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Fentanyl

Brand names of fentanyl

  • Actiq
  • Duragesic
  • Innovar
  • Oralet
  • Sublimaze

Fentanyl is a man-made synthetic that is potent and strong. It helps to increase the threshold of pain (the discomfort level in order to consider it painful) and reduces how we perceive the importance of pain.

Fentanyl is available as a skin application, transdermal, as a transmucosal where it can be applied to the mucus membranes, and as a parenteral, used for injecting. Fentanyl is well absorbed when it is applied to the upper parts of the body. The level of fentanyl in the body increases slowly once the fentanyl patch is applied and peaks between 12-24 hours. For 72 hours thereafter, the levels remain constant as long as the patch is worn. Once the patch is removed the level of fentanyl in the body decreases slowly as fentanyl continues to be absorbed from the fentanyl that has remained on the skin. Originally this medication was approved by FDA in 1968 as an injection.

Things you need to tell your physician before taking fentanyl skin patches

Before you use the skin patches be sure to tell the doctor if you are allergic to fentanyl, and any other medications or adhesives and glues.

Mention all the prescribed or non prescribed medications you are taking or plan to take including vitamins, nutritional supplements. Mention any herbal products you might be using particularly St. John's wort.

If you have suffered from paralytic ileus, a condition where the digested food cannot move through the intestines, then the doctor will probably ask you not to use the patch.

Before you use a fentanyl skin patch, communicate the fact to the doctor if you have ever had a head injury, brain tumour, a stroke or other conditions that pressurized your skull, slow heartbeat, seizures, difficulty in urinating or Addison's disease, when some substances cannot be made naturally by the adrenal gland, low blood pressure, thyroid problems, heart, liver, gallbladder, pancreas or kidney disease.

If you are pregnant or plan to get pregnant or if you are breast feeding then tell the doctor and if you get pregnant while you have the fentanyl patch on then inform the doctor. Also the dentist and the surgeon must be told you are using the fentanyl patch and if they have planned surgery for you including dental surgery.

There are some reactions that can happen as a result of using the patch. It could make you feel drowsy and so do not operate machinery or drive a car till you know how the fentanyl patch affects you. Fentanyl skin patches are also known to cause dizziness, fainting fits and light-headedness when you first use them, especially if you get up abruptly from a prone position. So get up slowly putting your feet firmly on the ground first. Alcohol must not be imbibed while using the skin patch as it may lead to serious side effects.

Fentanyl skin patches can also cause constipation. It is advisable to talk to your doctor about a change in medication if this happens or a change in diet or consider the use of other medication for as long as you are using the skin patch.

In case of a high fever of more than 38.9 C call your doctor as he will need to re-adjust the medicine as high fever may cause you to take in more dosage from the fentanyl skin patch, leading to over dosage.

You should also make sure that your fentanyl skin patch does not touch the skin of a person who is not being treated with the skin patch as it could cause harm to both children and adults, if the medication passes on to them from your patch. If the patch comes off and gets stuck to another person's skin remove it immediately, wash the surface of the skin with clean water and report the matter to the doctor so they can get medical attention.

Usage

Fentanyl is a potent synthetic opiate analgesic and more powerful than morphine. Patients who have post surgery pain or a severe typical pain are treated with fentanyl skin patches to manage these kinds of pain. Those patients who are tolerant to opiates but suffer from chronic pain are also treated with fentanyl skin patches.

How to use fentanyl

Transdermal fentanyl is a patch that is applied to the skin. The patch is changed after 72 hours. The patch should be changed at about the same time in the day every time you need to change it. Apply the patches exactly as directed on the prescription label and in case there are some questions the doctor or the pharmacist would be able to explain away your confusion.

The doctor will begin treatment with fentanyl skin patches with a low dose and then increase it to once in three days and will probably continue it to once in every six days. These patches are meant to be applied on the skin and should not be placed in the mouth or chewed and swallowed.

The gel that is sealed between layers of the patch contains the medication. If it leaks remove the patch right away without touching the gel. In case you or your caregiver accidently touch the gel then wash the affected area immediately in large amounts of clear water. No soap, alcohol or any other cleaners should be used to wash the gel away.

Fentanyl patches could become addictive and so do not change the patches more often than directed by the doctor and do not use them for a longer period of time. Also more than one patch should not be used at one time. The patches must not be stopped without asking the doctor. It is better to decrease the dose gradually as stopping them abruptly could cause withdrawal symptoms.

In case you have any of these withdrawal symptoms then call the doctor: restlessness, teary eyes, runny nose, sweating, chills and hair standing on end, yawning, large pupils which can be seen as a big black circle in the eyes, irritability, anxiety, backache, joint pains, weakness, stomach cramps, difficulty in falling asleep or remaining asleep, loss of appetite, nausea, vomiting, diarrhea, rapid heartbeat or any fast breathing.

Certain precautions need to be taken to protect the fentanyl skin patch from direct heat from heating pads, electric blankets, heat lamps, sauna and hot tub baths as also heated water beds. You should avoid taking long hot baths or sunbathing while you have the patch on your skin. You can of course bathe, swim, and shower with the patch on but if the patch comes off then dry the area thoroughly and apply a new patch.

How fentanyl works

Fentanyl works like a narcotic on the spinal cord and those parts of the brain that sends pain signals from the nerves to the entire body. Fentanyl binds itself to the body's opiate receptors, especially concentrated in those parts of the brain that control pain and emotions. In this way fentanyl works like heroin, morphine and other opioid drugs once the opiate drugs are bound to the receptors they stimulate dopamine levels to increase and this causes a feeling of euphoria and relaxation.

Side effects

Serious
  • severe drowsiness
  • slow heartbeat
  • cold
  • pinpoint pupils of eyes
  • seizures
  • very slow or weak breathing
  • hallucinations
  • clammy skin
Common
  • nausea or vomiting
  • itching
  • drowsiness
  • dizziness
  • urine retention
  • constipation
Less common
  • sweating
  • rigid muscles
  • jerking body movements (myoclonus)
  • skin reaction at patch site
  • fainting

Possible interactions

Herbal remedies like valerian and kava kava could cause additional drowsiness and so should be avoided. St John's wort can induce change or increase in the enzymes named P450 3A4 or 2D6 and this can lead to blunting the fentanyl effects. Before combining any herbal medicine with fentanyl consult your doctor. Alcohol consumption could cause an increased state of confusion and mental health disorder and depression of respiratory functions and so is best avoided. Smoking marijuana could block the vomiting effect of fentanyl but could have other adverse effects due to addiction.

Discontinuation

Fentanyl will continue to be released for about 17 hours from the site, even though the skin patch has been removed. If the patient still requires pain medicine then the substitute should be given only once the fentanyl levels are quite low. In case a fentanyl lozenge was being used and it is stopped, then the level of medication falls more rapidly and so the alternative medicine should be given earlier. The medication should be gradually lowered if the lozenge was being used as a matter of routine and should not be suddenly stopped.

Storage instructions

The fentanyl patches should be stored at room temperature, not in the bathroom but away from heat and moisture. They should not be stored inside the car either. It is advisable to store the patches tightly closed in the same pouch that they came in. They should be out of reach of children and pets and kept so safely that no one can take them out by accident or on purpose. It is important to keep a count of the patches that are left so you might know if they go missing.

The patches that are no longer needed should not be thrown in the garbage can. However before you discard any outdated patches remove the adhesive backing on each patch and fold the sticky side of the patches to each other so they stick together. Now flush these down the toilet and trash the protective liners and pouch. Wash your hands thoroughly once you finish this process of discarding the patches.

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