Fentanyl transdermal

Fentanyl transdermal is a transdermal system that is effective in the management of the severe pain associated with cancer. The transdermal system allows for a timed-release patch containing the drug fentanyl to be activated over a 72-hour period. A small number of patients may require systems applied every 48 hours. The nurse monitors for adverse effects in the same manner as for other narcotic analgesics (eg, the nurse notifies the primary health care provider if the respiratory rate is 10/min or less). 

Opioids are generally well absorbed enterally (Reisine and Pasternak 1996). However, blood levels of morphine only reach half of those reached by injection. The more lipid soluble opioids are absorbed through the nasal mucosa or transdermally (e.g., fentanyl). Transdermal administration is much slower and more prolonged, avoiding the fluctuating levels produced by injection. 

Fentanyl transdermal system Fentanyl transdermal systems contain a high concentration of the potent schedule II opioid agonist, fentanyl. Schedule II opioid substances have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Fentanyl can be abused and is subject to criminal diversion. The high content of fentanyl in the patches may be a particular target for abuse and diversion. 

Fentanyl transdermal system is indicated for management of persistent, moderate to severe chronic pain that ... 

Fentanyl transdermal system should only be used in patients who are already receiving opioid therapy, who have demonstrated opioid tolerance, and who require a total daily dose at least equivalent to fentanyl transdermal system 25 mcg/h. 

Because serious or life-threatening hypoventilation could occur, fentanyl transdermal is contraindicated ... 

Do not administer fentanyl transdermal system to children younger than 2 years of age. Administer to children only if they are opioid tolerant and 2 years of age or older. 

Fentanyl transdermal patches are intended for transdermal use (on intact skin) only. Using damaged or cut fentanyl transdermal patches can lead to the rapid release of the contents of the fentanyl transdermal patch and absorption of a potentially fatal dose of fentanyl. 

Only use in patients who are already receiving opioid therapy, who have demonstrated opioid tolerance, and who require a total daily dose at least equivalent to fentanyl transdermal system 25 meg/h. Patients who are considered opioid tolerant are those who have been taking, for a week or longer, morphine 60 mg/day or more, oral oxycodone 30 mg/day or more, oral hydromorphone 8 mg/day or more, or an equianalgesic dose of another opioid. 

Refer to Fentanyl Transdermal monograph for dosing conversion. 

Initial Fentanyl Transdermal Dose Based on Daily Morphine Equivalence Dose ... 

Do not use this table to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl is conservative. Use of this table for conversion to other analgesic therapies can overestimate the dose of the new agent. Overdosage of the new analgesic agent is possible. 

Pediatric patients initiating therapy on a fentanyl transdermal system 25 mcg/h should be opioid-tolerant and receiving oral morphine equivalents 60 mg/day or more. 

Fentanyl transdermal therapeutic system see below see below... 

Conversion from transdermal fentanyl to CR tablets Eighteen hours following the removal of the transdermal fentanyl patch, treatment with CR tablets can be initiated. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 10 mg every 12 hours of CR tablets, should be initially substituted for each fentanyl transdermal patch 25 mcg/h. Closely follow the patient for early titration as there is very limited clinical experience with this conversion. 

If disturbances of gastrointestinal function prevent the use of oral sustained-release morphine, the fentanyl transdermal system (fentanyl patch) can be used over long periods. Furthermore, buccal transmucosal fentanyl can be used for short episodes of breakthrough pain (see Alternative Routes of Administration). Administration of strong opioids by nasal insufflation has been shown to be efficacious, and nasal preparations are now available in some countries. Approval of such formulations in the USA is growing. In addition, stimulant drugs such as the amphetamines have been shown to enhance the analgesic actions of the opioids and thus may be very useful adjuncts in the patient with chronic pain. 

Parenteral (generic, Sublimaze) 50 mcg/mL for injection Fentanyl Transdermal System (Duragesic) 12.5, 25, 50, 75, 100 mcg/h delivery Fentanyl Buccal 100, 200, 400, 600, 800 meg oral lozenge Fentanyl Actiq 200, 400, 600, 800, 1200, 1600 meg lozenge on a stick Patient Controlled Transdermal Iontophoretic Fentanyl System 40 meg per dose for delivery Hydromorphone (generic, Dilaudid)... 

Fentanyl transdermal delivery systems (FTDS) use an unsealed multilaminate system containing a solid matrix, in which fentanyl is embedded instead of the reservoir designed in the TTS. FTDS is not to be recommended for routine postoperative pain treatment, even though it has a faster onset of action (4—6 hours) after cases of fentanyl toxicity, especially respiratory depression. FTDS has not been investigated adequately in chronic pain and is not expected to be superior to the TTS technique. 

FENTANYL TRANSDERMAL SYSTEM (Duragesic-12 transdermal system 1.25 mg)... 

The fentanyl transdermal patch releases the drug over 72 hours. The blood levels achieved will often provide analgesia for postoperative pain but at the same time will increase arterial Pco due to depression of the brain stem respiratory center. This effect has contributed to severe respiratory depression with occasional fatalities. The answer is (E). 

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