Herbal Spotlight
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 Fentanyl Patches
The Food and Drug Administration (FDA) has issued a public health advisory and is asking drug makers to provide more teaching information about transdermal fentanyl patches. Despite a similar advisory in 2005, the FDA continues to receive reports of deaths and life-threatening adverse effects from fentanyl patches.
FDA officials report that these patches are still being prescribed inappropriately for such problems as acute pain after surgery, headaches, or occasional or mild pain. They also say that patients are using the patches incorrectly, such as by replacing them more often than prescribed, applying more than prescribed, or applying heat to them--all of which may raise the blood fentanyl level to dangerously high levels.
When working with fentanyl patches, keep these FDA recommendations in mind:
- Fentanyl patches should be used only in patients age 2 or older who are opioid-tolerant, who have chronic moderate to severe pain poorly controlled by other drugs, and who need a total daily opioid dose at least equivalent to the 25-mcg/hour fentanyl patch.
- Never use fentanyl patches for treating postoperative, mild, or occasional pain.
- When converting a patient from another opioid, determine the initial fentanyl dosage with great care; overestimating the dosage could be dangerous or fatal.
- Make sure you know all drugs the patient takes, particularly CYP3A4 inhibitors, which may increase fentanyl levels.
- Monitor patients closely, and provide immediate care for evidence of overdose, such as slow or shallow breathing, a slow heartbeat, severe sleepiness, cold and clammy skin, trouble walking and talking, and feeling faint, dizzy, or confused.
- Give patients detailed instructions for using fentanyl patches correctly and safely.
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