fentanyl transdermal system, Duragesic
Emmanuel Saltiel, PharmD, FASHP, FCCP
Emmanuel Saltiel, PharmD, FASHP, FCCP
Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Medical and Pharmacy Editor:
GENERIC NAME: fentanyl transdermal system
BRAND NAME: Duragesic
DRUG CLASS AND MECHANISM: Fentanyl is a potent synthetic (man-made) narcotic. A 100 µg dose of fentanyl is approximately equal to 10 mg of morphine. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain (the amount of discomfort that a person must feel in order to be considered painful) and reduce the perception of pain (the perceived importance of the pain). Fentanyl is available in transdermal (for application to the skin), transmucosal (for application to mucus membranes) and parenteral (injectable) forms. When applied to the skin of the upper torso, fentanyl is well absorbed. The amount of fentanyl in the blood increases gradually after topical application, reaching a peak after 12-24 hours. Once this concentration is achieved, blood concentrations remain constant over the 72 hours that the patch is worn. After removal of the patch, blood concentrations of fentanyl decrease slowly due to ongoing absorption of fentanyl remaining on the skin. Fentanyl was originally approved by the FDA for injection in 1968.
GENERIC AVAILABLE: Yes
PREPARATIONS: Transdermal systems labeled as delivering 50, 75, or 100 µg/hour.
STORAGE: Patches should be stored at room temperature below 30°C (86°F). Used patches should be folded in half with the sticky sides together, and then flushed down the toilet. Patients must avoid exposing the patches to excessive heat as this promotes the release of fentanyl from the patch and increases the absorption of fentanyl through the skin which can result in fatal overdose.
DOSING: Patches should be applied to a flat, non-irritated area on the upper torso. The area of application should be clean and washed with water only prior to application. The patch should be applied immediately after removing it from the package and pressed firmly against the skin for 10 to 20 seconds especially around the edges. Patches should never be cut or otherwise damaged. Doses vary widely among patients. The manufacturer considers a fentanyl transdermal dose of 100 µg/hour approximately equivalent to 360 mg/day of oral morphine.
DRUG INTERACTIONS: The use of fentanyl with other central nervous
system (CNS) depressants can intensify the effects of fentanyl to depress
breathing, depress the brain, sedate, and lower blood pressure. Other drugs that
should be used cautiously with fentanyl include: antipsychotics [for example, Thorazine; Stelazine,
anxiolytics [for example, diazepam
(Valium), lorazepam (Ativan),
zolpidem (Ambien)], certain
antihistamines [for example,
barbiturates [for example,
phenobarbital (Donnatal)], tricyclic antidepressants [for example,
doxepin (Sinequan)], ethanol,
and skeletal muscle relaxants [for example,
baclofen (Lioresal)]. The use fentanyl with amiodarone (Cordarone) may result in slow heart rates. Cimetidine (Tagamet) when used with fentanyl can cause
confusion, disorientation, or
seizures due to impairment in breathing and brain function.
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