fentanyl: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
fentanyl: clinical details
Prescribing considerations
- Reserve transdermal fentanyl for opioid-tolerant patients with persistent severe pain; opioid-naive use can cause fatal respiratory depression.
- Agree treatment goals, review benefit and harm, and plan discontinuation without abrupt withdrawal.
- Assess concurrent sedatives, serotonergic medicines and CYP3A4 modifiers.
- Counsel about heat, accidental transfer, secure storage and disposal.
- Consider tolerance, opioid-induced hyperalgesia, dependence and opioid use disorder if pain escalates or medicine-seeking behaviour appears.
Contraindications and cautions
- Hypersensitivity to fentanyl or product excipients; Yemex additionally lists allergy to colophonium resin, soya or peanuts.
- Acute or postoperative pain.
- Severe respiratory depression.
Monitoring
- Pain control, function, sedation and respiratory status, particularly after initiation or treatment changes.
- Patch adhesion, skin reactions, fever and external heat exposure.
- Constipation and other opioid gastrointestinal effects.
- Signs of misuse, dependence, withdrawal, tolerance or opioid-induced hyperalgesia.
- Closer observation in older or debilitated people and those with pulmonary, hepatic, renal, neurological or cardiac disease.
Clinical pharmacology
Fentanyl is a potent opioid-receptor agonist. Transdermal delivery creates a skin depot and sustained systemic exposure. It is extensively metabolised, mainly through CYP3A4. Absorption increases with skin temperature, and concentrations decline slowly after patch removal.
Formulation and product differences
- Both selected products are matrix transdermal systems, but their excipients, appearance, packaging and application instructions differ.
- Yemex contains refined soya-bean oil and has product-specific contraindications relating to soya, peanut and colophonium-resin hypersensitivity; Matrifen has different excipients.
- Patients should follow the leaflet for their exact brand and check unexpected brand changes with a pharmacist or prescriber.
fentanyl preparations and strengths
Transdermal patch
Route: Transdermal
Strengths: 12 micrograms, 12 micrograms/hour, 25 micrograms, 25 micrograms/hour, 37.5 micrograms/hour, 50 micrograms, 50 micrograms/hour, 75 micrograms, 75 micrograms/hour, 100 micrograms, 100 micrograms/hour
fentanyl interactions
Check all prescribed, over-the-counter and recreational substances because interactions can cause sedation, breathing problems, withdrawal or altered pain control.
Benzodiazepines, sedatives, other opioids and anaesthetics
Combined central nervous system depression can cause profound sleepiness, low blood pressure, respiratory depression, coma or death.
Gabapentin or pregabalin
The combination increases sedation and respiratory-depression risk and requires careful clinical review.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.