From the Guidelines
The maximum recommended dose of a fentanyl transdermal patch is 100mcg/hour.
Key Considerations
- Patches are available in various strengths, including 12.5mcg/hour, 25mcg/hour, 50mcg/hour, 75mcg/hour, and 100mcg/hour, and should be titrated based on individual patient needs and tolerance 1.
- The dose should not be exceeded, and patches should not be cut or altered in any way to avoid accidental overdose.
- Transdermal fentanyl is complex, with gradually increasing serum concentration during the first part of the 72-hour dosing interval, and variable absorption affected by factors such as external heat 1.
Important Notes
- Pain should be relatively well controlled on short-acting opioid before initiating the fentanyl patch 1.
- Patches are NOT recommended for unstable pain requiring frequent dose changes 1.
- Use fentanyl patch only in patients tolerant to opioid therapy; application of heat (e.g., fever or topical heat from heat lamps, electric blankets) may accelerate transdermal fentanyl absorption and are contraindications to transdermal fentanyl 1.
- To convert or rotate from another opioid to transdermal fentanyl, determine the 24-h analgesic requirement of current opioid and select the mcg/h dose of transdermal fentanyl based on the 24-h dose of morphine, oxycodone, hydromorphone, codeine as listed 1.