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Cautions using fentanyl patches

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • fentanyl blood levels rise slowly - continue previous medication for 24 hours
  • fentanyl blood levels fall slowly on removal - there is prolonged toxicity in overdose
  • fentanyl has a long half-life - increase dose only every third day
  • ensure that analgesia for breakthrough pain is always available
  • avoid heat pads near a patch - these increase absorption and hence the risk of overdosage

Also use with caution:

  • if the patient has not had strong opioids
  • patients previously on doses of oral morphine (or equivalent opioid) < 60mg/24hr
  • pyrexial patients where rate of absorption may be unpredictable
  • with poor adherence of patches, e.g. patient with sweats or when applied to the chest wall of patients who are cachectic
  • during the dying phase - seek specialist palliative care advice

Contraindications: Sensitivity to fentanyl or silicone medical adhesive

Reference:

  • (1) West Midlands Palliative Care Physicians (2012). Palliative care - guidelines for the use of drugs in symptom control.

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