Transdermal fentanyl review

January 9, 2010, 5:09 pm

★★★½☆

TRANSDERMAL FENTANYL: PHARMACOLOGY AND TOXICOLOGY Nelson L, Schwaner R  J Med Toxicol Dec 2009;5:230-241.

This comprehensive review will probably tell you more than you ever wanted to know about fentanyl patches, but it is definitely worth reading.  Some important take-home lessons:

• Fentanyl — a pure mu-receptor opiate agonist — is approximately 100 times as potent as morphine.

• Because use of the fentanyl patch creates a reservoir of drug in the epidermis, drug effect will continue for several hours after the patch is removed.

• The fentanyl patch should be used only for chronic — not acute — pain.

• Used patches still contain significants amount of fentanyl, and should be disposed of carefully. 

• There have been reported cases of fentanyl patches being removed from dead bodies and nursing home patients.

• Fentanyl does not show up on the usual immunoassay urine drug screen.

• When using naloxone to treat fentanyl poisoning, it is best to start with very low doses (e.g., 0.05 mg IV) and titrate up if necessary.  This assumes that airway, ventilation, and oxygenation are adequate or can be supported until the antidote takes effect. However, since fentanyl is so potent, higher than normal doses of naloxone (sometimes up to 10 mg) may be required.

• The patient toxic from a fentanyl patch should be completely examined to detect the possible presence of other patches.

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