[NRSKarenRN]

Can Fentanyl Patches Be Replaced Sooner to Improve Pain Control? Medscape Pharmacists, January 11, 2008

[Angie O'Plasty, RN]

Interesting article, Karen, thanks for posting that.

We actually just had a case that (I feel) could've been helped by a shortened dosing schedule, so I wouldn't be surprised if the issue comes up again.

[earle58]

using fentanyl patches q 48 hrs, is very common where i work.
but then again, we get extremely creative and aggressive w/our pain control.
it works because we're in an inpt environment, where there is ongoing monitoring.
this fentanyl dosing, is not unusual at all.

leslie

[GLORIAmunchkin72]

We faithfully stick to Q72hrs unless the patch prematurely comes off while taking a shower or from too much sweating. Never had an order for Q48 hrs.

[rph3664]

The only benefit from changing a fentanyl patch after 48 instead of 72 hours is to the manufacturer of the patches because they sell more.

We get residents who write it this way, and we always correct them.

[rph3664]

The patches are designed to deliver medication for 72 hours, and changing them more often benefits nobody except the manufacturer, because that way they sell more.

Our residents often order a q48 change, and we inform them of this and I've never had one not change the order.

[earle58]

Originally Posted by rph3664

The patches are designed to deliver medication for 72 hours, and changing them more often benefits nobody except the manufacturer, because that way they sell more.

Our residents often order a q48 change, and we inform them of this and I've never had one not change the order.

i do understand the mechanisms of delivery, but i've seen many pts who DO benefit from closer dosing.
whether it is the metabolism or absorption, pts do get better pain mgmt in the first 48 hrs, w/an obervible tapering of efficacy more notable by the end of the 3rd day.

even if it is about $$ for the mfg, better outcomes are observed by the pt, nurse and doc.

leslie

[norcalidiot]

I am only a medical assistant fresh out of school......but my husband is on the fentynal patch Q48 hours. He was at Q72 hours and his pain was not controlled. When he was on the 72 hour dose he was also taking 10mg of Percocet every 4 hours and he was still in pain. They increased his patch from a 25mcg to a 50mcg but the side effects were too much. So he is now back to a 25 mcg patch and changes it every 48 hours and he is not taking percocet on a regular basis. So I am a firm believer that it makes a difference.

[nitengale166]

[quote=rph3664;2623904]The patches are designed to deliver medication for 72 hours, and changing them more often benefits nobody except the manufacturer, because that way they sell more.

I work on an oncology unit and we do q48 hr dosing with GREAT improvement in pain control over the 72 hr dosing. The idea that it only benefits the manufacturer is blocking pt outcomes. Mind sets need to change!

[presuppose]

I'm wondering how many of us have been asked to inappropriately administer fentanyl patches for acute pain. I can think of a case when such was ordered for back pain - the pt almost died.