What it Fentanyl (Duragesic®)? What is it used for?
Fentanyl is an opioid (narcotic) commonly used to control persistent, moderate to severe chronic pain. Fentanyl patches, such as Duragesic® (fentanyl transdermal system), are designed to be worn on the skin. The adhesive layer of the patch, the layer that sticks to your skin, is made of a special material that allows fentanyl to be absorbed through your skin into your bloodstream. The fentanyl is absorbed very slowly over a 72 hour period. The patch starts to work 12-18 hours after it is applied to your skin and continues working for up to 24 hours after the patch has been removed from the skin.
Fentanyl patches, such as the Duragesic patch, should be used only when a person is considered to be "opioid-tolerant." An "opioid-tolerant" person is someone who has been taking opioids daily for at least one week. Using opioids for this period of time allows your health care provider to monitor your usage and allows him/her to determine the proper dosage.
Fentanyl patches are to be used for persistent, moderate to severe chronic pain only and should never be used "when necessary."
Using Fentanyl (Duragesic®) Patches Safely
Keep an accurate, up-to-date medication list or card with you at all times. This list should include the names and dosages of all medications you are taking. Share your medication list with your health care provider. Be sure that he/she has reviewed your medication list before issuing a prescription for fentanyl (Duragesic) patches because many drugs are broken down by common pathways in the liver, which increases the risk for side effects.
Never use a patch that is damaged or cut. Damaged patches should be disposed of properly.
To properly dispose of a used or damaged patch:
- Fold the patch in half so that the sticky side sticks to itself.
- Flush the folded patch down the toilet.
Always apply the patch to clean, dry skin. Do not use soaps, lotions, oils, or alcohol on the skin where the patch will be applied. These products may prevent the patch from sticking and/or may increase the rate at which the fentanyl is absorbed. If the skin must be cleansed prior to applying the patch, do so with plain water. Allow the skin to dry completely before to apply the patch to the skin.
The patch should be applied to intact, non-irritated skin only. Applying the patch to open or abraded skin may increase the rate of fentanyl absorption.
Duragesic patches may be worn for 72 hours. After removing a patch, the next patch should be applied to a different skin site from the previous patch to prevent skin irritation. Always remove the old patch when a new patch is applied.
Write the date the patch was applied on a piece of tape that can be applied to the top of the patch. Do not write on the patch.
To apply the patch:
- Choose a flat skin site on which to apply the patch, such as the back, chest, flank (sides of the waist), or upper arm.
- If there is hair on the application site, clip the hair. DO NOT SHAVE the application site.
- Remove the clear protective liner from the patch. The patch must be applied immediately after the liner is removed.
- Avoid touching the sticky side of the patch as much as possible.
- With the palm of your hand press the sticky side of the patch to the desired skin site.
- Hold your hand on the patch for at least 30 seconds to ensure the patch edges seal properly.
- Wash your hands.
If gel from the patch leaks out onto the skin, rinse skin well with plain water. Do not use soap, alcohol, etc. to rinse the skin.
Do not expose the patch skin site and the area around the patch site to direct heat (e.g., heating pads, electric blankets, hot tubs, tanning lamps, etc.). Heat increases the rate of fentanyl absorption, which could lead to an overdose.
Side Effects/Adverse Effects
Be sure you share your medication list with all of your health care providers. Many medications interact when taken with other medications. If you are taking other medications along with fentanyl, you may be at risk for drug interactions.
Opioids can cause constipation; therefore, it is important for you to drink at least two quarts of non-alcoholic liquids per day, unless your health care provider tells you not to do so. Eat a balanced diet consisting of five servings of fruits and vegetables a day to help combat constipation. You may also need a stimulant laxative, such as senna, to relieve constipation. Ask your health care provider which laxative is best for you. Another way to help reduce constipation is to get some form of exercise each day. A regular walking regimen -- even 10 to 15 minutes several times a day -- can help your body and your digestive system function optimally. Consult your health care provider before starting any vigorous exercise program.
Do not drink alcohol while using fentanyl patches. Alcohol may increase the blood level of fentanyl and put you at risk for respiratory depression (breathing that has slowed so much that the body is not able to supply the oxygen they need to survive).
Watch for signs of oversedation. Oversedation will always precede respiratory depression. Some signs of over sedation are:
- Falling asleep in the middle of a sentence
- Unable to arouse
You may experience "breakthrough" pain while using fentanyl patches. Breakthrough pain is pain that occurs because of an activity or pain that comes on suddenly. Breakthrough pain should be controlled with an immediate release opioid. An Immediate release opioid is a pain medication that works very quickly. You and your health care provider can decide what immediate release opioid is best for you. If you need more than two doses of immediate release pain medication a day, talk to your health care provider about increasing the dose of your fentanyl patch.
Other family members should never use your fentanyl patches.
Be sure your patches are stored out of the reach from children. Do not let children handle fentanyl patches. There have been reports of children dying from fentanyl overdoses. Children may think that the patches are stickers or temporary tattoos.
When to Call Your Health Care Provider
Call your HCP if:
- You are falling asleep in the middle of a sentence during a conversation.
- Your breathing is shallow.
- Your skin becomes red, irritated, or itchy.
- You have not moved your bowels for three days.
- You are vomiting.
- Your pain is not well-controlled.
Call 911 immediately if you find someone who cannot be awakened or aroused.