fentanyl topical; fentanyl transdermal (Duragesic, Ionsys)
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Indications
- treatment of moderate to severe chronic pain syndromes
Contraindications
- do not use patches for unstable or acute pain
- do not use in opioid-naive patients
Dosage
Transdermal:* Tradename: Duragesic. (2 generics: Sandoz, Mylan)#
Patches: 25, 50, 75 & 100 ug/hr
* reservoir for transdermal fentanyl is the skin removal of patch will NOT remove fentanyl in skin
do not cut patches, improper use may cause leakage[5]
# Sandoz (same as Duragesic) liquid reservoir[4]
Ionsys Works by iontophoresis
12.5 ug patch = 30-59 mg morphine PO daily
25 ug patch = 60-134 mg morphine PO daily
50 ug patch = 134-224 mg morphine PO daily
75 ug patch = 225-314 mg morphine PO daily
100 ug patch = 315-404 mg morphine PO daily
125. ug patch >= 405 mg morphine PO daily
Patients should be on an equivalent of at least 60 mg of oral morphine daily for at least 1 week prior to using a fentanyl patch
Pharmacokinetics
- absorption varies with body temperature & the application of heat to the skin surface
- onset of action is 12-24 hours; 6-12 hours after placement[1]
- steady state reached in 72 hours
- post-removal, steady state concentrations are seen for 24-48 hours; 72-96 hours[1] (skin is reservoir for drug delivery)[1]
- reservoir is skin
Adverse effects
- rash with transdermal delivery
- dependence (physical &/or psychological)
- constipation
- overdose & death reported from use of transdermal patch[2]
- accidental exposure to fentanyl via transdermal patch, particularly by children[2]
- drug adverse effects of opiates
- drug adverse effects of psychotropic agents
- drug adverse effects of sedatives
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 2.0 2.1 2.2 http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Fentanyl http://www.fda.gov/medwatch/safety/2007/safety07.htm#Fentanyl
- ↑ FDA Issues Warning on Fentanyl Patches 04/19/2012 http://www.medscape.com/viewarticle/762326?sssdmh=dm1.777166&src=nl_newsalert
- ↑ 4.0 4.1 Prescriber's Letter 12(5): 2005 Generic Duragesic (Fentanyl) Patches Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210504&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 Prescriber's Letter 14(10): 2007 Safe Use of Fentanyl (Duragesic) Patches Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231010&pb=PRL (subscription needed) http://www.prescribersletter.com