Fentanyl

Brand names: Duragesic

Why is Fentanyl prescribed?

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Duragesic patches deliver a continuous dose of the potent narcotic painkiller fentanyl for a period of three days. The patches are prescribed for chronic pain when short-acting narcotics and other types of painkillers fail to provide relief.

Most important fact about Fentanyl

When wearing a Duragesic patch, check with your doctor before taking any other drugs that slow the nervous system. The combined effect can impair breathing, reduce blood pressure, and lead to coma. Drugs in this category include the following:

Antidepressants such as nefazodone
Antipsychotic drugs such as chlorpromazine, prochlorperazine, thioridazine, and trifluoperazine
Muscle relaxants such as cyclobenzaprine, metaxalone, and methocarbamol
Narcotic painkillers such as hydrocodone bitartrate, and meperidine, oxycodone
Sleep aids such as triazolam, and zaleplon, zolpidem
Sleep-inducing antihistamines such as diphenhydramine and promethazine
Tranquilizers such as alprazolam, chlordiazepoxide, diazepam, and lorazepam
Alcoholic beverages

How should you take Fentanyl?

Apply the patch to a flat surface such as the chest, back, side, or upper arm. Children should have the patch applied to their upper back to discourage them from removing it. Hair at the site should be clipped (but not shaved). If the skin needs to be washed, use clear water. Do not use soaps, oils, lotions, alcohol, or any other cleanser that could irritate the skin. Allow the skin to dry completely.

Apply the patch as soon as you open the sealed package. Do not cut or tear the patch. Press it firmly in place with the palm of your hand for 30 seconds. Make sure that contact with the skin is complete, especially around the edges.

After 3 days (72 hours), remove the patch, fold the adhesive side together, and flush the patch down the toilet.

If you miss a dose...
If needed, after a used patch is removed a fresh patch can be applied at a different site on the skin.

Storage instructions...
Store below 77 degrees Fahrenheit. Keep out of reach of children. Unused patches should be removed from their package and flushed down the toilet.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe to continue using Duragesic.

Side effects may include:
Abdominal pain, anxiety, confusion, constipation, depression, decreased libido, diarrhea, dizziness, dry mouth, exaggerated high spirits, fatigue, hallucinations, headache, impaired or interrupted breathing, indigestion, insomnia, itching, loss of appetite, nausea, nervousness, shortness of breath, sleepiness, sweating, urinary retention, vomiting, weakness

Why should Fentanyl not be prescribed?

Duragesic should never be used in situations where the right dosage hasn't been established in advance—for instance, after an operation or an accident. It should not be used for mild or intermittent pain that responds to other painkillers.

Duragesic should not be used in individuals who have a paralyzed bowel wall. The drug should also be avoided if it causes an allergic reaction.

Duragesic should not be given to children under 2 years old or children who are not tolerant to narcotic painkillers.

Special warnings about Fentanyl

Heat can increase the release of fentanyl from the Duragesic patch, thereby increasing the risk of impaired breathing and other side effects. Do not expose the patch to heating pads, electric blankets, heated water beds, heat lamps, saunas, hot tubs, or other external sources of heat. Alert your doctor if you develop a high fever (104 degrees Fahrenheit or more).

If the Duragesic patch is cut or damaged, do not use it. This may result in a quick release of fentanyl, which could cause death.

Duragesic patches should only be used if you have already had a form of opioid therapy.

Like other narcotic painkillers, Duragesic can impair your reactions. Do not drive or operate dangerous machinery until you are certain you can tolerate the drug.

Extended use of Duragesic can lead to physical and psychological dependence, but may be necessary to control chronic pain. Your doctor will take this into account when prescribing Fentanyl.

If your breathing is already impaired by chronic pulmonary disease, Duragesic's tendency to reduce respiration can be especially dangerous. The doctor will determine your dosage with extra caution.

Duragesic is not recommended for people with head injuries and other conditions that increase pressure on the brain, or for those who are semi-conscious or in a coma. It should be used with caution by people with brain tumors.

Use Duragesic with caution if you have an irregular heartbeat; Duragesic can make the problem worse. Caution is also advised if you have kidney or liver disease.

When wearing the Duragesic patch, be careful when touching others; hugging, helping in patch positioning, or accidentally touching the patch may result in serious medical problems for the other person. If the gel does come into contact with your skin, or your caregiver's skin, wash immediately with water only. Do not use soap or alcohol─these may increase the gel's absorption into the skin.

Possible food and drug interactions when taking Fentanyl

Remember to check with your doctor before taking any other drugs that slow the nervous system. (See "Most important fact about Fentanyl.") The dose of such drugs should be reduced by at least half.

Certain other drugs can increase the effects of Duragesic, triggering the need for a dosage reduction. They include:

Antifungal medications such as fluconazole, itraconazole, and ketoconazole
HIV drugs classified as protease inhibitors, including amprenavir, indinavir, lopinavir, nelfinavir, ritonavir, and saquinavir,
Macrolide antibiotics such as azithromycin, clarithromycin, and erythromycin

Some drugs may have the opposite impact, decreasing the effects of Duragesic. They include:

Carbamazepine
Phenytoin
Rifampin

Special information if you are pregnant or breastfeeding

The effects of Duragesic during pregnancy have not been adequately studied. Make sure the doctor knows if you are pregnant or planning to become pregnant.

The active ingredient fentanyl does make its way into breast milk; and Duragesic is not recommended for nursing women.

Recommended dosage for Fentanyl

The Duragesic patch comes in four sizes: Duragesic-25, 50, 75, and 100. If you have not been taking a narcotic painkiller prior to Duragesic, the doctor will start with the smallest size. If this proves inadequate, the size will be increased after the first 3 days. If necessary, further increases can be made every 6 days thereafter.

For people who are already taking a narcotic painkiller, the dosage of Duragesic is determined by the type of painkiller they've been using, its potency, and the size of the dose. Older adults and the debilitated generally receive a smaller dose of Duragesic.

When Duragesic is to be discontinued, the doctor will reduce the dose gradually to avoid withdrawal symptoms.