Fentanyl Patch

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Specializes in Micu,Hospice.

We ordered a 12 mcg Fentanyl patch for our bedbound end stage Parkinsons disease and Dementia pt who was taking 3gms of Tylenol daily for generalized pain. she was moaning in pain prior to this change with also increase bp and heart rate.

Has anyone out there seen someone not come around after over a week with the Fentanyl patch? By this I mean, she has a decrease appetite, not as responsive, and generally not the same. Although no further moaning when turned. Caregiver is really upset at me, the nurse, for suggesting this change for the pt.

What have other hospice nurses seen with low dose Fentanyl patches?:eek:

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Not being a hospice nurse, though have used the patch in orthopedics and not seen a problem. I am assuming her vital signs are more stable not increased BP/HR etc. and respirations fine? It may help to talk to the pharmacist having a list of all her meds to make sure there is no untoward interaction with all of them, what does the doctor say?

http://www.duragesic.com/duragesic/

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Specializes in hospice.

I have had this reaction with the patch. I am not a big fan of those patches.

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Yes, I too have seen this reaction to a Fentenyl patch. I suggest you

stop the patch and see if the patient perks up. The 12 mcg patch is

equivalent to approx. 40-55 mg of morphine/day.

Best wishes!

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maybe the pt is catching up on all the sleep they hadnt been getting??

but that does seem to be a rather big leap....how about roxanol....or is there a prob with diversion in ther household?

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Specializes in Hospice, LTC.

We use MS gel, 20 mg/ml alot. It can be applied routinely as well as PRN. The pt is only absorbing about 1/2 of that and it is easy to titrate up and down. I am wondering if this pt has had a dramatic decline however and that is why you are seeing the increase in pain, and now in sedation.

Also, I have been told that it takes up to 14 days to get maximum effects of Fentanyl patch.

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Specializes in Hospice, Palliative Care, Gero, dementia.

I have to say, I'm not used to seeing people who are opiate naive on fentanyl -- it's too hard to titrate. As someone suggested, unless they have a morphine allergy I'd start w/a morphine solute (doesn't even have to be at the strength of roxanol). If they are allergic, you could go with a liquid Oxycontin.

And I also was wondering if this a sign of a terminal decline -- the sedation and loss of appetite.

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Specializes in Hospice, Palliative Care, OB/GYN, Peds,.

I don't usually see these symptoms more than 2-3 days after starting a patch or any narcotic for that matter. It could be a sign of the decline, usually sedation is the sign of too much med but everyone has their own reaction. I would usually go from Tylenol to a prn narcotic before going to a long acting one first, then base it on how much prn the patient uses. I have had this same issue before and the care giver reacted in the same way, we try until we get it right and certainly want to control pain. Don't be haard on yourself for caring.:redpinkhe

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Specializes in Micu,Hospice.

Thanks for all the support. Things were better today. Pt is very comfortable. Eating less than two weeks ago but VS stable and caregiver seems tolerate at this point. I truly felt that roxanol would have been better but I could bet my life on it that the caregiver would not have given it. Very old world and old school.

Afraid of the M word.

Again, thanks all!:heartbeat

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I suspect her reduced appetite and increased lethargy is also due to decline more than the patch. But next time you could try low-dose Roxanol for a few days and see how the pt does prior to starting a patch, which is hard to titrate. I might have tried this lady on Roxanol 5 mg BID (like, 9 am and 5 pm, continuing the tylenol), or if she can swallow it, percocet liquid 5/325 5 ml q4 or q6 while awake, d/c the tylenol, prior to starting the patch.

Tylenol 3 mg to fentanyl 12 mcg is NOT big leap, in my opinion.

BTW, it's the fentanyl 25 mcg that's equivalent to 45 mg of morphine a day. Not the 12 mcg, which is equal to half that.

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Specializes in Hospice, Palliative Care, Gero, dementia.
I suspect her reduced appetite and increased lethargy is also due to decline more than the patch. But next time you could try low-dose Roxanol for a few days and see how the pt does prior to starting a patch, which is hard to titrate. I might have tried this lady on Roxanol 5 mg BID (like, 9 am and 5 pm, continuing the tylenol), or if she can swallow it, percocet liquid 5/325 5 ml q4 or q6 while awake, d/c the tylenol, prior to starting the patch.

Tylenol 3 mg to fentanyl 12 mcg is NOT big leap, in my opinion.

BTW, it's the fentanyl 25 mcg that's equivalent to 45 mg of morphine a day. Not the 12 mcg, which is equal to half that.

I guess by big leap I meant that if the person is opiate naive, then going to something that you can't titrate is a bit of a leap. But the OP then explained that she was concerned that the family CG wouldn't administer, so it makes a certain sense to go that route.

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Not to be disagreeable, but not wanting anyone to be misinformed. You

may wish to check with yor pharmacist/MD for equivalency of morphine

with fentenyl 12 mcg. Best wishes!

I suspect her reduced appetite and increased lethargy is also due to decline more than the patch. But next time you could try low-dose Roxanol for a few days and see how the pt does prior to starting a patch, which is hard to titrate. I might have tried this lady on Roxanol 5 mg BID (like, 9 am and 5 pm, continuing the tylenol), or if she can swallow it, percocet liquid 5/325 5 ml q4 or q6 while awake, d/c the tylenol, prior to starting the patch.

Tylenol 3 mg to fentanyl 12 mcg is NOT big leap, in my opinion.

BTW, it's the fentanyl 25 mcg that's equivalent to 45 mg of morphine a day. Not the 12 mcg, which is equal to half that.

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