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Introduction
There are two different analgesic transdermal patches available; fentanyl and buprenorphine. These
provide an alternative method of drug administration but are generally not recommended as a first
line analgesic and should not be used for unstable pain. Analgesic patches are considerably more
expensive than oral therapy. Consider using patches only when the person:
Has pain that is stable and therefore their analgesic requirement is stable
Apply to intact, non-hairy skin on the upper trunk or upper area (any hairs should be cut with
scissors rather than shaved). Avoid areas treated with radiotherapy, scar tissue or oedematous
areas
If needed clean the skin with water only and make sure the skin is dry (soap products can alter
absorption)
Remove the protective layer and apply the patch by firmly pressing with the palm of the hand for
30 seconds to ensure good contact. If patch adherence is poor, adhesive dressing or tape can be
used
Bathing, showering or swimming should not affect the patch. If a patch falls off, a new one can be
applied
Used patches still contain active drug. To discard a patch, fold it in half so it sticks together and
dispose of it safely in a sharps bin
Heat /pyrexia increases the rate of transdermal drug absorption and can cause toxicity - avoid
direct contact with heat (e.g. hot water bottle, heat pad)
Showering is possible as the patches are waterproof but avoid soaking in a hot bath, saunas or
sunbathing
If the patient has a persistent temperature of 39oc, the patch dose may need review
mg = milligrams
Fentanyl patches
These are available as a matrix patch and a reservoir patch. You should not switch between the
different formulations/brands. Fentanyl is a potent opioid; a fentanyl 50mcg/hr patch is equivalent to
90mg twice a day of oral morphine! Therefore fentanyl patches must be prescribed carefully. A
12mcg/hr patch is available for sensitive patients and incremental dose increases.
Brand
Available strengths
(in mcg/hr)
Patch type
Matrix patch (can cut)
Reservoir patch (cant cut)
10
15
30
45
60
90
120
180
270
360
12
25
50
75
100
Previous opioid
* Caution look out for breakthrough pain and side effects such as drowsiness
Change the patch every third day (72 hours) at about the same time, avoiding the same skin site
for several days
Once a patch has been removed, the drug is eliminated from the body slowly, and significant
blood levels persist for at least 24 hours. Side effects should be monitored for up to 24 hours after
patch removal
Regular laxatives should be prescribed for patients taking opioids for moderate to severe pain.
Regular fluid intake should be encouraged. Fentanyl is often less constipating than morphine, so
monitor stools and adjust laxative dose if necessary
Buprenorphine patches
These are available in two formulations and may be a useful option for patients with chronic pain who have
already tried weak opiates such as codeine or dihydrocodeine. Buprenorphine is over 100 times more potent
than oral morphine (refer to equivalence guide below).
Patch type
5, 10, 20
35, 52.5, 70
The table below shows approximate dose equivalents of buprenorphine patches and other opioid analgesics:
Pre-treatment opioid (in mg per 24 hrs)
(This is a guide only and patients should always be titrated individually for pain control)
Weak opioids
Buprenorphine
patch (in mcg
per hour)
5 mcg/hr
10 mcg/hr
20 mcg/hr
35 mcg/hr
52.5 mcg/hr
70 mcg/hr
Strong opioids
Codeine
Dihydrocodeine
Tramadol
Oral
morphine
Fentanyl
patch
30-60 mg
60-120 mg
120-180 mg
-
60 mg
60-120 mg
120-180 mg
-
50 mg
50-100 mg
100-150 mg
-
30-60 mg
90 mg
120 mg
25 mcg/hr
-
Duration of action?
Treatment of non-malignant
moderate pain unresponsive to
non-opioid analgesics
References
1. J Reason, Transdermal patch guidance. BCAP, Nov 09
2. http://www.palliativecareguidelines.scot.nhs.uk/pain%5Fmanagement/ accessed 4.3.11
3. http://www.palliativedrugs.com/advanced-search. Accessed 4.3.11
th
4. Mims, Handbook of pain management, 5 edition, 2009
5. The British pain societys Opiates for persistent pain: good practice, January 2010
http://www.britishpainsociety.org/book_opioid_main.pdf
6. BNF 61, March 2011
7. SIGN 106; Control of pain in adults with cancer, November 2008 http://www.sign.ac.uk/pdf/SIGN106.pdf
Bethan Lewis/Jenny Gibbs - Medicines Management Department NHS Bristol. 03/2011