Transdermal Opioid Patches: Quick Reference Guide: Important Information

Transdermal Opioid Patches: Quick Reference Guide
Important Information
 Transdermal opioid patches have been associated with medication errors. Incorrect use of opioid
patches can result in significant patient harm, including death.
 There is a SLOW ONSET and SLOW OFFSET of analgesia and there is a SLOW ONSET and SLOW OFF-
SET of side-effects.
 Transdermal opioid patches are NOT appropriate for acute pain.
 The strength of the patch is prescribed in micrograms/hour.
If in DOUBT seek advice
The types of transdermal patches available:
Opioid Brands and Strengths (micrograms/hr) available Frequency of Administration

Butrans® 5, 10, 15, 20 7 days
Buprenorphine Transtec® 35, 52.5, 70 96 hours
®
Durogesic DTrans 12, 25, 50, 75, 100 3 days
®
Fentanyl* Matrifen 12, 25, 50, 75,100 3 days
®
Fentadur 12, 25, 50, 75, 100 3 days
* Please note other brands of fentanyl transdermal patches may be available. This list is not exhaustive.
Table 1: Dose Equivalence Table (Please see notes below).
Oral Morphine Equivalent Fentanyl Buprenorphine

(over 24 hours.)
10mg 5 micrograms/hour
20mg - 10 micrograms/hour
30mg 12 micrograms/hour -
60mg 25 micrograms/hour
120mg 50 micrograms/hour 52.5 micrograms/hour
There are differences in the literature regarding opioid conversion ratios. The conversion ratios listed above are the conversion ratios commonly used in prac-
tice at Our Lady’s Hospice and Care Services (OLH&CS). The conversion ratios are approximate only. A dose reduction of between 30 and 50% may be appropri-
ate when converting from one opioid to another to allow for incomplete cross tolerance.
Please see OLH&CS Opioid Conversion Chart available from the Palliative Meds Info webpages on www.olh.ie. The information outlined above is intended as a
guide only. All medication doses derived using the information below should be checked and prescribed by an experienced practitioner.
The dosage of a new opioid is based on several factors including the available equi-analgesic dose data, the clinical condition of the patient, concurrent
medications and patient safety. It is recommended that the new dose should be reduced by 30-50% to allow for incomplete cross-tolerance. The patient should
be monitored closely until stable when switching opioid medications.
Prepared by: Palliative Meds Info. (See www.olh.ie for Terms and Conditions.) Reviewed: August 2016 Review: August 2018
Drug Safety Issues
! Transdermal opioids should not be used to treat acute pain.
! Be familiar with the potency of the drug prescribed.
! Always double check the calculation when switching between opioids.
! Always ensure that the correct product has been selected.
! Patients and carers should be educated on the safe use of transdermal patches. Various memory aids
can be used to remind patients when to change the transdermal patch and where the patch was
applied.
! Always check that a newly admitted/ transferred patient does not already have a patch applied before
applying another.
! Healthcare professionals administering transdermal patches should record the location of the patch in
The the
types of transdermal
patient’s patches
healthcare available:
records and/or on the prescription chart. The transdermal patch should be
checked
Opioidevery day.
Brands and Strengths (micrograms/hr) available Frequency of Administration
®
! Always ensure that an old patch has been
Butrans removed
5, 10, 15, 20before a new patch is applied. An old patch can
7 days
®
Buprenorphine Transtec
continue to release the drug and cause an35,overdose.
52.5, 70 96 hours
®
Durogesic
! The patient should avoid exposureDTrans 12, 25,heat
to excessive 50, 75,
(e.g100
hot water bottle, heat pad3or
days
hot bath) as it
®
Fentanyl*
can cause an increase in theMatrifen 12,the
delivery of 25,drug
50, 75,100 3 days
from the patch. Febrile patients may also experience
®
Fentadur
an increase in delivery of drug 12,patch.
from the 25, 50, 75, 100 3 days
! Always dispose of the old patch appropriately. Fold the patch in half, adhesive sides together and place
in the original packaging and sachet and then discard safely out of reach of children. In the United
States, the FDA recommends that the used transdermal patch should be flushed down the toilet.
Hospital staff should dispose of the patch according to local policy.
! Please be aware that fentanyl or buprenorphine remains in the skin and will continue to
enter the circulation providing analgesia for a variable period of up to 12-24 hours after removal of the
patch.
Other Frequently Asked Questions
Can transdermal opioid patches be cut in half?
Butrans®, Transtec®, Durogesic DTrans® and Matrifen® transdermal patches can be cut in half. The
administration of half a patch is unlicensed. Please check with the pharmacist or prescribing doctor. The
second half of the patch cannot be kept for future use. It must be disposed of immediately. Fentadur® and
Fental Matrix® should NOT be cut in half.
Can more than one patch be applied at one time?
Yes, sometimes it is necessary to apply more than one patch. The dose to be administered should be clearly
prescribed. If in any doubt double check with the prescriber or pharmacist.
Are other brands of transdermal fentanyl patches interchangeable with Durogesic DTrans?
It is not possible to ensure the interchangeability of different brands of fentanyl transdermal patches in
individual patients. Therefore, it should be emphasised that patients should not be changed from one brand
of fentanyl transdermal patches to another without specific counselling on the change and
monitoring from their healthcare professional.
Prepared by: Palliative Meds Info. (See www.olh.ie for Terms and Conditions.) Reviewed: August 2016 Review: August 2018

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Transdermal Opioid Patches: Quick Reference Guide

The types of transdermal patches available:

Opioid Brands and Strengths (micrograms/hr) available Frequency of Administration

Table 1: Dose Equivalence Table (Please see notes below).

Oral Morphine Equivalent Fentanyl Buprenorphine

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