1.1.6. Transdermal Patch (Duragesic®, generics)

To initiate fentanyl transdermal patch therapy in patients prescribed other opioids, discontinue all other around-the-clock opioid therapy. Short-acting opioid agonists may be used as needed for the first 24 hours after initial application. Breakthrough pain may require supplemental doses even after a transdermal dose is established. Conversion doses from an oral or parenteral fentanyl preparation to fentanyl transdermal patches is summarized in Table 46-11. Conversion doses from daily oral morphine dosages to fentanyl transdermal patches is provided in Table 56-11. This table does NOT represent equianalgesic doses and is only intended to provide dosage conversions from other opioids to fentanyl transdermal patches, but does NOT provide dosage conversions from fentanyl transdermal patches to other fentanyl/opioid dosage forms as the new opioid dose would be overestimated and may potentially result in a fatal drug overdose.

Patients requiring fentanyl transdermal patch therapy and taking an opiate not listed in Table 4 should calculate the previous 24-hour analgesic requirement and convert the quantity to an equianalgesic oral morphine dose and use Table 4 or an additional dosage conversion chart such as the “Table 2. Morphine Milligram Equivalent (MME) Doses for Commonly Prescribed Opioids” table provided in the “CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016” to identify an appropriate transdermal fentanyl patch conversion dose. The fentanyl transdermal patch dose should be titrated to a dose that provides adequate analgesia and minimal adverse reactions. The patch should be changed every 72 hours. If adequate analgesia is not achieved, the initial dose can be titrated after three days; subsequent dosage titrations should not be made more frequently than every six days. In the event that breakthrough pain occurs, a dosage adjustment may be necessary as well as rescue medication administration with an immediate-release analgesic. A small percentage of adult patients may not have adequate pain control with an every 72 hour dosage scheme and may require an every 48 hour dosing regimen. The patch should be applied to non-irritated, non-irradiated skin on a flat surface; avoid exposing the patch to external heat sources6, 7-11.