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Related Experiment Videos

[Transdermal opioid administration: the pain plaster]

C J Vecht1, P A Sillevis Smitt

  • 1Academisch Ziekenhuis Rotterdam-Daniel den Hoed Kliniek, afd. Neuro-oncologie en Pijn-polikliniek, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|April 26, 1997
PubMed
Summary

Fentanyl transdermal (Durogesic) offers a new option for cancer pain management. Initial dosing requires careful equianalgesic conversion from oral morphine, with continued morphine supplementation during dose adjustment for optimal pain control.

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Area of Science:

  • Pharmacology
  • Oncology
  • Pain Management

Context:

  • A novel opioid administration method, fentanyl transdermal (Durogesic), has been approved.
  • This formulation is specifically indicated for managing cancer pain.

Purpose:

  • To describe the characteristics and initial dosing guidelines for fentanyl transdermal.
  • To evaluate its suitability for different pain types.

Summary:

  • Fentanyl transdermal provides sustained release due to its lipid solubility and skin deposition, with a biological half-life of approximately 20 hours.
  • Equianalgesic conversion from oral morphine to fentanyl transdermal is recommended at a 100:1 ratio, though under-dosing is a potential risk.
  • Dose titration requires 12-24 hours for stable fentanyl levels, necessitating continued oral morphine for 12 hours post-application and allowing for short-acting morphine as needed.

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  • Current evidence does not support the use of transdermal fentanyl for neuropathic or chronic benign pain.

    • Impact:

    • Provides clinicians with guidance on initiating and managing fentanyl transdermal therapy for cancer pain.
    • Highlights the importance of careful dose conversion and monitoring to ensure efficacy and safety.
    • Suggests limitations in the current indications for transdermal fentanyl, guiding future research and clinical application.