Appropriate Use

transdermal fentanyl should only be prescribed by healthcare professionals knowledgeable in use of potent opioids for chronic pain management; reserve extended-release and long-acting opioid analgesic formulations for pts w/o tx alternatives; not indicated for prn analgesic use; proper dosing and titration essential to decr. resp. depression risk

Addiction, Abuse, and Misuse

opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; reserve opioid analgesics for pts w/ inadequate tx alternatives; assess opioid abuse or addiction risk prior to prescribing; regularly monitor all pts for misuse, abuse, and addiction

Respiratory Depression

serious, life-threatening, or fatal cases may occur even w/ recommended use; monitor for resp. depression esp. during tx initiation or after dose incr; due to resp. depression risk, contraindicated for use in as-needed pain mgmt, non-opioid tolerant pts, acute pain, and post-operative pain

Accidental Exposure

accidental ingestion of even one dose, esp. by children, can result in fatal fentanyl overdose; death from overdose has occurred in children and adults who were accidentally exposed to transdermal fentanyl; instruct pts about strict adherence to proper patch handling and disposal

Neonatal Opioid Withdrawal Syndrome

prolonged maternal use of opioid tx during pregnancy can lead to potentially life-threatening neonatal opioid withdrawal syndrome; infants may require tx according to neonatology protocols; advise pregnant pts of risks and ensure appropriate tx avail. if prolonged opioid use required

CYP450 3A4 Interaction

concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. fentanyl conc. which may incr. or prolong adverse effects incl. potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer

Avoid Heat Exposure

pts should avoid exposure of application site/surrounding area to external heat sources; exposure to direct external heat sources such as heating pads, electric blankets, heat/tanning lamps, saunas, hot tubs, and heated water beds may incr. fentanyl absorption and has resulted in fatal overdose and death; pts w/ fever or incr. core body temp are at incr. risk for fentanyl exposure and may require fentanyl dose adjustment to avoid overdose and death

Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants

concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options; limit to minimum required dosage and duration; monitor pts for s/sx of resp. depression and sedation