by Dr Pandula Siribaddana

Created on: January 08, 2011   Last Updated: January 12, 2011

Fentanyl is a synthetic opioid analgesic used to relieve moderate to severe pain. It is a controlled medication classified as a schedule II drug by the Federal Drug Enforcement Administration (DEA) because of its high abuse risk as well as its therapeutic uses in the United States.

Fentanyl transdermal system: Overview

The fentanyl transdermal system is one of its administering techniques and this refers to a ‘skin patch’ containing fentanyl. Thus, the medicines will get absorbed through the skin before it enters the circulation. As with any other opioid, it will act on the opioid receptors of the body including the brain, which will alter the pain sensation and the emotions to a certain extent.

Criteria to use fentanyl transdermal system:

According to FDA guidelines on using fentanyl transdermal system, it should only be used in patients who have already taken other opioid analgesics and has shown tolerance to this medication.

Thus, if a patient is taking at least 60 mg of morphine daily, at least 30 mg of oxycodone daily, at least 8 mg of oral hydromorphone daily, or an equivalent dose of an opioid analgesic for a week or longer, they are considered ‘opioid tolerant’.

Furthermore, the FDA highlights several criteria which should be considered before recommending this medication by health care professionals. These include,

-Having persistent, moderate to severe chronic pain,

-Requires continuous, around the clock opioid administration for extended period of time,

-Other means of pain relief such as non-steroidal analgesics, opioid combination products, or immediate-release opioids,

-Requires a total daily dose at least equivalent to Fentanyl Transdermal system 25 mcg/hr.

Added to this list of criteria for determining the need for fentanyl transdermal system are some of the contraindications. They were determined based on the risk of hypoventilation, which is the most serious side effect of fentanyl, and the list includes,

-Patients who are not opioid-tolerant,

-Managing acute pains requiring short term use of opioid analgesics,

-When managing post operative pains,

-Managing mild pain,

-When managing intermittent pain.

Thus, it is apparent that health care professionals will have a complex task at hand in determining the use of fentanyl transdermal system for pain relief.

Side effects of fentanyl transdermal system:

Following administering the fentanyl transdermal system, one should always lookout for its side effects. Although many

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