Durogesic D-Trans

Fentanyl

Management of severe chronic pain that requires continuous long-term opioid administration in adults.

Individualised dosage. Replace patch every 72 hr. Initiate dose based on patient's current opioid use. Recommended to use in opioid-tolerant patients. Dosage may be titrated upwards or downwards, if required, in increments of either 12 or 25 mcg/hr to achieve the lowest appropriate dose depending on response & supplementary analgesic requirements. After a dose increase, wear the higher-dose patch through two 72-hr applications before any further increase in dose level is made. Use >1 patch for doses >100 mcg/hr. If insufficient analgesia during the 1st application, replace patch after 48 hr w/ a patch of the same dose, or increase dose after 72 hr. If the patch needs to be replaced before 72 hr, apply patch of the same strength to a different skin site.

Hypersensitivity. Acute or post-op pain. Severe resp depression.

Drug dependence & potential for abuse. Discontinue gradually to prevent w/drawal symptoms. Do not use cut, divided, or damaged patches. Monitor patients who have experienced serious adverse events for at least 24 hr after patch removal. Monitor patients w/ fever for opioid undesirable effects & adjust dose if necessary. Avoid exposing the application site to direct external heat sources. In case of accidental patch transfer, immediately remove transferred patch from the skin of the non-patch wearer. Stop treatment if paralytic ileus is present or suspected. Risk of resp depression; more severe adverse effects in patients w/ chronic obstructive or other pulmonary disease; hypotension, especially in patients w/ acute hypovolaemia. Use w/ caution in patients susceptible to the intracranial effects of CO₂ retention eg, those w/ evidence of increased intracranial pressure, impaired consciousness, or coma; brain tumours; bradyarrhythmias; chronic constipation; myasthenia gravis. Not recommended w/ CYP3A4 inhibitors; buprenorphine, nalbuphine or pentazocine. Concomitant use of serotonergic active substances (eg, SSRIs & SNRIs), & w/ active substances which impair serotonin metabolism (including MAOIs). Discontinue treatment if serotonin syndrome is suspected. May impair ability to drive or operate machinery. Patients w/ renal or hepatic impairment. Do not use during pregnancy. Discontinue breastfeeding during treatment & for at least 72 hr after patch removal. Not recommended in opioid-naïve patients. Elderly.

Somnolence, dizziness, headache; nausea, vomiting, constipation. Hypersensitivity; anorexia; insomnia, depression, anxiety, confusional state, hallucination; tremor, paraesthesia; vertigo; palpitations, tachycardia; HTN; dyspnoea; diarrhoea, dry mouth, abdominal pain, upper abdominal pain, dyspepsia; hyperhidrosis, pruritus, rash, erythema; muscle spasms; urinary retention; fatigue, peripheral oedema, asthenia, malaise, feeling cold.

Additive depressant effects w/ other CNS depressants (eg, opioids, sedatives, hypnotics, general anaesth, phenothiazines, tranquilizers, sedating antihistamines, & alcoholic beverages) & skeletal muscle relaxants. Increased risk of serotonin syndrome w/ serotonergic medicinal products eg, SSRIs, SNRIs or MAOIs. Partially antagonised analgesic effect w/ mixed opioid agonists/antagonists eg, buprenorphine, nalbuphine or pentazocine. Increased plasma conc w/ CYP3A4 inhibitors eg, amiodarone, cimetidine, clarithromycin, diltiazem, erythromycin, fluconazole, itraconazole, ketoconazole, nefazodone, ritonavir, verapamil & voriconazole. Decreased plasma conc w/ CYP3A4 inducers eg, carbamazepine, phenobarb, phenytoin & rifampicin.

Analgesics (Opioid)

N02AB03 - fentanyl ; Belongs to the class of phenylpiperidine derivative opioids. Used to relieve pain.

DD, P₁S₁