Can Fentanyl Patches Be Replaced Sooner to Improve Pain Control?

UM Review RN, ASN, RN · Jan 17, 2008

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.

leslie :-D · Jan 18, 2008

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 · Jan 22, 2008

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 · Jan 25, 2008

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 · Jan 25, 2008

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.

leslie :-D · Jan 26, 2008

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 · Mar 5, 2008

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 · Mar 7, 2008

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 · Mar 11, 2008

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.

janet helen · Oct 11, 2009

Have joined this site especially to write this post in the hope that it may benefit people. I am not a nurse or an administrator of fentanyl patches - I am a patient who has to use them so I know from experience the answer to the question. The answer is YES but probably after many things are taken into consideration. In my case I think it is because of living in the tropics that they do not last for 72 hours - extra heat and excessive sweating due to humidity and also probable side effects of Femara which may cause hot flashes and sweating. (I am not a health professional so I don't pretend to be certain of causes.) When I was on the patches at first I was mentally very muddle headed due to lots of drugs etc. I was on my own during most of the day time and went through hell not knowing why I felt so bad. Some times I was not so bad, sometimes I was mediocre and sometimes I felt like I just could not possibly go on any longer. I was in contact with health professionals but none of them could/would suggest anything to help me. Finally I worked out that there was a pattern to it all - a three day pattern! Day one was quite good, day two was so-so day three was abominable. I asked if I could have the patches changed every two days instead of three and have not looked back since! (Actually that is not quite true - when the wet season with its heat and high humidity set in this year suddenly I was living a life of one good day one bad day so we have now lowered the level of the patch slightly and change it daily. I hope this information is of use and prevents someone from going through the same torture that I did.

rph3664 · Oct 12, 2009

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.

When those patches first came out, a DENTIST :eek: ordered one for a teenager after oral surgery. The boy died. They are NOT intended for people who need short term pain relief!

I once saw them used as a withdrawal medication for a patient who had been on a ventilator, sedated with fentanyl, for about a month.

As for my earlier posts, some people have reported that patches made by certain generic manufacturers work better than others. Most of the complaints have been about the Mylan patches.