John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. It should only be used in people who are already using an opioid medication. Recommend an appropriate dose of transdermal fentanyl when. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. Fentanyl actiq side effects, dosage, interactions drugs. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Duragesic patches are intended for transdermal use on intact skin only. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only.
Fentanyl patches scottish palliative care guidelines. Durogesic 25mcg patch is a synthetic opioid medication. Use this table to find the calculated 24hour morphine dose and the corresponding recommended initial duragesic dose. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. If the patch accidentally sticks to a family member while in close contact, take the patch off, wash the area with. Fentanyl is metabolised by the liver and excreted renally. Converting to transdermal fentanyl palliative care network of. To prevent tolerance, leave the patch on 12 to 14 hours, then remove for 10 to 12 hours prior to applying the next patch. These bidirectional differences are not captured in a traditional equianalgesic table.
Transdermal and parenteral fentanyl dosage calculations and. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. A strong prescription pain medicine that contains an opioid narcotic that is used to manage pain severe enough to require daily aroundtheclock, longterm treatment with an opioid, in people who are already regularly using. Rate of absorption is dependent on a number of factors and body temperature, skin type and placement of the patch can have major effects. A void exposing the duragesic application site and surrounding area to direct external heat sources, such as heating pads or electric blankets, heat.
The fentanyl patch is one of a few medications that may be especially harmful, and in some cases fatal, with just one dose, if used by someone other than the person for whom the medication was prescribed. The fentanyl patch duragesic is a medicated skin patch used to treat moderatetosevere chronic pain. Duragesic fentanyl transdermal drugs requiring prior authorization drugs requiring prior authorization label name gcn duragesic 12 mcghr patch 24635 duragesic 25 mcghr patch 19200 duragesic 50 mcghr patch 19201 duragesic 75 mcghr patch 19202 duragesic 100 mcghr patch 19203 fentanyl 12 mcghr patch 24635. Duragesic should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least duragesic 25 mcg. Durogesic dtrans 12 mcghr transdermal patch summary of. Unused fentanyl patches should be kept in a secure location out. The following information contains guidelines for the proper clinical. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Do not use table 2 to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl transdermal system is conservative and will overestimate the dose of the new agent. It is used in combination with anesthesia to prevent postsurgery pain or other medical procedures that may prove to be painful on using durogesic 25mcg patch you may experience side effects such as nausea, vomiting, respiratory issues, fever. Side effects of duragesic fentanyl transdermal, warnings.
The initial dosage your healthcare provider recommends will mostly depend on the type and dose of the other opioids you have been taking. An alternative algorithm for dosing transdermal fentanyl for. Important information about duragesic get emergency help right away if you use too much duragesic overdose. Fentanyl patches durogesic for chronic pain nps medicinewise. Webmd provides common contraindications for duragesic transdermal. Dec 23, 2019 duragesic is the brand name of fentanyl transdermal therapeutic systems which is a system of delivering pain relief in the form of a patch placed on the skin. Duragesic label page 1 full prescribing information for. Opioid analgesic, anesthesia adjunct controlled substance schedule ii pregnancy risk category c action binds to specific opioid. Duragesic patches have a boxed warning regarding the abuse potential, fatal respiratory depression even in opioid tolerant patients, accidental exposure, cytochrome p450 3a4 interaction. Fentanyl is also sold as a lozenge under the brand name actiq, a tablet that goes under the tongue abstral, a film thats applied to the.
Refer to table 2 for the range of 24hour oral morphine doses that are recommended for conversion to each duragesic dose. Dose equivalence and switching between opioids specialist. Parenteral fentanyl is indicated for perioperative. Duragesic fentanyl is one of the long acting opioid medications available as a transdermal patch in the armamentarium of medications suitable for chronic pain management. Duragesic fentanyl transdermal system for transdermal. I have been on the brand name duragesic patch for years then it went generic to jansen and was almost identical to the original duragesic which i used for almost a year. Fentanyl transdermal system fentanyl transdermal system. Duragesic is the brand name of fentanyl transdermal therapeutic systems which is a system of delivering pain relief in the form of a patch placed on the skin. Duragesic fentanyl transdermal dosing, indications. The recommended starting dose when converting from other opioids to duragesic is intended. Jan 06, 2017 refer to table 2 for the range of 24hour oral morphine doses that are recommended for conversion to each fentanyl transdermal system dose.
Do not use a duragesic patch if the pouch seal is broken or the patch is cut, damaged, or changed in any way. Your doctor may start you on a low dose fentanyl patch and gradually increase your dose, not more often than once every 3 days at first, and then not more often than once every 6 days. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response. Duragesic label page 1 full prescribing information for use. To rotate to the fentanyl patch from another opioid, it is best to determine the equivalent oral morphine dose that the patient is taking. Find out what health conditions may be a health risk when taken with duragesic transdermal. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Although there are several available strengths, your healthcare provider may prescribe 12. In general, the 12 mcgh dose, which allows for smaller dose. This tool does not contain all of the important safety information needed to prescribe butrans. Fentanyl duragesic is a moderately priced drug used to treat chronic pain.
Do not drive or operate heavy machinery when starting or changing the dose of duragesic. Unused fentanyl patches should be kept in a secure location out of childrens sight and reach, such as a locked cabinet. Aug 12, 2019 if analgesia is insufficient during the first application only, the durogesic dtrans patch may be replaced after 48 hours with a patch of the same dose, or the dose may be increased after 72 hours. Of course they dont have a crystal ball but discussed switching me into another medication and spoke of the conversion table they use to determine what dose to use. Duragesic vs mylan generic fentanyl patches page 4.
See the detailed instructions for use for information about how to apply and dispose of the duragesic patch. Duragesic fentanyl transdermal dosing, indications, interactions. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. Recommend an appropriate dose of transdermal fentanyl when switching from other opioids, including rescue opioid dosing. A study conducted with the duragesic patch in elderly patients demonstrated that fentanyl. Your doctor may decrease your dose if you experience side effects. Generic fentanyl is covered by some medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. Duragesic fda prescribing information, side effects and uses. Each initial duragesic dose is highly individualized. Duragesic patch dose duragesic patches are fentanyl transdermal systems that deliver extremely potent pain medication to patients via patches placed on the skin. Converting from oral morphine to fentanyl transdermal patch. Fentanyl patches are manufactured in five patch sizes. Just one dose can cause death in someone using duragesic accidentally or improperly.
Duragesic transdermal patch is contraindicated in outpatient or day surgeries because there is no opportunity for proper dose titration, in the management of mild or intermittent pain, for use as an as needed analgesic, and in patients who require opioid analgesia for a short period of time. Convert this amount to the equianalgesic 24hour oral morphine dose using the multiplication factors in table 1 for the appropriate route of administration. Tables 1, 2, and 3 should only be used to convert from other opioids to durogesic dtrans and not from durogesic dtrans to other therapies. Transdermal and parenteral fentanyl dosage calculations. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on singledose studies, and there is substantial individual variation in response. The appropriate duragesic patch dose for a particular patient will depend on. Opioid withdrawal symptoms are possible in some patients after conversion or dose adjustment.
You should wear the duragesic patch continuously for 3 days, unless advised otherwise by your healthcare provider. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Overestimating the duragesic dose when converting patients from another opioid medication can result in fatal overdose with the first dose. Talk to your doctor about how you are feeling during your treatment with fentanyl patches. The duragesic transdermal system patch is used for the management of persistent, moderate to severe chronic pain in opioidtolerant patients when a continuous, aroundtheclock opioid analgesic is needed for an extended period of time. Fentanyl transdermal patch 72 hour 100mcg drug medication dosage information. Durogesic 25mcg patch uses, side effects, substitutes. Medscape analgesic dosing for duragesic fentanyl transdermal. Can anyone tell me if they are using the mylan brand duragesic patch for pain relief. When you first start taking duragesic, when your dose is changed, or if you take too much overdose, serious or lifethreatening breathing problems that can lead to death may occur. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Duragesic patch fentanyl patch rationale for inclusion in pa. Levemir insulin detemir the leaflets are freely available for download and can be reproduced for free distribution to consumers.
Duragesic is a prescription skin patch approved to treat moderatetosevere pain. Indications, dose, contraindications, sideeffects, interactions, cautions. Fentanyl and buprenorphine patches are third line opioids and should be. Conversion of opioid analgesics to fentanyl transdermal. Dose conversion in opioid rotation from continuous intravenous. Side effects of duragesic fentanyl transdermal, warnings, uses. A 25 microgramhour fentanyl patch is equivalent to about 60mg to. Tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal overdosage.
Table 2 should not be used to convert from duragesic to other therapies because this conversion to duragesic is conservative. Duragesic fentanyl transdermal system is available in generic form. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications. Made by orthomcneil, duragesic patches are nearly 100 more potent than morphine and can provide up to 72 hours 3 days of pain relieve when used as directed. When converting from one opioid to another, the initial dose depends on the relative. Do not initiate treatment with duragesic in opioid nontolerant patients see contraindications 4 the recommended starting dose when converting from other opioids to duragesic is intended to minimize the potential for overdosing patients with the first dose. Patient information medication guide and instructions. Duragesic fentanyl dose, indications, adverse effects. No studies directly investigating dose equivalence between morphine injection continuous iv administration and the transdermal fentanyl patch have been. Initially, the smallest dosing amount should be used. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Apply duragesic exactly as prescribed by your healthcare provider.
Just one dose can cause death in someone using this medicine accidentally or improperly. Durogesic dtrans 12 mcghr transdermal patch summary of product characteristics smpc by janssencilag ltd. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Now i just found out yesterday that cvs switched manufacturers to a new generic named mylan. Abstral, actiq, duragesic, durogesic uk, fentanyl oralet, fentora, lazanda, matrifen ca, onsolis, ranfentanyl ca, ratiofentanyl ca, sublimaze pharmacologic class. Highalert medications levemir insulin detemir consumer. This page of the emedtv web site gives an indepth overview of this medication, describing how it works and offering information on how to use the skin patch properly. Use this table to find the calculated 24hour morphine dose and the corresponding fentanyl transdermal system dose. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. It is used to treat pain that has not been adequately controlled with other pain medications. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg.
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