High-Alert Medications - Fentanyl Patch

Learn More About High-Alert Medications
Download this Safety Information: Fentanyl Patch
The leaflets are FREELY available for download and can be reproduced for free distribution to consumers. Or, if you are a facility or organization, you can order professional pre-printed leaflets shipped directly to you.

Extra care is needed because fentanyl is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Fentanyl Patches

Before you use the patches
1.	Use for long-term chronic pain only. Fentanyl patches should ONLY be used to treat long-term chronic pain by people who have previously taken high doses of prescription pain medicine (opioids) for 7 or more days without relief. Otherwise, the medicine can cause serious breathing problems.
Use intact patches.
2.	Use intact patches. Never cut the patches or use damaged patches (could result in an overdose).
3.	Avoid broken skin. Apply patches only on skin without cuts or sores.
When picking up the prescription
4.	Talk to your pharmacist. Tell your pharmacist the type of pain you are experiencing and any other pain medicines you have been taking and for how long.
While wearing a fentanyl patch
5.	Follow directions. Use the patches exactly as directed to prevent serious side effects. Do not use more patches than prescribed. Take off the old patch before applying a new patch.
6.	Do not warm your patches. While wearing a fentanyl patch, do not expose the site to heat from a heating pad, electric blanket, sauna, hot tub, heated waterbed, or excessive sun exposure, or hot climate. Also, avoid tight coverings over the patch and strenuous exercise, which can heat the body. The body absorbs too much medicine with excessive heat.
7.	Take care around children. Don’t let children see you apply a patch. Don’t apply the patch where children can see it or on areas with frequent movement. Used patches still contain medicine, so check often that the patch has not fallen off, especially after exercising, bathing, and sleeping. Consider taping the patch to your skin so it doesn’t come off your body. Children have found patches that have fallen off or removed patches on sleeping adults and put them in their mouths or on their bodies with deadly results. If a patch is chewed, sucked on, or ingested, seek immediate medical attention.
8.	Report signs of an overdose. Signs of fentanyl overdose include: trouble breathing, shallow or very slow breathing; tiredness, extreme sleepiness; inability to think, talk, or walk normally; and feeling faint, dizzy, or confused.
Storing and discarding the patches
9.	Store patches safely. Keep new patches far away from the reach or discovery of children. Do not let children see you apply patches or call them stickers, tattoos, or Band-Aids. This could attract children and encourage them to mimic your actions.
10.	Dispose of patches safely. Safely discard used or unneeded patches by folding the sticky sides together and flushing them down the toilet. Some of the medicine remains in each patch even after use, which could harm others who come into contact with it. The US Food and Drug Administration recommends flushingpatches to quickly and effectively make sure a child or pet can't get to them and be harmed by the leftover medicine.

Used fentanyl patches still contain some medicine after you take them off. This is why it is important to always take off the old patch before placing a new one on your skin. If you don't, you could receive an overdose of the medicine.

Both new and used patches can also be dangerous to children or pets. In a tragic accident, a 4-year-old child died after placing a fentanyl patch on his body. His mother had been using fentanyl patches to treat pain from Crohn's disease, a digestive tract disorder. After she found her son dead, she also found a torn fentanyl patch wrapper in an overturned trashcan in her bedroom. A 2-year old child and a 15-month-old baby died recently after they found used fentanyl patches, put them in their mouths, and swallowed them.

Children have also been exposed to medicine patches that have fallen off a family member. One child sat on a fallen patch and it stuck to her thigh. Another child removed a patch while his grandmother was sleeping and put it on himself. In these cases, the patches were noticed quickly and the children were not injured.

See safety tips # 7, #9 and #10 for safe ways to keep children safe

Topics	Fast Facts
Generic name	fentanyl (pronounced FEN ta nil) transdermal system patches (generic available)
Common brand names	Duragesic
Common uses	Management of persistent, moderate-to-severe, long-term (chronic) pain when around-the-clock pain control is needed for an extended period of time ONLY used if patients have previously taken high doses of opioids for more than 1 week
Usual dose	Doses vary widely, from 12.5 mcg per hour to 100 mcg per hour or more The initial safe dose is determined by the amount of pain medicine that has been previously required in a typical 24-hour period The dose should not be increased more often than every 3 days after the initial dose or every 6 days thereafter
What to do if you miss a dose	Apply the patch as soon as remembered after removing the old patch Do not use more than the prescribed dose (just one patch at a time unless your pharmacist tells you that two patches are needed for your prescribed dose)
Special instructions and precautions	Prior to application, clean the skin with water (no soap), allow it to dry completely, and clip hair if necessary (do not shave the area) Apply the patch to unbroken skin on the chest, back, flank, or upper arm; do not apply to areas getting radiation therapy Firmly press the patch in place and hold for 30 seconds Change the patch every 72 hours (or 48 hours if directed by your doctor) Remove the old patch and clean the site; apply a new patch to a different site Do not use damaged or cut patches (could result in an overdose) If gel leaks from the patch, serious effects are possible; thoroughly wash the affected skin with lots of water (not soap or alcohol, just water) Avoid heat on the site of the patch (e.g., heating pad, electric blanket, hot tub, sun) Avoid drinking grapefruit juice or eating grapefruit while taking this medicine Have a family member watch you closely for side effects during the first 24 hours of wearing the first patch or if your doctor increases your dose
Safety during pregnancy/breastfeeding	Do not use during pregnancy; may result in newborn having withdrawal symptoms Enters breast milk, so not recommended while breastfeeding
Tell your doctor if you have:	Lung diseases such as asthma or sleep apnea, liver or kidney disease Been using recreational drugs or consuming alcohol
Storage and disposal	Do not store in temperatures above 77° (F) Dispose of patch by folding the sticky sides together and flushing it down the toilet
Side effects	Shallow or slow breathing, confusion, dizziness, drowsiness, poor coordination, headache, blurred vision, sweating, nausea, vomiting, constipation
Side effects to report to your doctor immediately	Shallow or very slow breathing, significant dizziness, chest pain, slow or rapid heartbeat, bad headache, confusion, swelling of extremities or unusual weight gain, temperature of 102° (F) or higher, vision changes
Nonprescription medicines and herbals to avoid when using fentanyl patches	Alcohol, St. John's wort, kava kava, gotu kola, sleep aids, antihistamines, other pain medicines unless directed by your doctor
Prescription medicines that should not be taken when using fentanyl patches	Check with your doctor; some of the medicines that may be a problem include: ritonavir, indinavir, nelfinavir, erythromycin, clarithromycin, fluconazole, ketoconazole, itraconazole, nefazodone, verapamil, some heart medicines, many antidepressants

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

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