Treatment Name: Fentanyl (Duragesic®)
Fentanyl (Duragesic®) is a Supportive Care Therapy for Pain
How does fentanyl (Duragesic®) work?
Fentanyl is designed to bind to and activate receptors in the brain called mu (pronounced mew) receptors. When bound to mu receptors, fentanyl helps to reduce the pain signals that go to the brain, which provides pain relief.
Goals of fentanyl (Duragesic®) therapy:
Fentanyl is typically taken to relieve moderate to severe chronic pain. The goal of fentanyl therapy is not to completely relieve pain, but to lessen it to a manageable level. It is most commonly prescribed as a long-acting patch (Duragesic®) that delivers the medication through the skin (transdermal).
How is fentanyl (Duragesic®) therapy given?
Doses of fentanyl can vary greatly depending upon the amount of pain that you are experiencing and the amount of fentanyl or other opioid medications that you are currently taking.
Typical starting doses for fentanyl (Duragesic®):
- 12 mcg/hr or 25 mcg/hr transdermal patch that is changed every 3 days (72 hours)
- In some cases, your doctor may prescribe the patch to be changed every 2 days (48 hours)
- Once a fentanyl patch is applied, it may take 8 to 12 hours to take full effect. Likewise, once a patch is remvoed, it may take 8 to 12 hours for the medicine to wear off
Fentanyl can be used while in the hospital or it can be used at home. Because fentanyl is used for chronic pain, your doctor determines the duration of therapy.
Store fentanyl at room temperature (77°F).
What are the most common side effects from fentanyl?
In the prescribing label information (Duragesic® package insert), the most commonly reported side effects from fentanyl are shown here:
Note: The exact percentages of patients that will experience fentanyl side effects is unknown because it has been used under widely varying patient populations in a variety of clinical trials.
The use of fentanyl during pregnancy can cause opioid withdrawal syndrome in newborn babies. Fentanyl should only be used in pregnant women and women who are breastfeeding if your doctor determines that the potential benefits to the mother outweigh the potential risks to the baby.
Watch videos on common fentanyl therapy side effects below
How often is monitoring with fentanyl (Duragesic®) needed?
Labs (blood tests) are not routinely done with fentanyl therapy, but may be checked periodically. Labs may include: Comprehensive Metabolic Panel (CMP) plus any others your doctor may order.
Fentanyl may slow how many times you take a breath per minute. This is known as your respiratory rate. Some patients choose to purchase a pulse oximeter, or "pulse ox," monitor to ensure that they they are maintining their oxygen levels, or oxygen saturation, at an adequate level as recommended by their Doctor.
How often is imaging needed with fentanyl (Duragesic®) therapy?
Imaging is not routinely needed during fentanyl therapy.
How might blood test results/imaging affect fentanyl (Duragesic®) treatment?
Depending upon the results, your doctor may advise to continue fentanyl as planned, change your dose, or switch to an alternative pain medication.
What are some of the most important things to know about fentanyl (Duragesic®) while receiving therapy?
- Always place your fentanyl patch on an intact, non-irritated part of your skin. Common sites for placement include the chest, upper arms, back, or stomach. Clean the area prior to each use. If body hair is present, you may clip the hair but don’t shave. Wash your hands immediately after applying. Apply to a different body site the next time you change your patch
- After removing an old patch, fold the sticky side of patch together and dispose of it right away. Used patches may still contain medication that could be dangerous to babies, children, or adults for whom fentanyl has not been prescribed
- Avoid exposing yourself to sources of heat (sunbathing, heating pad, electric blanket, tanning bed, hot tub, sauna) while wearing the fentanyl patch as this may alter the absorption of fentanyl through your skin
- In the event of an overdose, naloxone (Narcan®) may be used to reverse the effects of fentanyl. Patients who require naloxone may have rebound pain due to the reversal of the pain relieving effect of fentanyl
- Fentanyl slows down the movement of the intestines and may cause constipation as a common side effect. If you are not having at least one bowel movement every other day, over-the-counter laxatives such as Senna-S® or MiraLAX® may help to keep your bowels regular
- Fentanyl is a FDA Schedule II medication and cannot be prescribed with refills. Before you run out of your medication, be sure to contact your doctor to get another prescription ahead of time. Abruptly stopping fentanyl may cause withdrawal symptoms and increased pain
- Taking other depressant medications such as benzodiazepines (lorazepam, alprazolam, midazolam, etc.) or drinking alcohol can increase side effects and can slow your breathing and can be life threatening. Try to limit taking these types of medications together when possible
- Be sure to store fentanyl in a very safe place away from children and pets and consider storing it in a locked container or cabinet
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately. Certain antifungal and seizure medications may interact with fentanyl causing either increased blood levels causing increased side effects or cause decreased levels and decreased effectiveness of fentanyl
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Fentanyl (Duragesic®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Fentanyl (Duragesic®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Fentanyl (Duragesic®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.