Transdermal opiod preparations

TRANSDERMAL OPIOID PREPARATIONS

Transdermal opioid patches may be considered when patients have an opioid-responsive pain and where pain control is stable, as an alternative to morphine, (ie. a 2nd line strong opioid) where the patient is…

•  unable to tolerate morphine, unable to take oral medication, e.g. dysphagia, vomiting

•  where drug compliance needs to be improved

BUT NOT in situations where the pain is acute, and rapid dose titration is required.

When applying a new patch consider writing the date (and time) on the patch in order to identify when the next patch is due to be applied. This may be useful as an aide memoir or when the patient is moving between different care settings.

 

Cautions when using transdermal opioid patches:

•  If the patient has not had strong opioids

•  In patients previously on doses of oral morphine (or equivalent opioid) less than 60mg/24hr

•  In pyrexial patients where rate of absorption may be unpredictable

•  With poor adherence of patches, e.g. patient with sweats or when applied to the chest wall of patients who are cachectic

•  During the dying phase – seek specialist palliative care advice

 

Transdermal Fentanyl Patches

For approximate equivalent doses see Relative doses of opiods

Fentanyl is a strong opioid, available in a patch applied to the skin, for transdermal administration  over 72 hours for chronic cancer pain. Both matrix and reservoir patch formulations are available see here. Patches should be prescribed by their brand name or specify ‘matrix’ or ‘reservoir’ to avoid confusion.

 

Contraindications:

Sensitivity to fentanyl or silicone medical adhesive.


Ini
tial dose:

Convert from the oral morphine dose using the table in Relative doses of opiods


P
atch Application

•  Patch should be applied to dry non-hairy non-irritated, non- irradiated skin on torso or upper arm. Replacement patch should be sited on a different area. Avoid previous area for several days

•  After application of the first patch, plasma levels rise for 24 hours, analgesic levels are reached by 6-12 hours and a steady state is reached by the time of application of the second patch

•  The patch should be replaced every 72 hours

•  Currently 12 microgram per hour patches are only licensed for titration of doses, rather than initiating transdermal fentanyl

•  When converting doses greater than 100 microgams per hour fentanyl seek specialist palliative care advice

 

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Transdermal fentanyl patch preparations⁸

For approximate equivalent doses Relative doses of opiodsTransdermal fentanyl patches releasing ’25’, ‘50’, ‘75’, and 100’ micrograms of fentanyl per hour over 72 hours. A 12 microgram per hour fentanyl matrix formulation patch is available, licensed for titration of patients already on fentanyl patches.In the matrix formulation patch (Durogesic D Trans®) fentanyl is contained throughout the patch.In the reservoir formulation patch (Tilofyl®) – fentanyl is contained in a gel reservoir in the middle of the patch and should not be cut. When prescribing, patches should be prescribed by their brand name or specify ‘matrix’ or ‘reservoir’ to avoid confusion.Fencino® (matrix patch with aloe vera oil extract): 12, 25, 50, 75, 100
micrograms/72hours
Durogesic® (matrix patch): 12, 25, 50, 75, 100 micrograms/72hours
Fentalis® (reservoir patch): 25, 50, 75, 100 micrograms/72hours
Matrifen® (matrix patch): 12, 25, 50, 75, 100 micrograms/72hours
Mezolar® (matrix patch): 12, 25, 50, 75, 100 micrograms/72hours
Osmanil® (matrix patch): 12, 25, 50, 75, 100 micrograms/72hours
Tilofyl® (reservoir patch): 12, 25, 50, 75, 100 micrograms/72hours
Victanul® (matrix patch): 25, 50, 75, 100 micrograms/72hours

 


T
ransdermal Buprenorphine Patches

For approximate equivalent doses see Relative doses of opiods

Buprenorphine is a partial opioid agonist. The transdermal preparation releases the patch strength in micrograms per hour of buprenorphine over several days.

The manufacturers recommend changing the Transtec® patch twice weekly. It takes at least 24 hours for full analgesic effect. After removal, plasma concentrations of buprenorphine will be halved after 30 hours.

A transdermal buprenorphine patch formulation containing a lower dose of buprenorphine  is available (BuTrans®, releasing between 5 and 20 micrograms per hour of buprenorphine over 7 days). These buprenorphine patches may be of some benefit in patients who have difficulties in taking oral medication and have low analgesic requirements.

 

Transdermal buprenorphine patch preparations:
Transtec® patches releasing ‘35’, ‘52.5’, or ‘70’ micrograms buprenorphine per hour as a twice weekly patch.
BuTrans® patches releasing ‘5’, ‘10’ or ‘20’ micrograms of buprenorphine per hour over 7 days

 

General information about opioid analgesic patch preparations

•  Laxatives may need to be reduced and titrated to need as transdermal fentanyl and buprenorphine are less constipating than other opioids

•  Replace the patches at the same time of day (as indicated on the product information)

•  Vary the site of application with each change

•  Apply to clean, dry, undamaged, non-hairy, flat areas of skin

•  Never apply heat over the patch as this will increase absorption. Excessive heat should be avoided e.g. sauna, infra-red radiation

•  Dispose of patches by folding in half, sticky side together, and putting in safe disposal unit e.g sharps box

•  Check that patches stick well. Sweating, crinkling and lifting at edges can make pain control inadequate

•  Patients can shower or swim, but often a vapour-permeable film dressing needs to be placed over the patch to aid adhesion