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fentanyl topical; fentanyl transdermal (Duragesic, Ionsys)

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)# - start: 12.5-25 ug/hr - one patch every 3 days. - titrate after 2-3 patch changes [1] 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] Mylan solid reservoir - some say Mylan generic NOT as effective as Duragesic - FDA says both generics equivalent to Duragesic 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: transdermal 1) absorption varies with body temperature & the application of heat to the skin surface 2) onset of action is 12-24 hours; 6-12 hours after placement [1] 3) steady state reached in 72 hours 4) post-removal, steady state concentrations are seen for 24-48 hours; 72-96 hours [1] (skin is reservoir for drug delivery) [1] 5) reservoir is skin Adverse effects: 1) rash with transdermal delivery 2) dependence (physical &/or psychological) 3) constipation 4) overdose & death reported from use of transdermal patch [2] 5) accidental exposure to fentanyl via transdermal patch, particularly by children [2]

Interactions

drug adverse effects of opiates

General

fentanyl (Sublimaze, Subsys, Fentanyl Oralet, Actiq, Fentora, Onsolis, Abstral, Lazanda) topical agent transdermal therapeutic system (TTS, transdermal patch)

References

  1. 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. http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Fentanyl http://www.fda.gov/medwatch/safety/2007/safety07.htm#Fentanyl
  3. FDA Issues Warning on Fentanyl Patches 04/19/2012 http://www.medscape.com/viewarticle/762326?sssdmh=dm1.777166&src=nl_newsalert
  4. Prescriber's Letter 12(5): 2005 Generic Duragesic (Fentanyl) Patches Detail-Document#: 210504 (subscription needed) http://www.prescribersletter.com
  5. Prescriber's Letter 14(10): 2007 Safe Use of Fentanyl (Duragesic) Patches Detail-Document#: 231010 (subscription needed) http://www.prescribersletter.com