Adult Dosing
Moderate to severe pain
Opioid tolerant patients
- Individualize dose based on current opioid intake; usual dose: 25-100 mcg/hr q72 hrs; may increase dose q3-6 days. Some patients may require q48 hrs dosing or doses >100 mcg/hr
Dosing guidelines- Calculate the previous 24-hr analgesic requirement
- Convert this to correspond to the oral morphine dosage using table 1
Table 1: Equianalgesic efficacy of medicinal products
| Name | Equianalgesic
Dose (mg) |
|---|
| IM | PO |
|---|
| Morphine | 10 | 60 (30) |
Hydromorphone
(Dilaudid®) | 1.5 | 7.5 |
Methadone
(Dolophine®) | 10 | 20 |
| Oxycodone | 15 | 30 |
Levorphanol
(Levo-Dromoran®) | 2 | 4 |
Oxymorphone
(Numorphan®) | 1 | 10(Rectal) |
Meperidine
(Demerol®) | 75 | - |
| Codeine | 130 | 200 |
Use table below to find calculated 24 hr morphine dose and corresponding fentanyl transdermal dose
Table 2: Recommended dosage of Fentanyl transdermal patch based upon oral daily morphine dosage
Oral 24 hr morphine
mg/day | Fentanyl dose
mcg/hr |
|---|
| 60-134 | 25 |
| 135-224 | 50 |
| 225-314 | 75 |
| 315-404 | 100 |
| 405-494 | 125 |
| 495-584 | 150 |
| 585-674 | 175 |
| 675-764 | 200 |
| 765-854 | 225 |
| 855-944 | 250 |
| 945-1034 | 275 |
| 1035-1124 | 300 |
Pediatric Dosing
- Therapy is indicated for moderate to severe pain in opioid tolerant patients > 2yrs
Moderate to severe pain
Opioid tolerant patients
- Individualize dose based on current opioid intake; usual dose: 25-100 mcg/hr q72 hrs; may increase dose q3-6 days. Some patients may require q48 hrs dosing or doses >100 mcg/hr
Dosing guidelines- Calculate the previous 24-hr analgesic requirement
- Convert this to correspond to the oral morphine dosage using table 1
Table 1: Equianalgesic efficacy of medicinal products
| Name | Equianalgesic
Dose (mg) |
|---|
| IM | PO |
|---|
| Morphine | 10 | 60 (30) |
Hydromorphone
(Dilaudid®) | 1.5 | 7.5 |
Methadone
(Dolophine®) | 10 | 20 |
| Oxycodone | 15 | 30 |
Levorphanol
(Levo-Dromoran®) | 2 | 4 |
Oxymorphone
(Numorphan®) | 1 | 10(Rectal) |
Meperidine
(Demerol®) | 75 | - |
| Codeine | 130 | 200 |
Use table below to find calculated 24 hr morphine dose and corresponding fentanyl transdermal dose
Table 2: Recommended dosage of Fentanyl transdermal patch based upon oral daily morphine dosage
Oral 24 hr morphine
mg/day | Fentanyl dose
mcg/hr |
|---|
| 60-134 | 25 |
| 135-224 | 50 |
| 225-314 | 75 |
| 315-404 | 100 |
| 405-494 | 125 |
| 495-584 | 150 |
| 585-674 | 175 |
| 675-764 | 200 |
| 765-854 | 225 |
| 855-944 | 250 |
| 945-1034 | 275 |
| 1035-1124 | 300 |
[Outline]
- Schedule II controlled substance; significant potential for abuse liability similar to other opioid agonists, legal or illicit. Evaluate patient’s risk for opioid abuse or addiction before administrating fentanyl. Patients at increased risk for abuse are those with a personal or family history of substance abuse or mental illness. Monitor patients for signs of misuse, abuse, addiction during treatment (US Black Boxed warning)
- Respiratory depression is the chief hazard of this drug; Fentanyl should only be prescribed by healthcare professionals who are well trained in the use of potent opioids for the management of chronic pain. Contraindicated in patients who are not opioid tolerant, acute pain, patients who require opioid analgesia for a short period of time, and postoperative pain (US Black Boxed warning)
- Peak fentanyl levels occur between 24-72 hrs of treatment; serious and life threatening hypoventilation can occur even in opioid-tolerant pts during initial application period. Fatal overdose with 1st dose can occur due to overestimation of conversion from another opioid; monitor and treat patients with serious adverse events including overdose for more than 24 hrs since fentanyl transdermal half-life is 17 hrs
- Elderly, cachectic, debilitated patients and patients with chronic pulmonary disease or cor pulmonale are at increased risk of respiratory depression and should be monitor closely, especially when initiating fentanyl and when given concomitantly with other drugs that depress respiration. Use fentanyl cautiously in conditions accompanied by hypoxia, hypercapnia, or decreased respiratory reserve
- Use with caution in patients with evidence of increased intracranial pressure, impaired consciousness, or coma, brain tumors
- Concomitant use with other CNS depressants may cause respiratory depression, hypotension, and profound sedation or potentially result in coma
- Concomitant use with CYP450 3A4 inhibitors may increase plasma fentanyl concentrations which may increase or prolong adverse effects including potentially fatal respiratory depression; monitor patients receiving fentanyl and any CYP3A4 inhibitor
- Avoid exposure of application site or surrounding area to direct external heat sources
- Patients with fever or increased core body temperature should be monitored for opioid side effects and fentanyl dose adjusted as required. Instruct patients to avoid strenuous exertion that leads to increased core body temperature while wearing patch to avoid the risk of potential overdose and death
- Therapy may cause bradycardia. Evaluate patient with bradyarrhythmias for changes in heart rate, particularly when initiating therapy
- Therapy may cause spasm of the sphincter of Oddi. Closely monitor patients with biliary tract disease, including acute pancreatitis for worsening of symptoms
- Opioid withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering may occur after conversion to another opioid or when decreasing or discontinuing fentanyl
- Fentanyl may impair the mental or physical abilities required for the performance of certain tasks such as driving and operating dangerous machinery
- Fentanyl should be applied immediately upon removal from the sealed package. The transdermal patch should be pressed firmly against the skin with the palm of the hand for 30 seconds, making sure that the contact is complete, especially at the edges
- Fentanyl is indicated for persistent moderate to severe chronic pain requiring round the clock opioid treatment not managed by NSAIDs, opioid combination products, or immediate release opioids. Patients must be opioid tolerant and require total daily dose equivalent to 25 mcg/hr. Patients are considered opioid tolerant if taking at least 60 mg/day morphine or at least 30 mg/day oxycodone, or at least 8 mg/day hydromorphone or equianalgesic dose of other opioid for more than 1wk
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Hx of cardiac disease
- Bradyarrhythmias
- Hx of pancreatic/biliary tract disease
- Bladder &/or Bowel obstruction
- Head injury
- Intracranial tumor
- Alcohol or substance abuse
- CNS depressant use
- Asthma
- COPD
- Impaired pulmonary function
- Elderly population
Pregnancy Category:C
Breastfeeding: Limited information indicates that transdermal fentanyl in a dosage of 100 mcg/hr results in undetectable fentanyl concentrations in breastmilk. A single study for a woman using transdermal fentanyl patch (100 mcg/hr) during pregnancy and post partum indicates that the infant required treatment for neonatal abstinence syndrome. The infant had no additional medical problems and fed well until discharge after 27 days and gained 500 g. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 16 February 2011). Manufacturer advises that fentanyl should not be administered to lactating women due to the potential to cause adverse reactions in the infants.
US Trade Name(s)
US Availability
fentanyl transdermal (generic)
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Duragesic
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Canadian Trade Name(s)
Canadian Availability
fentanyl (generic)
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Duragesic
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Duragesic Mat
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
UK Trade Name(s)
- Durogesic DTrans
- Fentalis reservoir
- Matrifen
- Mezolar Matrix
- Osmanil
- Victanyl
UK Availability
fentanyl (generic)
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Duragesic DTrans, Matrifen, Mezolar Matrix
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Fentalis reservoir, Osmanil, Victanyl
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
Australian Trade Name(s)
Australian Availability
Durogesic
- TDP: 12 mcg/hr
- TDP: 25 mcg/hr
- TDP: 50 mcg/hr
- TDP: 75 mcg/hr
- TDP: 100 mcg/hr
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- FentaNYL 75 MCG/HR PT72 [Box] (MYLAN)
5 hr = $195.98
10 hr = $379.98 - FentaNYL 25 MCG/HR PT72 [Box] (MYLAN)
5 hr = $66.66
10 hr = $133.33 - Fentanyl 12 (12.5) MCG/HR PT72 [Box] (MYLAN)
5 hr = $95.99
10 hr = $190.96 - Duragesic-25 25 MCG/HR PT72 [Box] (JANSSEN)
5 hr = $115
10 hr = $228.98 - Duragesic-100 100 MCG/HR PT72 [Box] (JANSSEN)
5 hr = $459.97
10 hr = $906.01
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
2 years of age
