Fentanyl patches - transdermal continual release
Other names – Durogesic DTrans® patches
Who is the leaflet for? What is its aim?
This leaflet is for patients (and their relatives or carers), who have been discharged from hospital on fentanyl patches for moderate to severe pain. Its use will have been explained to you before you left hospital. Do not hesitate to ask for more information or to have it repeated, if needed.
Fentanyl is a strong painkiller from the same family of drugs as morphine. It works in a similar way to morphine. Fentanyl patches are commonly used for moderate to severe pain from many different causes. The painkiller is contained within the patch and is absorbed through the skin slowly and continuously while the patch is in place. Fentanyl is safe and effective when used properly and will be helpful in controlling your pain.
Pain control may be an ongoing process and health professionals will work with you to adjust the medication doses as needed. Health professionals (including doctors, nurses, pharmacists and opticians) will need to know that you are taking these medications, so do inform them, even if you are seeing them for an unrelated matter.
Benefits
The medication you have been prescribed will help to manage your pain, enabling you to be more comfortable and active at home.
How to use fentanyl patches
The very first patch will take 12-24 hours to take full effect. You may need to take top-up doses of your short-acting painkiller until your fentanyl patch starts working. Each patch after that will last for three days (72 hours).
Change your patch (or patches) every third day, at about the same time of day. It can be helpful to use a calendar to mark the day when your patch is due to be changed.
The patches are waterproof so you can have a shower, bathe or go swimming. However, avoid soaking the patch in a hot bath. Avoid too much direct heat, such as from a hot water bottle, electric blanket, heat lamp or hot water, as this affects the way the medicine is released and absorbed from the patch. If you develop a fever, try to keep your temperature down and contact your doctor. Sweating or applying the patch to hairy skin may prevent it sticking well, and you may be given some additional adhesive to keep the patch on. Discuss this further with your doctor or nurse.
You should not stop using fentanyl patches abruptly.
How do I change my patch(es)?
Take the old patch off, fold it in half so that it sticks together and put it back in its original pouch. The used patch can then be put in the bin with your household rubbish. Discard safely out of reach of children.
- Wash your hands and choose a new place on the upper body or upper arm. Avoid parts of the body that are submerged in warm bath water or come into contact with heat pads or hot water bottles. Avoid putting the patch on skin that will be under a bra, bag strap or anything else that will compress the patch. The skin should not have any cuts, scars or spots and should not be too hairy. Hairy skin can be trimmed with scissors but must not be shaved.
- Clean the skin with water only. Make sure it is cool and completely dry.
- Tear open the pouch of the new patch and peel off the plastic backing. Stick the patch on to the clean area of skin. Press it down firmly and hold until completely stuck. Wash your hands. Do not stick the patch on the same area twice in a row.
- Keep all patches (used and unused) out of the reach and sight of children.
- Do not use fentanyl patches after their expiry date. This is printed on the box and on the pouch itself. The expiry date refers to the last day of that month. If the patches are out of date, take them to your pharmacy.
Side effects
Fentanyl patches may cause you to feel sick (nausea) when you first start using them. It is likely that you will have been given an anti-sickness medication (anti-emetic) to take regularly when the painkiller is started. For most patients, symptoms of nausea fade within a few days as the body gets used to the new drug. If the symptoms persist or are not controlled by an anti-emetic, please speak to a doctor or nurse as alternatives are available.
Fentanyl causes less constipation than other similar painkillers, but you may still need to take a laxative. Maintaining a good fluid intake, being active and having fibre in your diet will also help.
Some mild drowsiness is common. Some people report vivid dreams or feeling jittery. These symptoms will usually resolve over a few days while your body is getting used to the new medication, or after a change to a higher dose. Please avoid driving and operating heavy machinery if you are affected. If the drowsiness stops you from reading a newspaper, following the plot of a television programme or does not improve after a few days, please seek medical advice promptly.
If you develop itching or redness under or around the patch site, tell your doctor or nurse.
Very occasionally, patients who change from a different painkiller to fentanyl feel unwell in the first 24-48 hours with sickness, shivering, stomach pains or diarrhoea. Contact your doctor if this happens.
These medications can be dangerous if they are taken by those they are not prescribed for. Please keep them out of the reach of children or anyone else who might use them inadvertently. If this happens seek medical advice immediately. They should be stored in the original container to protect from light and below 25°C.
Common questions asked about fentanyl and other opioid painkillers
No. Fentanyl is given for different sorts of moderate and severe pain. If you have cancer, treatment with fentanyl may be needed to allow you to live as comfortably as possible. Fentanyl can be taken for as long as it’s needed and the dose can be changed over time.
Addiction is very rare when fentanyl is used for pain relief, under the guidance of your doctor. If you no longer require fentanyl, the dose can be gradually and safely reduced by your doctor. Fentanyl should not be stopped abruptly.
If you are using fentanyl patches regularly and you forget to change it, or if it falls off, apply a new patch on as soon as you can. You may need to take top-up doses of your short-acting painkiller until your fentanyl patch starts working again.
Some people find that doing certain activities, such as having a bath or going for a walk, brings on the pain. Your doctor or nurse may suggest that you try taking a dose of your short-acting pain killer (e.g. short-release morphine or oxycodone) 30 minutes before starting an activity that brings on the pain.
Although fentanyl is a very good painkiller, it is not helpful for all types of pain and may require adjustments by your doctor or nurse. Sometimes other treatments are be needed and suggested by your medical team.
If you still have pain and feel unwell in one or more of the following ways:
- Feeling more sleepy than usual
- Feeling sick more of the time
- Feeling restless or jumpy
- Experiencing bad dreams
tell your doctor or nurse. Your doctor may reduce your dose of fentanyl and suggest other treatments to help the pain.
If you find that you are regularly needing extra doses of your short-acting pain killer (two or more in a day), tell your doctor or nurse. It may be helpful to review your pain medication at this time.
Once you get used to taking fentanyl and do not feel sleepy or unwell, you may be able to drive. You must not drive if you feel that your driving may be impaired. The Department for Transport advises patients to carry evidence that you have been prescribed fentanyl by a doctor in case you are stopped by the Police.
It may be best to avoid alcohol whilst taking fentanyl as you're more likely to get side effects, such as feeling sleepy.
Patches which are no longer needed, or which are past their expiry date, should be returned to your pharmacy.
Alternatives
The team looking after you will continue to manage your pain as well as possible, using a combination of drug and non-drug treatments. If your pain continues despite these treatments, please inform your medical team who will explore this further and consider alternative options. Being completely pain-free is not always possible, but bringing your pain into comfortable levels is the main priority of all treatments. While you are awaiting advice do not alter the amount of your medication that you are taking or stop taking it suddenly.
Contacts and further information
Once you are discharged, your GP or community specialist palliative care nurse will provide support to help you manage your pain and to help you use the short-acting fentanyl as effectively as possible.
References and Sources of evidence
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Other formats
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
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Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ
Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/