[fit2nurse]

Is there benefit for pts., i.e. better pain control, if fentanyl patches are changed on alternate days?

I.e. An order for fentanyl patches 125 mcg. to be changed q72h. So there would be two different dosage of patches, a 50 and a 75. I have seen in some cases the 50 patch will be changed on a different day then the 75 (on purpose), with the rationale of better pain control. Is this true? Would this be a med. error, as the dosage is "125mcg. to be changed q72h"?

I cannot find any literature on alternating the different dosage of patches to better benefit the pt., and I continue to see it being done with palliative patients.

All thoughts and expertise are welcome!!

[heron]

My first response ... ask the patient ... if her/his pain control is good, then there's your answer. I've never done that particular strategy myself, but meds affect each person differently and this may be the way it worked out for this particular person.

Another possibility is that a patch was already in place that was not yet expired when the order was changed. One could have been added to make up the difference rather than the old one being removed and a new total dose applied. I could see this happening due to the expense of the patches.

I am not familiar enough with the kinetics of the fentanyl patch ... maybe the blood levels are more level this way than when the total dose is changed all at the same time. I'd have to look that one up.

Either way, sounds like a pain in the neck to keep track of which patch needs changing. I would not call it a med error since the total dose is correct ... and it IS being changed q72hr, just in two parts.

[NRSKarenRN]

BOTH Duragesic patches should be changed on the same day so a steady constant amount of the drug is released along with preventing "which patch was changed" roulette.

Please see full prescribing info who has good chart showing who drug peaks and then bulids steady state:
http://www.duragesic.com/duragesic/s...c.pdf#zoom=100

[vamedic4]

In addition to what NRSKaren and heron have said, you have to consider this:

Changing patches may lead to withdrawal symptoms in some people. When you remove a patch and place another, there is going to be a lag in the time it takes for one patch to achieve the level of pain control of the one that was removed. So if you're changing the patches, it makes best sense to remove both and replace both at the same time. Hope that helps.

vamedic4

[Suesquatch]

I can tell you that they can also be changed Q48H and often should be but never are.

[fit2nurse]

Thanks for taking the time to reply.

I was not agreeing with what was being done (not changing the patches at the same time), but had nothing to back it up....I appreciate the link, and I will have a look.....

[squirrel40]

Originally Posted by fit2nurse

Is there benefit for pts., i.e. better pain control, if fentanyl patches are changed on alternate days?

I.e. An order for fentanyl patches 125 mcg. to be changed q72h. So there would be two different dosage of patches, a 50 and a 75. I have seen in some cases the 50 patch will be changed on a different day then the 75 (on purpose), with the rationale of better pain control. Is this true? Would this be a med. error, as the dosage is "125mcg. to be changed q72h"?

I cannot find any literature on alternating the different dosage of patches to better benefit the pt., and I continue to see it being done with palliative patients.

All thoughts and expertise are welcome!!

as a pt on fentanyl myself, because the patches seem to have a hard time staying on correctly (thus not properly working,) the method you are reffering to gives your pt a better chance of having way less pain.