The most common side effects with transdermal administration are:
(See chapter: Nausea and Vomiting)
An immediate release opioid preparation should always be available PRN. for breakthrough pain.
No further modified release morphine
Before removing an opioid patch and changing to an alternative opioid consider carefully the reasons for doing this.
Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice.
On removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting. Different methods of conversion are practised. REVIEW the patient regularly during the changeover period.
If converting a patient with renal failure from transdermal fentanyl to an alternative opioid, always seek specialist advice.
Change to oral opioid
Change to subcutaneous opioid e.g. diamorphine or morphine or oxycodone infusion.
Consider why the pain was not responding and address any other issues.
Consider seeking specialist palliative care advice.
Administer an immediate release opioid (e.g. PRN. oral morphine or SC opioid). Re-titrate new analgesics to the patient’s requirements.
In some areas, it is best practice to continue with fentanyl patch administration, adding an appropriate dose of opioid via the subcutaneous route. Consult local guidelines.
It is advised that transdermal opioid patches should be prescribed by their brand name where possible.
Two different transdermal formulations are currently available, reservoir and matrix:
Use the links below for further information about Transdermal Opioids:
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.