to a fentanyl patch.

Cut the Risk of Accidental Exposure

If you or someone in your home uses the fentanyl patch, follow the instructions given by the prescriber and in the Medication Guide, which should accompany each fentanyl patch prescription.

To reduce the chance that children will be exposed to fentanyl, take these precautions:

  • Keep fentanyl patches and other drugs in a secure location out of children’s sight and reach. Toddlers and young children may think the patch is a sticker, tattoo, or bandage.
  • Consider covering the fentanyl patch with a transparent adhesive film to make sure the patch doesn’t come off your body. You can apply first aid tape to the edges of the patch to secure it to your skin.
  • Throughout the day, make sure the patch is still in place, by touching it or looking at it.
  • When you apply a new patch, promptly dispose of the used one properly.

Infants and toddlers are especially at risk of accidental exposure to fentanyl. When children are held by or are sleeping with adults wearing a patch, it is possible that a partially detached patch could be transferred from adult to child.

How to Dispose of Fentanyl Patches

Even after a patch is used, there is enough fentanyl left to cause illness, overdose, or death in babies, children, adults, and pets who are accidentally exposed to the medicine in the patch. That’s why the drug comes with special instructions on how to dispose of used or leftover patches.

The FDA recommends promptly disposing of used patches by folding them in half with the sticky sides together, and then flushing them down a toilet. They should not be placed in the household trash, where children or pets can find them. Children may find lost, discarded, or improperly stored patches and ingest them or stick them on themselves or others.

The FDA has included fentanyl patches on a list of medicines that should be flushed down a toilet because they could be especially harmful, and possibly fatal, in a single dose if used by someone other than the person for whom the medicine was prescribed.

What to Do if a Child Is Exposed to Fentanyl

If you suspect that a child has been exposed to a fentanyl patch, use naloxone if you have it, call 911 and seek emergency medical help immediately.

Early signs of fentanyl exposure might be hard to notice in young children. Drowsiness has been among the reported symptoms, and that could be misinterpreted as the child just being tired or sleepy.

Other signs that the child may have been exposed to fentanyl include:

  • trouble breathing
  • shortness of breath
  • swelling of the face, tongue, or throat
  • agitation
  • high body temperature
  • stiff muscles

Because overdoses can happen anywhere, naloxone is designed to be used by anyone, even a bystander. You can give naloxone to people of all ages, from infants to elderly adults. Even if you use naloxone, you still need to call 911 and seek emergency medical help right away.

Talk to your health care professional about the benefits of naloxone and how to obtain it. In most states and the District of Columbia, you can obtain naloxone from a pharmacy under a standing order (a prewritten medication order) that takes the place of an individual prescription.

Have Naloxone and Learn How to Use It

Fentanyl, like all opioids, should be stored securely. If you have naloxone, tell your family about it, and keep naloxone in a place where family, friends, and close contacts can easily get it in an emergency. If you have naloxone, advise family and friends on how to administer it in the event of an accidental exposure or overdose.

If you have a question about the fentanyl patch, talk to your health care provider or pharmacist. Also, the FDA’s Division of Drug Information (DDI) will answer almost any drug question. DDI pharmacists are available by email, [email protected], and by phone, 1-855-543-DRUG (3784) and 301-796-3400.

Health care professionals and patients are encouraged to report cases of accidental exposure to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

How to apply a fentanyl patch

Learn how to apply and remove a transdermal patch (specifically Fentanyl) to a patient for medication administration.

Transdermal patch application requires you know how to properly remove a previous patch along with how to properly apply another one.

What are transdermal patches? They are patches that deliver a continuous amount of medication to a patient via the skin. Each patch has an adhesive backing that contains a specific amount of medication ordered for the patient. In this video, I demonstrate how to apply a Fentanyl transdermal patch. It is important to note that many medications are available in the transdermal form as well.

Fentayl is used for patients with chronic pain who are opioid-tolerant and are unable to achieve pain management with oral forms of opioids. The transdermal patch allows for continuous amount of the drug to be delivered from the skin to the bloodstream.

As the nurse, who is administering this medication, you must always monitor the patient’s respiratory and hemodynamic status because this medication can cause respiratory depression and hypotension. In addition, the nurse will want to evaluate the patient’s pain rating to determine the effective of the medication.

Transdermal patches should never be applied to broken or irritated skin, and the site should always be rotated during new applications. During the removal and application of the patch the nurse should always wear gloves to prevent becoming contaminated with the drug.

Fentanyl transdermal patches can be applied to the upper arm, chest, or back. It is VERY important to ALWAYS remove the previous patch before applying the new patch. In addition, after removing the patch it is vitally important to have another nurse witness the disposal of the patch because it is a controlled substance. Always dispose of the transdermal patch according to hospital protocol.

NOTE: The patch used in the video is a demo dose and used as stimulation for teaching purposes . It does NOT contain any medication or substances whatsoever.

Transdermal patch administration nursing skill. Learn how to apply and remove a transdermal patch (specifically Fentanyl) to a patient for medication administration.

Transdermal patch application requires you know how to properly remove a previous patch along with how to properly apply another one.

What are transdermal patches? They are patches that deliver a continuous amount of medication to a patient via the skin. Each patch has an adhesive backing that contains a specific amount of medication ordered for the patient. In this video, I demonstrate how to apply a Fentanyl transdermal patch. It is important to note that many medications are available in the transdermal form as well.

Fentayl is used for patients with chronic pain who are opioid-tolerant and are unable to achieve pain management with oral forms of opioids. The transdermal patch allows for continuous amount of the drug to be delivered from the skin to the bloodstream.

As the nurse, who is administering this medication, you must always monitor the patient’s respiratory and hemodynamic status because this medication can cause respiratory depression and hypotension. In addition, the nurse will want to evaluate the patient’s pain rating to determine the effective of the medication.

Transdermal patches should never be applied to broken or irritated skin, and the site should always be rotated during new applications. During the removal and application of the patch the nurse should always wear gloves to prevent becoming contaminated with the drug.

Fentanyl transdermal patches can be applied to the upper arm, chest, or back. It is VERY important to ALWAYS remove the previous patch before applying the new patch. In addition, after removing the patch it is vitally important to have another nurse witness the disposal of the patch because it is a controlled substance. Always dispose of the transdermal patch according to hospital protocol.

NOTE: The patch used in the video is a demo dose and used as stimulation for teaching purposes . It does NOT contain any medication or substances whatsoever.

Duragesic is the brand name of the fentanyl transdermal pain patch. It is intended only for those over two years of age, with moderate-to-severe chronic pain, seeking continual pain management. This unique patch contains fentanyl, an opioid narcotic. The powerful medication is slowly absorbed through the skin, providing controlled pain relief for a period of up to 72 hours.

Risk Factors Associated with the Duragesic Transdermal Patch

The Food and Drug Administration (FDA) considers the Duragesic patch a category C drug. It has the potential to pose harm to a fetus and inflict withdrawal symptoms or addiction in a breastfed child. Due to the risks involved, it is essential that patients inform their healthcare provider before using the patch, if they are thinking about becoming pregnant or are currently pregnant or breastfeeding.

There are known medications that interact with the transdermal patch, so patients should consult their healthcare provider and note all of the prescription and over-the-counter medications they are taking. The transdermal patch is not recommended for everyone.

  • Patients who are not opoid-tolerant
  • Patients who suffer from acute asthma or asthma-related symptoms
  • Patients who have non-chronic pain, such as pain from any dental or health-related procedures
  • Patients who require short-term treatment
  • Patients whose pain can be managed by other pain medications

The fentanyl pain patch should only be used when other medications are not alleviating the chronic pain, and it should always be used while under the care of a physician.

How to Use and Apply a Fentanyl Patch

Before using a transdermal fentanyl patch, patients should read all of the information and instructions that come with the prescription and follow the physician’s directions.

When a skin patch needs to be removed prior to the application of a new one, it should be folded in half, with the sticky side facing inward, and flushed down the toilet.

  1. Use water to clean the area of skin where the patch will be placed. Adequate drying time should be allotted prior to patch placement. Do not apply substances, such as lotions or soaps, to the area where the patch will be placed, as this could cause the skin to absorb more medication than necessary.
  2. The patch may be applied to hairless areas, such as the back, upper outer arms, or chest. It should never be applied to the same area twice in a row.
  3. Using the palm, apply firm pressure to the patch for a minimum of 30 seconds. All edges of the patch should be pressed against the skin.

Disclaimer:

The above information regarding the fentanyl (Duragesic) pain patch is for educational purposes only and should not replace the advice of a licensed health care provider.

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Transdermal patch administration nursing skill. Learn how to apply and remove a transdermal patch (specifically Fentanyl) to a patient for medication administration.

Transdermal patch application requires you know how to properly remove a previous patch along with how to properly apply another one.

What are transdermal patches? They are patches that deliver a continuous amount of medication to a patient via the skin. Each patch has an adhesive backing that contains a specific amount of medication ordered for the patient. In this video, I demonstrate how to apply a Fentanyl transdermal patch. It is important to note that many medications are available in the transdermal form as well.

Fentayl is used for patients with chronic pain who are opioid-tolerant and are unable to achieve pain management with oral forms of opioids. The transdermal patch allows for continuous amount of the drug to be delivered from the skin to the bloodstream.

As the nurse, who is administering this medication, you must always monitor the patient’s respiratory and hemodynamic status because this medication can cause respiratory depression and hypotension. In addition, the nurse will want to evaluate the patient’s pain rating to determine the effective of the medication.

Transdermal patches should never be applied to broken or irritated skin, and the site should always be rotated during new applications. During the removal and application of the patch the nurse should always wear gloves to prevent becoming contaminated with the drug.

Fentanyl transdermal patches can be applied to the upper arm, chest, or back. It is VERY important to ALWAYS remove the previous patch before applying the new patch. In addition, after removing the patch it is vitally important to have another nurse witness the disposal of the patch because it is a controlled substance. Always dispose of the transdermal patch according to hospital protocol.

NOTE: The patch used in the video is a demo dose and used as stimulation for teaching purposes . It does NOT contain any medication or substances whatsoever.

Download a printable copy of Fentanyl Transdermal Patch article.

What is a fentanyl transdermal patch?

The fentanyl patch sticks to the pet’s skin and slowly releases a constant amount of pain medication that is absorbed into the bloodstream, providing several days of pain relief.

It is very important that you do not allow your pet to lick or chew at the fentanyl patch site or the bandage that covers it, while the patch is on and for 48 hours after its removal.

When should I remove the patch?

The patch is generally removed five days after it was applied. The date for removal should be on the patch or on your discharge instructions.

How do I remove the patch?

Carefully cut away or unwrap the bandage that covers it and pull the patch off like a band-aid. Fold the patch in half, place in coffee grounds, used cat litter or other unfriendly substance, secure in a plastic bag and place in the trash. Do not attempt to clean the patch site for 48 hours after removal. Do not allow your pet to lick at the site.

What normal side effects of fentanyl might occur in some pets?

  • Increased whining
  • Increased panting
  • Slight decrease in appetite
  • Some episodes of vomiting/regurgitation
  • Constipation

When should I be concerned about changes in my pet’s behavior?

  • If your pet is disoriented or stumbling while still wearing the patch, remove the patch (following the instructions above) and call our office during business hours, or call your local veterinary emergency clinic.
  • If your pet has severely decreased or no appetite for more than two days, please call our office during regular business hours.
  • Upon removal of the patch, some animals may experience a transient reaction, including panting, whining, weakness or vomiting. If you are concerned, or if these symptoms do not subside within one hour, please call our office or your local veterinary emergency clinic.

CAUTION: Keep the patch away from other pets and children, as the patch can be harmful or fatal if chewed, swallowed or handled. If this occurs, seek medical attention immediately.

John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).

The fentanyl patch is prescribed to give a slow release of a powerful opioid painkiller for people who are in pain. But it has the potential to be abused, turning it into a way of delivering a quick and dangerous high. Fentanyl is an opioid that is 100 times more potent than morphine. Fentanyl patch abuse can result in an overdose that can be fatal. People who are prescribed the patch must be educated to prevent misuse.

How Fentanyl Patches Are Abused

Because the patch is a sustained-release form of the drug, it can potentially be dangerous or fatal when it is misused.   Fentanyl patch misuse often involves extracting the drug from the patches and then injecting, ingesting, or smoking it. Even used patches discarded in the trash are sought after by people who misuse the drug since some drug remains in the patch. Other people might simply apply multiple patches at the same time.

Those who misuse fentanyl are seeking a state of euphoria and relaxation common to opioid drugs. These drugs increase dopamine in the brain’s reward areas. Like heroin, fentanyl can also produce the effects of drowsiness, nausea, confusion, constipation, and lead to tolerance and addiction.

People who misuse fentanyl might get the patches through prescription, by stealing them, or by buying them on the street. In some cases, people get them by scrounging through the trash of people who had a prescription and didn’t dispose of them appropriately.

Dangers of Fentanyl Overdose

Taking a large dose of fentanyl can depress and stop breathing. You may become unconscious, go into a coma, and die. This happens because opioid receptors in the brain also control breathing.

Because fentanyl is more potent than many other opioids, it is easier to misjudge how much of the drug is being taken. This is amplified if extracting it from patches and using other delivery methods.  

Fentanyl overdose has an antidote, naloxone, which restores normal respiration. However, naloxone has to be used immediately and it can take higher doses of naloxone to reverse a fentanyl overdose compared to other opioids.   EMTs and emergency room personnel must learn to recognize these situations.

An example of the dangers was that 115 deaths in Florida were attributed to fentanyl patch abuse in 2004. Overdoses from fentanyl have continued to rise, but most deaths are due to injecting the powdered form, which is usually manufactured in clandestine laboratories rather than being diverted from legal pharmaceutical sources.

A review of the published research literature found 674 deaths over a period of 26 years that were attributed to the transdermal fentanyl patch.   Transdermal use was the most common route of administration, followed by oral and injection use. Drug misuse was the cause of death in 63.5% of cases, although accidental death accounted for 16.2% of the cases.

The Problem Is Addiction

Experts suggest that doctors must adequately educate their patients about the potential dangers of the transdermal fentanyl patch. Adequately informing people about the potential risks associated with misuse may help lower the risk of death.

While fentanyl patch abuse continues to be a problem, the use of illegally-manufactured powdered fentanyl is also playing a role in contributing to more overdoses.  

FENTANYL PATCH

(for veterinary information only)

BRAND NAME: DURAGESIC PATCHES

AVAILABLE IN
12.5 microgram per hour,
25 microgram per hour,
50 microgram per hour,
75 microgram per hour,
and 100 microgram per hour
PATCHES

BACKGROUND

Research into the human experience of pain and its relief has yielded some important information:

  • Recovery from illness is faster if pain is alleviated.
  • It is more effective to prevent pain than to alleviate existing pain (i.e., using pain medications in anticipation of pain is more effective than waiting until the pain already exists).
  • Continuous delivery of pain relief is more effective than periodic administration of pain relief.

Animals need pain relievers in the same situations that humans do.

Clearly it behooves us to relieve animal pain and this must be done effectively and with neither struggling with the sick patient nor with being bitten during attempts to give pills. Transdermal (through the skin) drug delivery has been very popular for a number of human medications. It turns out many of these can be adapted to pets. This allows not only for continuous pain relief delivery but also allows for medication to be administered without manipulating the patient’s mouth.

HOW THIS MEDICATION IS WORKS

Fentanyl is a narcotic, a member of the same group of drugs to which opium and morphine belong.

Most of us are familiar with at least some of the opiate effects: pain relief, drowsiness, euphoria, addictiveness, diarrhea control, respiratory depression, hallucinations etc. There are opiate receptors of various types throughout the nervous system. Stimulation of different receptors produce different opiate effects. In this way, certain opiate drugs can achieve different effects from other opiate drugs. The “mu” receptor is responsible for the narcotic effects of euphoria, strong pain relief, addiction, and respiratory depression. There are also “kappa,” “delta,” and “sigma” receptors with other effects such as pupil constriction and hallucinations. In seeking to relieve pain, we want to select a strong mu receptor stimulant without stimulating the other receptors.

Fentanyl binds only the mu receptor and does so approximately 75 to 100 times stronger than morphine, making it an excellent choice for pain relief. It reaches its peak blood level in 3 to 6 hours in cats but may require a full 12 hours in dogs to reach its full effect. After removal, fentanyl blood levels drop to zero within 24 hours. Patches last at least 4 days in pets as does a dose of the newer Recuvyra™ topical product.

SIDE EFFECTS

The most serious potential side effect is respiratory depression (i.e. not breathing adequately). This is a rare problem but if unusual weakness or drowsiness is observed, the drug may be creating a stronger effect than expected. A fentanyl patch may be removed if there is any concern. This effect could become a significant risk if the patch is exposed to heating (electric blankets, sitting near a heater vent, heated water bed etc.) The patch may be toxic if swallowed.

Occasionally, a pet reacts to the adhesive on the back of the patch. Such skin reactions should resolve with patch removal and application of a topical cortisone product.

The euphoria effect can lead to an excessive appetite though in some animals, nausea results from the fentanyl leading to a reduced appetite.

Fentanyl is not felt to be a sedative in cats but in dogs some sedation may be observed. A wobbly gait may be a sign of sedation.

There is some variability in the blood levels achieved by different individuals. Some individuals require additional medication for breakthrough pain.

Fentanyl may cause dilated pupils in cats. This could manifest as aversion to bright light or sunshine.

Fentanyl can slow heart rate. This is generally not an issue unless other medications are added (see below).

INTERACTIONS WITH OTHER DRUGS

Fentanyl should be used with caution in combination with medications that have sedating properties such as antihistamines or other sedating pain relievers. Over-sedation may result.

Narcotics, including fentanyl, should not be used in patients using Anipryl/L-Deprenyl for either the treatment of Cushing’s disease or for senility/cognitive dysfunction.

Concurrent use of fentanyl and diuretics may reduce the effectiveness of the diuretics.

Macrolide antibiotics (such as erythromycin) may slow removal of fentanyl from the body and create a stronger than expected fentanyl effect. Similar issues occur with ketoconazole, itraconazole, fluconazole, and cimetidine. Conversely, there are medications that enhance clearing of fentanyl for a weaker effect: phenobarbital, mitotane, and griseofulvin.

Fentanyl should not be combined with tramadol as high blood pressure or seizures could result.

Medications that reduce blood pressure may compound the slowing of the heart rate that can occur with fentanyl. Blood pressure can drop lower than expected.

CONCERNS AND CAUTIONS

  • Fentanyl is a controlled drug, meaning that specific government paperwork is required to order it and stock it. Your veterinarian may require you to return any used patches for documentation of proper disposal.

THE APPLICATION OF HEAT TO A FENTANYL PATCH CAN LEAD
TO SUDDEN DELIVERY OF A LARGE AMOUNT OF FENTANYL.

Human deaths have been reported in patients
with patches sleeping on heated water beds.
If your pet has a fentanyl patch, be sure to avoid situations
where the patch could be excessively heated.

I need some feedback, I use Fentanyl Patches (150 mg) for pain relief. I have Degenerated Disc Disease and it just seems that I cannot get the pain relief needed to manage my life.

So if you or someone you know uses these patches, where should or where is the best location to place theses patches.

My pain is from two lower discs in my back that are shot!

I also have Oxycodone for break-through pain, but I hate taking these drugs, I am going to a pain management group in the near future for hope that I can find a better way to manage this.

Any feedback would be appreciated.

Fentanyl 25 mcg/H am curios if this is seen as a high, low , or moderate dose?

Has anyone had an adverse reaction to the brand Alvogen fentanyl patch?

Pain meds

Opiate withdrawal due to addict daughter

I know what you are feeling as I have Severe DDD and have been on the Fentanyl Patches for 19 months now. I’m on 87 mcg’s evdery 48 hours and take Percocet 10/325 3 times a day. I normally cut them in half but sometimes do need to take a whole one.

I was told by my PM (Pain Management) Doctor to place them on my upper back and switch from side to side with each new application. I’ve been doing this for 17 months and they don’t come off and the sweat doesn’t effect them. It’s my understanding that this is by far the best place to place them. It’s definitely helped me to manage the DDD.

I hope that you will be able to get to a PM Doctor or Clinic soon as they can afford you several options to help you with your pain. I’ve had tremendous luck with the RFA (Radio Frequency Ablation) where they “burn or kill” the nerves. I know that it sounds terrible, but believe me it’s not bad at all and I have mine done without any anesthesia. I do have a very high tolerance to pain but it truly isn’t bad at all. This has helped my Lumbar DDD (which is the most severe) almost 100%. However, unfortunately, I have it over my entire back along with 5 bulging discs in the Thoracic as well as the Cervical areas. That’s what I use the Fentanyl and the Perc’s for. I wouldn’t be able to function without them. 🙁 I don’t enjoy having to use them either but it sure beats the other option of not being able to get out of bed in the mornings or being able to do anything at all.

I hope that you will be a candidate for the RFA and will be able to get the same results that I have from it. I have been almost completely free from pain in the Lumbar area for 16 months now. I’m hoping to make it to the 24 month time period!! 🙂

I wish you the very best and hope that this information has been helpful to you.

Please keep us updated on how you are doing as I’m hoping to hear very good results for you.

I wish you the very best and will be looking for your updates. Sherry 🙂

Thanks for the input, I have never heard of the RFA before, I will bring it up with my doctor.

Also, I think I have a mind or brain issue when it comes to pain relief from the patches.

The pain relief seems to work best when I put the patches right on my lower back where I have the bad discs! If I put them up my back I do not get the same relief. Am I just in such a state where my mind says I get relief here, but not enough when I place them somewhere else? But I will try the upper back on the shoulder blades and see how it works.

Thanks much for your feedback,
Oz.

Oz, I don’t know if it’s a matter of your mind or not. 🙂 I put them on my upper back because that’s where my Doctor said that his patients have received the best results. LOL. I always listen to my Doctor as he has never led me astray as of yet. 🙂

I hope you will ask about the RFA as it has worked wonders for me. I was always walking stooped over and had such horrific pain down my legs and in my buttocks that it was hard for me to even be able to function. I didn’t even want to get out of the house as it was so hard for me to get in and out of the car. 🙁 It has made a world of difference for me!!

I look forward to hearing from you again as you find the answers to your problem. Hope it works for you.

I’m giving you a link to WebMD that will tell you all about the RFA. Hope you enjoy it.

a) Classification

i) A pure mu agonist

b) General Information

i) Duration of effect is 30 to 45 minutes

c) Advantages/Recommended use

i) Short-term analgesia

(1) Excellent as an intra-operative “top up” analgesic

ii) Induction agent when combined with a benzodiazepine

iii) CRI analgesic use

d) Cautionary Information

i) May see panting and muscle rigidity

e) Dosage Information

(1) See Diazepam & an Opioid section under Induction protocols for details

(1) Bolus – 0.002 mg/kg (0.001 mg/lb)

(2) CRI – 0.001 to 0.004 mg/kg/hr (0.005 to 0.002 mg/lb/hr)

(3) Duragesic patch – based upon weight

Fentanyl Content

Small Dogs ** (<5kg) & Cats

(a) Small dogs and cats, use the 25 mcg/hr patch but only expose ½ of the patch

(b) For even smaller cats consider exposing ¼ of the patch

(c) Never cut the patch

(d) Clip hair as closely as possible at planned patch site without irritating the skin. Gently wipe area once or twice with slightly dampened gauze to remove loose hair. Let area dry. Warm patch to body temperature. Remove backing and apply patch to skin. Hold firmly against skin with hand for 2 full minutes. White tape and Kling gauze are used to cover and support the patch when possible.

(e) For dogs greater than 30 kg, two 50 mcg patches will likely provide better drug delivery than one 100 mcg patch.

i) Low per IV use

ii) High per patch

2) FIROCOXIB (PREVICOX)

3) FLUMAZENIL (ROMAZICON(R))

a) Classification

i) Benzodiazepine antagonist

b) General Information

i) Reversal agent for diazepam and midazolam

c) Advantages/Recommended use

i) To reverse any undesirable effects resulting from diazepam or midazolam use

How to apply a fentanyl patch

Fentanyl is a narcotic pain reliever intended to provide relief to patients experiencing chronic pain. The fentanyl patch is prescribed to allow individuals a convenient method of receiving a consistent dosage of the analgesic. It generally takes a few days for fentanyl to build up in the system and provide optimal pain relief. Therefore, it is recommended for new users of the medication to continue taking an additional narcotic orally until the patch begins to work effectively at managing chronic pain. As with any prescription medication it is important to carefully follow a doctor’s instructions regarding use of the drug.

Fentanyl skin patches are designed to be worn by most patients for a maximum of three days at which point the patch should be removed and a new one placed in a different location. It is advisable to apply the patch to a dry area of skin, preferably on the back, chest or arm in close proximity to the shoulder. Some individuals find their fentanyl patch keeps falling off despite following recommendations for application. Optimal results should occur when the fentanyl is placed in a location free of hair and abrasions, on skin that is dry and not oily. In order to minimize irritation from a transdermal method of medication patients need to find a location on their skin that is intact and free of rashes, cuts or scars. If despite these recommendations the individual still experiences that their fentanyl patch wont stay on it is beneficial to investigate the use of tegaderm film.

Patients utilizing fentanyl patches for relief of their chronic pain symptoms should be able to shower and swim without the adhesive of the patch being compromised. However, individuals often discover that their fentanyl patch keeps falling off and need to discard a dose that has not been completely used and reapply another. Transparent tegaderm film is an available solution when the fentanyl patch wont stay on the skin after it has become moistened during a daily shower or day at the beach.

Tegaderm film is manufactured to enhance breathability and help keep the area of skin free from excess moisture while maintaining a waterproof barrier designed to keep external contaminants from entering and irritating the skin. Pain sufferers depend on narcotic analgesics to keep discomfort at a minimum and be able to perform daily activities and responsibilities. The convenience of a skin patch allows a patient to benefit from a higher quality of life despite chronic pain conditions without worrying about taking an oral medication at specific time intervals throughout the day.

The transparency of tegaderm products provides the ability to monitor the condition of a fentanyl patch and ensure that it remains properly adhered to the skin. Tegaderm applications are comfortable while being worn and in spite of the strength of the adhesive it is gentle enough that removal should not cause irritation or discomfort to the person. Fentanyl users aggravated with wasting unused patches that fall off too early will find multiple advantages to utilizing a transparent tegaderm dressing whenever a new patch is applied.

P roblem : The Institute for Safe Medication Practices (ISMP) has received several reports of deaths that occurred after accidental exposure to adhesive fentanyl skin patches.

Report No. 1: A nurse practitioner’s 77-year-old family member died after a fentanyl patch was incorrectly prescribed and subsequently misused. A week before the death, the family member had been given a prescription for hydrocodone and acetaminophen (Vicodin, Abbott) at a dose of 5 mg/500 mg four times daily for sciatica. She took about four doses each day for a week but was still in pain.

The patient’s primary care physician called the pharmacy and prescribed a fentanyl 50-mcg per hour patch (e.g., Duragesic, PriCara) to be applied every 48 to 72 hours. A friend picked up the prescription. She was given a box of five patches, but the pharmacist did not provide educational materials or instructions for use of the patch. Not understanding how the patch worked, the friend helped the patient place a patch on her buttock, the site of her pain. When the patient went to bed, she placed a heating pad on her lower back and buttock area, her usual practice.

After not hearing from the patient for two days, friends went to her apartment and found her dead in bed. Only three fentanyl patches were left in the box.

It is suspected that the patient had applied a second patch without removing the first patch. According to the nurse practitioner, the pharmacist did not question the prescriber about the initiation of fentanyl therapy or about the strength of the prescription and did not provide counseling when the prescription was picked up. The physician had prescribed fentanyl over the telephone without examining the patient and without advising her about the drug and its potential adverse effects. The patient had not been warned to avoid applying heat over the patch, which increases the rate of drug absorption.

Report No. 2: A grieving mother reported that her child had died after exposure to a fentanyl transdermal patch. The mother, who had chronic pain from Crohn’s disease, reported that her four-year-old son either had used a discarded patch retrieved from the trash or had opened a wrapper from a box of stored patches and applied a patch to his body. His mother found him dead on the floor near an overturned wastebasket that held torn wrappers and disposed patches. It is not known how long the patch had been in place.

Report No. 3: A child was accidentally exposed to a fentanyl patch that had fallen off the skin of a family member. No serious injury occurred.

Report No. 4: A boy removed a patch while his grandmother was sleeping and applied it to himself. Fortunately, again, in this case, the child was not seriously injured.

In addition to these scenarios, a review of error reports in both the ISMP Medication Errors Reporting Program and the Pennsylvania Patient Safety Reporting System revealed numerous cases of hospitalized patients who were wearing more than one transdermal patch. This can happen if nurses do not have a good system in place to remind them to remove patches before they administer the next dose. It is also unfortunate that patches from various manufacturers can be clear or translucent, thereby rendering them difficult to see after they are applied. Although the drug name may be printed on the patch, this does not always increase visibility. Poor visibility of the patch may also hinder the ability of emergency services personnel to properly assess and treat an individual who has overdosed and needs a narcotic antagonist. Patches can also fall off during use.

Several problems contributed to these serious errors and fatalities in the four reports listed. In the first case, the elderly woman was not an appropriate candidate for a fentanyl patch. The product’s labeling states that this patch is intended only for patients who are already tolerant to opioid therapy of comparable strength; this patient was not. Non-tolerant patients may develop respiratory depression, potentially leading to death. Instead, fentanyl patches should be used to manage persistent, moderate-to-severe chronic pain that necessitates continuous, around-the-clock opioid administration for an extended period of time and to manage pain that cannot be controlled by non-steroidal analgesics, opioid combination products, or immediate-release opioids.

Transdermal fentanyl should be used only in patients who require a total daily dose of other opioids at least equivalent to a 25-mcg-per-hour fentanyl patch. Patients who are considered opioid-tolerant are those who have been taking at least 60 mg of morphine daily for a week or longer, at least 30 mg of oral oxycodone daily (e.g., OxyContin, Percocet), or at least 8 mg of oral hydromorphone daily (e.g., Palladone, Dilaudid) or an equianalgesic dose of another opioid.

An FDA advisory, as well as the product labeling, specifically mentions the need to dispose of used patches by folding the sticky sides together and flushing the patch down the toilet. However, patient education alone does not always prevent serious accidents. In the case of the child who died after placing a patch on his body, the mother had been informed about proper disposal. Yet she decided to throw used patches in the trash because she was concerned that she might clog the toilet or that the drug’s chemicals might have a negative effect upon the environment, as she had recently read.

S afety P ractice R ecommendations : Here are some suggestions to help prevent accidental patch exposure:

Fentanyl patches for use at home should include a risk-management program that calls for disposal of patches in biohazard containers that cannot be opened.

Drug manufacturers and pharmacists should be required to package and dispense patches in child-resistant packages. Children enjoy applying stickers, bandages, tattoos, and the like on themselves, a motivating factor that the mother believed might have played a role in her son’s death. Some children might also mimic adults after seeing them apply a patch.

In the hospital, the drug entry on the medication administration record (MAR) should be accompanied by a second entry by which nurses can document the location and time of application and removal of the patches.

At home, a dosing calendar can serve the same purpose to note the site and time of patch application and removal. An auxiliary label can be applied to the patch to prompt documenting the application date and time.

For increased visibility, notes should not be written directly on the patch. Caution should be used with pens: ink might leak through the “skin” of the patch into the drug reservoir, and a ball-point pen could accidentally puncture the patch.

This medication is used to help relieve severe ongoing pain (such as due to cancer). Fentanyl belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.Do not use the patch form of fentanyl to relieve pain that is mild or that will go away in a few days. This medication is not for occasional (“as needed”) use.

How to use Fentanyl Patch, Transdermal 72 Hours

See also Warning section.

Read the Medication Guide and, if available, the Instructions for Use provided by your pharmacist before you start using this medication and each time you get a refill. Learn how to properly use, store, and discard the patches. If you have any questions, ask your doctor or pharmacist.

Use this medication on a regular schedule as directed by your doctor, not as needed for sudden (breakthrough) pain.

Transdermal fentanyl comes as a patch to apply to the skin. The patch is usually applied to the skin once every 72 hours. Change your patch at about the same time of day every time you change it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply fentanyl patches exactly as directed.

Your doctor may start you on a low dose fentanyl patch and gradually increase your dose, not more often than once every 3 days at first, and then not more often than once every 6 days. Your doctor may decrease your dose if you experience side effects. Talk to your doctor about how you are feeling during your treatment with fentanyl patches.

Fentanyl patches are only for use on the skin. Do not place patches in your mouth or chew or swallow the patches.

Do not stop using fentanyl patches without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop using fentanyl patches you may have symptoms of withdrawal. Call your doctor if you experience any of these symptoms of withdrawal: restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, large pupils (black circles in the center of the eyes), irritability, anxiety, backache, pain in the joints, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast heartbeat, or rapid breathing.

Do not use a fentanyl patch that is cut, damaged, or changed in any way. If you use cut or damaged patches, you may receive most or all of the medication at once, instead of slowly over 3 days. This may cause serious problems, including overdose and death.

You may bathe, swim, or shower while you are wearing a fentanyl patch. If the patch falls off during these activities, dispose of it properly. Then dry your skin completely and apply a new patch. Leave the new patch in place for 72 hours after you apply it.

You can apply a fentanyl patch to your chest, back, upper arms, or the sides of your waist. If you are applying the patch to a child or to a person who is unable to think clearly, choose an area on the upper back to make it more difficult for the person to remove the patch and place it in his or her mouth. Choose an area of skin that is flat and hairless. Do not apply the patch to parts of the body that move a lot or to skin that has been exposed to radiation or that is sensitive, very oily, broken out, irritated, broken, cut or damaged. If there is hair on the skin, use scissors to clip the hair as close to the skin as possible. Do not shave the area.

How to apply a fentanyl patch

Its important to know what is Fentanyl before you proceed to buy Fentanyl online from a genuine online pharmacy. Fentanyl is an opioid pain medication, sometimes called a narcotic.

Fentanyl patches are a strong prescription pain medicine. The patches are used to treat moderate to severe chronic pain around the clock.

Fentanyl patches are used when other pain treatments such as non-opioid pain medicines or immediate-release opioid medicines do not treat your pain well enough or you cannot tolerate them.

Fentanyl patches are not for treating mild or occasional pain or pain from surgery. The patches are not for use to treat pain that is not around-the-clock. if you are looking to get relief from the pain the you should buy Fentanyl online from a trusted online pharmacy.

How should I use a fentanyl patch?

Its necessary to know how to use Fentanyl before you decide to buy Fentanyl online from a reliable online pharmacy. Apply the fentanyl patch exactly as prescribed by your healthcare provider. Follow the directions on your prescription label and read all medication guides. Never use fentanyl patches in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more fentanyl patches. Never use a skin patch if it has been cut or damaged.

Stop using all other around-the-clock opioid medications.

Do not allow the skin patch to come into contact with your mouth, eyes, nose, or lips, or another person’s skin.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Wear the fentanyl skin patch around the clock, removing and replacing the patch every 72 hours (3 days). Do not wear more than 1 patch at a time unless your doctor has told you to.

When placing a skin patch on a young child, choose a wearing area where the child cannot easily remove the patch unsupervised.

Do not stop using fentanyl suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store each patch in its foil pouch at room temperature.

Keep both used and unused patches out of the reach of children or pets. The amount of fentanyl in a used skin patch can be fatal to a child or pet who accidentally sucks or chews on the patch. Seek emergency medical attention if this happens.

After removing a skin patch: fold it in half with the sticky side in, and flush the patch down the toilet right away. Do not place a used skin patch into a trash can.

Fentanyl Patch dosing information

its important to know the dosing information for Fentanyl before you proceed to buy Fentanyl online from a legit online pharmacy

Usual Adult Dose for Chronic Pain:

Due to the risk of respiratory depression, the transdermal patch is for use in opioid-tolerant patients only; opioid tolerant patients have been taking at least: morphine 60 mg daily, oral oxycodone 30 mg daily, oral hydromorphone 8 mg daily, or an equianalgesic dose of another opioid for 1 week or longer.
-Discontinue all other extended-release opioids when beginning therapy.

Initial doses: The initial dose should be individualized taking into account the patient’s prior treatment experience. This dose may be calculated based on the dose conversion guidelines in the product package insert, local protocol, or another reliable reference; when calculating, be aware there is substantial inter-patient variability in the relative potency of different opioid drugs and products and therefore it is preferable to underestimate a 24-hour fentanyl requirement and provide rescue medication than to overestimate which could result in adverse reactions.
Dose titration:
-Initial: May increase dose after 3 days based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application.
-Further titration should occur after no less than two 3-day applications as it may take up to 6 days for fentanyl levels to reach equilibrium. Titration should be based on the daily dose of supplementary opioids required and the following ratio may be used: Increase transdermal fentanyl by 12 mcg//hr for use of supplemental oral morphine doses of 45 mg/24 hours.
Maintenance dose: Adjust dose to obtain an appropriate balance between pain management and opioid-related adverse reactions. During chronic therapy, periodically reassess the continued need for opioid analgesics.

Comments:
-Do not begin a patient on a fentanyl transdermal patch as their first opioid.
-A small number of patients may require a 48-hour dosing interval; an increase in dose should be evaluated before changing dosing intervals.

Fentanyl patch side effects

We recommend that you know the side effects of Fentanyl before you proceed to buy Fentanyl online for a reputable online pharmacy. Get emergency medical help if you have signs of an allergic reaction to a fentanyl patch: hives; chest pain, difficult breathing; swelling of your face, lips, tongue, or throat.

Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Remove the skin patch and call your doctor at once if you have:

    , sighing, weak or shallow breathing (up to several days after removing the skin patch);
  • confusion, severe drowsiness, feeling like you might pass out;
  • chest pain, fast or pounding heartbeats; or
  • low cortisol levels – nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are overweight, malnourished, or debilitated.

How to apply a fentanyl patch

Its important to know what is Fentanyl before you proceed to buy Fentanyl online from a genuine online pharmacy. Fentanyl is an opioid pain medication, sometimes called a narcotic.

Fentanyl patches are a strong prescription pain medicine. The patches are used to treat moderate to severe chronic pain around the clock.

Fentanyl patches are used when other pain treatments such as non-opioid pain medicines or immediate-release opioid medicines do not treat your pain well enough or you cannot tolerate them.

Fentanyl patches are not for treating mild or occasional pain or pain from surgery. The patches are not for use to treat pain that is not around-the-clock. if you are looking to get relief from the pain the you should buy Fentanyl online from a trusted online pharmacy.

How should I use a fentanyl patch?

Its necessary to know how to use Fentanyl before you decide to buy Fentanyl online from a reliable online pharmacy. Apply the fentanyl patch exactly as prescribed by your healthcare provider. Follow the directions on your prescription label and read all medication guides. Never use fentanyl patches in larger amounts, or for longer than prescribed. Tell your doctor if you feel an increased urge to use more fentanyl patches. Never use a skin patch if it has been cut or damaged.

Stop using all other around-the-clock opioid medications.

Do not allow the skin patch to come into contact with your mouth, eyes, nose, or lips, or another person’s skin.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Wear the fentanyl skin patch around the clock, removing and replacing the patch every 72 hours (3 days). Do not wear more than 1 patch at a time unless your doctor has told you to.

When placing a skin patch on a young child, choose a wearing area where the child cannot easily remove the patch unsupervised.

Do not stop using fentanyl suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using this medicine.

Store each patch in its foil pouch at room temperature.

Keep both used and unused patches out of the reach of children or pets. The amount of fentanyl in a used skin patch can be fatal to a child or pet who accidentally sucks or chews on the patch. Seek emergency medical attention if this happens.

After removing a skin patch: fold it in half with the sticky side in, and flush the patch down the toilet right away. Do not place a used skin patch into a trash can.

Fentanyl Patch dosing information

its important to know the dosing information for Fentanyl before you proceed to buy Fentanyl online from a legit online pharmacy

Usual Adult Dose for Chronic Pain:

Due to the risk of respiratory depression, the transdermal patch is for use in opioid-tolerant patients only; opioid tolerant patients have been taking at least: morphine 60 mg daily, oral oxycodone 30 mg daily, oral hydromorphone 8 mg daily, or an equianalgesic dose of another opioid for 1 week or longer.
-Discontinue all other extended-release opioids when beginning therapy.

Initial doses: The initial dose should be individualized taking into account the patient’s prior treatment experience. This dose may be calculated based on the dose conversion guidelines in the product package insert, local protocol, or another reliable reference; when calculating, be aware there is substantial inter-patient variability in the relative potency of different opioid drugs and products and therefore it is preferable to underestimate a 24-hour fentanyl requirement and provide rescue medication than to overestimate which could result in adverse reactions.
Dose titration:
-Initial: May increase dose after 3 days based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application.
-Further titration should occur after no less than two 3-day applications as it may take up to 6 days for fentanyl levels to reach equilibrium. Titration should be based on the daily dose of supplementary opioids required and the following ratio may be used: Increase transdermal fentanyl by 12 mcg//hr for use of supplemental oral morphine doses of 45 mg/24 hours.
Maintenance dose: Adjust dose to obtain an appropriate balance between pain management and opioid-related adverse reactions. During chronic therapy, periodically reassess the continued need for opioid analgesics.

Comments:
-Do not begin a patient on a fentanyl transdermal patch as their first opioid.
-A small number of patients may require a 48-hour dosing interval; an increase in dose should be evaluated before changing dosing intervals.

Fentanyl patch side effects

We recommend that you know the side effects of Fentanyl before you proceed to buy Fentanyl online for a reputable online pharmacy. Get emergency medical help if you have signs of an allergic reaction to a fentanyl patch: hives; chest pain, difficult breathing; swelling of your face, lips, tongue, or throat.

Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Remove the skin patch and call your doctor at once if you have:

    , sighing, weak or shallow breathing (up to several days after removing the skin patch);
  • confusion, severe drowsiness, feeling like you might pass out;
  • chest pain, fast or pounding heartbeats; or
  • low cortisol levels – nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are overweight, malnourished, or debilitated.

There are many different ways fentanyl can be administered. This is one of the most potent opioids available, often estimated to be tens or even hundreds of times stronger than morphine, and it’s a Schedule II drug that requires a prescription.

Despite the fact that this incredibly powerful opioid is intended for the treatment of chronic pain from conditions like cancer, it’s become one of the most commonly abused opioids in America, leading to numerous overdoses and deaths.

How to apply a fentanyl patch

What Is a Fentanyl Patch?

The transdermal patch is for severe pain in people who are already receiving around-the-clock opioid pain treatment and have breakthrough pain. As with other opioids, the fentanyl patch alters the way the brain feels and responds to pain.

The transdermal patch goes directly on the skin and it contains a gel-like substance that’s medicated. It’s applied once every 72 hours and the fentanyl builds up in the skin before it’s released. The objective of the fentanyl patch is to release the drug slowly into the body, and the patches can be left on the skin for up to three days before they need to be changed out.

The most widely known brand name of fentanyl patches is called Duragesic.

Due to the rise in the use and abuse of fentanyl, there are a lot of questions people have about fentanyl patch abuse including “Are fentanyl patches addictive?” and “Are fentanyl patches dangerous?” Below covers some of these topics.

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Fentanyl Patch Abuse

There are many different ways fentanyl patch abuse is possible.

One possibility of fentanyl patch abuse happens when someone changes the patch more often than what’s prescribed or wears multiple patches at the same time. Fentanyl patches are specifically designed to release medicine into the system of the person in a controlled way over a period of around three days. If someone wears multiple patches, more of the drug is being absorbed into their bloodstream than normally would be with one patch, and they may feel a euphoric high.

This example shows one-way fentanyl patches are dangerous because it can take longer for the effects of the drug to wear off, leading to a higher likelihood of adverse side effects.

Another way fentanyl patch abuse is possible and fentanyl patches are dangerous is when someone removes the gel from the patch and injects it. The person may take the gel, heat it or mix it with water and then use a needle to inject it into their vein. Fentanyl is extremely potent and injecting the gel can lead to an overdose.

Fentanyl patch abuse can also occur when someone chews the patches and then the drug is absorbed by the mucous membranes, or when they smoke the gel that’s inside, or when they steep the fentanyl patches in hot water and drink the liquid as if it’s tea.

All of these types of fentanyl patch abuse are extremely dangerous.

Are Fentanyl Patches Addictive?

Are Fentanyl Patches Dangerous?

If fentanyl patch abuse occurs, continued use of the patches is incredibly dangerous and can result in respiratory depression and trouble breathing, extreme drowsiness, memory and cognition problems, dizziness, confusion and even coma. Fentanyl, since it is so powerful, can lead to a rapid overdose.

Fentanyl patches can also be dangerous to the people around you. For example, if children even touch the gel on a patch accidentally, it could be harmful or even deadly. This fact is why it’s important for people who use fentanyl patches to be careful themselves, but also make sure the patches are properly stored.

While there are benefits to these transdermal patches, fentanyl patch abuse is a very real possibility, and fentanyl patches are also addictive and potentially dangerous.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

This medication is used to help relieve severe ongoing pain (such as due to cancer). Fentanyl belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.Do not use the patch form of fentanyl to relieve pain that is mild or that will go away in a few days. This medication is not for occasional (“as needed”) use.

How to use Fentanyl Patch, Transdermal 72 Hours

See also Warning section.

Read the Medication Guide and, if available, the Instructions for Use provided by your pharmacist before you start using this medication and each time you get a refill. Learn how to properly use, store, and discard the patches. If you have any questions, ask your doctor or pharmacist.

Use this medication on a regular schedule as directed by your doctor, not as needed for sudden (breakthrough) pain.

Transdermal fentanyl comes as a patch to apply to the skin. The patch is usually applied to the skin once every 72 hours. Change your patch at about the same time of day every time you change it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply fentanyl patches exactly as directed.

Your doctor may start you on a low dose fentanyl patch and gradually increase your dose, not more often than once every 3 days at first, and then not more often than once every 6 days. Your doctor may decrease your dose if you experience side effects. Talk to your doctor about how you are feeling during your treatment with fentanyl patches.

Fentanyl patches are only for use on the skin. Do not place patches in your mouth or chew or swallow the patches.

Do not stop using fentanyl patches without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop using fentanyl patches you may have symptoms of withdrawal. Call your doctor if you experience any of these symptoms of withdrawal: restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, large pupils (black circles in the center of the eyes), irritability, anxiety, backache, pain in the joints, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast heartbeat, or rapid breathing.

Do not use a fentanyl patch that is cut, damaged, or changed in any way. If you use cut or damaged patches, you may receive most or all of the medication at once, instead of slowly over 3 days. This may cause serious problems, including overdose and death.

You may bathe, swim, or shower while you are wearing a fentanyl patch. If the patch falls off during these activities, dispose of it properly. Then dry your skin completely and apply a new patch. Leave the new patch in place for 72 hours after you apply it.

You can apply a fentanyl patch to your chest, back, upper arms, or the sides of your waist. If you are applying the patch to a child or to a person who is unable to think clearly, choose an area on the upper back to make it more difficult for the person to remove the patch and place it in his or her mouth. Choose an area of skin that is flat and hairless. Do not apply the patch to parts of the body that move a lot or to skin that has been exposed to radiation or that is sensitive, very oily, broken out, irritated, broken, cut or damaged. If there is hair on the skin, use scissors to clip the hair as close to the skin as possible. Do not shave the area.