- Transdermal (Adults ): 25 mcg/hr is the initial dose; patients who have not been receiving opioids should receive not more than 25 mcg/hr. To calculate the dose of transdermal fentanyl required in patients who are already receiving opioid analgesics, assess the 24-hr requirement of currently used opioid. Using the equianalgesic table in Equianalgesic Dosing Guidelines, convert this to an equivalent amount of morphine/24 hr. Conversion to fentanyl transdermal may be accomplished by using the fentanyl conversion table (Equianalgesic Dosing Guidelines). During dose titration, additional short-acting opioids should be available for breakthrough pain. Morphine 10 mg IM or 60 mg PO every 4 hr (60 mg/24 hr IM or 360 mg/24 hr PO) is considered to be approximately equivalent to transdermal fentanyl 100 mcg/hr. Transdermal patch lasts 72 hr in most patients. Some patients require a new patch every 48 hr.
- Transdermal (Adults >60 yr, Debilitated, or Cachectic Patients): Initial dose should be 25 mcg/hr unless previous opioid use was >135 mg morphine PO/day (or other opioid equivalent).
Hepatic Impairment
- Transdermal (Adults ): Mild to moderate hepatic impairment: 12 mcg/hr is the initial dose.
Renal Impairment
- Transdermal (Adults ): Mild to moderate renal impairment: 12 mcg/hr is the initial dose.