fentanyl 100mcg patch (also known as fentanil) is a potent, synthetic opioid pain medication with a rapid onset and short duration of action. It is a strong agonist at the μ-opioid receptors. Fentanyl is estimated to be between 50 and 100 times as potent as morphine.
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Fentanyl 100mcg patch was first made by Paul Janssen in 1960,following the medical inception of pethidine (also known as meperidine, marketed as Demerol) several years earlier. Janssen developed fentanyl by assaying analogues of the structurally related drug pethidine for opioid activity. The widespread use of fentanyl triggered the production of fentanyl citrate (the salt formed by combining fentanyl and citric acid in a 1:1 stoichiometry), which entered medical use as a general anaesthetic under the trade name Sublimaze in the 1960s. Following this, many other fentanyl analogues were developed and introduced into medical practice, including sufentanil, alfentanil, remifentanil, and lofentanil.
Fentanyl 100mcg patch In the mid-1990s, fentanyl was introduced for palliative use with the fentanyl patch, followed in the next decade by the introduction of the fentanyl lollipop, dissolving tablets, and sublingual spray which are resorbed through the skin inside the mouth.As of 2012 fentanyl was the most widely used synthetic opioid in medicine.In 2013, 1700 kilograms were used globally.
Fentanyl is also used as a recreational drug, and this use has led to thousands of overdose deaths each year in recent years. Deaths have also resulted from improper medical use. Fentanyl has a relatively wide therapeutic index (270) which makes it a very safe surgical anesthetic when monitored carefully; however, its extreme potency requires careful measurements of highly diluted fentanyl in solution; attempting to accurately measure a dose of pure fentanyl powder is impractical without advanced scientific equipment as an effective dose and a lethal dose of fentanyl powder placed next to each other would be difficult or impossible to differentiate with the naked eye
- Second line opioid for moderate to severe opioid responsive pain.
- Pain must be stable.
- Oral and subcutaneous routes are not suitable.
- Patient unable to tolerate morphine/ diamorphine due to persistent side effects.
- Compliance is poor, but supervised patch application is possible.
- Fentanyl is a potent opioid analgesic; check the dose conversion carefully. 100 to 150 times more potent than oral morphine.
- A 25micrograms/hour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
- Frail or elderly patients may need lower doses and slower titration.
- Heat/pyrexia increases the absorption of fentanyl and can cause toxicity. Avoid direct contact with heat (for example hot water bottle, heat pad). Showering is possible as the patches are waterproof, but patients should avoid soaking in a hot bath, sauna or sunbathing. If the patient has a persistent temperature of 39◦C, the patch dose may need reviewed – use anti-pyretic measures.
- Liver impairment: dose reduction may be needed in severe liver disease.
- Renal impairment: no initial dose reduction. May accumulate gradually over time. Monitor patient and reduce dose. Fentanyl is not usually removed by dialysis.
- Hepatic metabolism is reduced by grapefruit juice and a number of medications (for example fluconazole, QTclarithromycin, QTerythromycin): check British National Formulary (BNF).
- Alcohol and CNS depressants increase side effects.
- Anticonvulsants may reduce its effect. Refer to BNF.
- Manufacturers warn of a risk of serotonin toxicity when fentanyl is used in combination with other serotonergic drugs.
- Similar to other opioids (dizziness, sedation, delirium) but less constipation and possibly less nausea.
- If signs of opioid toxicity (for example sedation, delirium), remove the patch and seek advice. Fentanyl will be released from the site for up to 24 hours. Monitor the patient for 24 to 48 hours.
- Naloxone (in small titrated doses) is only needed for life-threatening respiratory depression (refer to Naloxone guideline).
- An allergic reaction to the patch adhesive can occur – consider switching brand of patch, change opioid or consider one to two doses of a 50micrograms to 100micrograms beclometasone dipropionate inhaler on to site prior to application of patch.
Dose and Administration
Starting a fentanyl patch
- Do not start at end of life.
- Choose a suitable patch – matrix patch allows titration in smaller increments.
- Calculate the dose of fentanyl from the conversion chart given here or seek advice. Patch strengths can be combined to provide an appropriate dose.
- Patches are licensed for dose initiation and titration.
- Make sure the patient takes another regular opioid for the first 12 hours after the patch is first applied to allow the fentanyl to reach therapeutic levels (refer to Switching opioid to fentanyl patch table below).
- An immediate release opioid (for example oral morphine or morphine SC) must be available 1-2 hourly, as required, for breakthrough pain or to treat any opioid withdrawal symptoms (diarrhoea, abdominal pain, nausea, sweating). These can occur during the fentanyl initiation period due to the variable time to reach steady state. The correct 4 hourly equivalent dose should be used.
- Fentanyl is often less constipating than morphine; half dose of any laxative and titrate.
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