Fentanyl is a strong opioid, available in a patch applied to the skin for transdermal administration, over 72 hours for chronic cancer pain.
Both matrix and reservoir patch formulations are available -when prescribing, patches should be prescribed by their brand name or specify 'matrix' or 'reservoir' to avoid confusion. Transdermal fentanyl could be considered when patients have an opioid-responsive pain and where pain control is stable, as an alternative to morphine, (ie. a 2nd line strong opioid) where the patient is
- unable to tolerate morphine
- unable to take oral medication, e.g. dysphagia, vomiting
- where drug compliance needs to be improved
- BUT NOT in situations where the pain is acute, and rapid dose titration is required
Following a review of the risks associated with use of opioid medicines for non-cancer pain, the Commission on Human Medicines (CHM) has recommended that fentanyl transdermal patches are contraindicated in opioid-naive patients in the UK (2).
Advice for healthcare professionals:
- fentanyl is a potent opioid – a 12 microgram (µg) per hour fentanyl patch equates to daily doses of oral morphine of up to 45mg a day
- do not use fentanyl patches in opioid-naive patients
- use other analgesics and other opioid medicines (opioids) for non-cancer pain before prescribing fentanyl patches
- if prescribing fentanyl patches, remind patients of the importance of:
- not exceeding the prescribed dose
- following the correct frequency of patch application, avoiding touching the adhesive side of patches, and washing hands after application
- not cutting patches and avoiding exposure of patches to heat including via hot water (bath, shower)
- ensuring that old patches are removed before applying a new one
- following instructions for safe storage and properly disposing of used patches or patches that are not needed (see advice issued previously); it is particularly important to keep patches out of sight and reach of children at all times
- make patients and caregivers aware of the signs and symptoms of fentanyl overdose and advise them to seek medical attention immediately (by dialling 999 and requesting an ambulance) if overdose is suspected
- remind patients that long-term use of opioids in non-cancer pain (longer than 3 months) carries an increased risk of dependence and addiction, even at therapeutic doses (see Drug Safety Update on risk of dependence and addiction with opioids); before starting treatment with opioids, agree with the patient a treatment strategy and plan for end of treatment
- report suspected adverse drug reactions, including dependence, accidental exposure, or overdose associated with fentanyl patches, via the Yellow Card scheme
Reference:
- (1) West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptom control.
- (2) MHRA (23 September 2020). Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients. Drug Safety Update volume 14, issue 2: September 2020: 2