Fentanyl Patches

FENTANYL (FEN ta nil) treats severe, chronic pain. It is prescribed when other pain medications do not work well enough or cannot be tolerated. It works by blocking pain signals in the brain. It belongs to a group of medication called opioids. It is a long-acting pain medication. Do not use it to treat sudden pain.

This medication is for external use only. Apply the patch to your skin. Select a clean, dry area of skin above your waist on your front or back. The upper back is a good spot to put the patch on children or people who are confused, because it will be hard for them to remove the patch. Do not apply the patch to oily, broken, burned, cut, or irritated skin. Use only water to clean the area. Do not use soap or alcohol to clean the skin because this can increase the effects of the medication. If the area is hairy, clip the hair with scissors, but do not shave. Do not cut or damage the patch. A cut or damaged patch can be very dangerous because you may get too much medication.

Take the patch out of its wrapper and take off the protective strip over the sticky part. Do not use a patch if the packaging or backing is damaged. Do not touch the sticky part with your fingers. Press the sticky surface to the skin using the palm of your hand. Press the patch to the skin for 30 seconds. Wash your hands at once with soap and water.

Keep patches far away from children. Do not let children see you apply the patch and do not apply it where children can see it. Do not call the patch a sticker, tattoo, or bandage, as this could encourage the child to mimic your actions. Used patches still contain medication. Children or pets can have serious side effects or die from putting used patches in their mouth or on their bodies.

Take off the old patch before putting on a new patch. Apply each new patch to a different area of skin. If a patch comes off or causes irritation, remove it and apply a new patch to a different site. If the edges of the patch start to loosen, apply first aid tape to the edges of the patch. If problems with the patch not sticking continue, cover the patch with a see-through adhesive dressing (like Bioclusive or Tegaderm). Never cover the patch with any other bandage or tape.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as 2 years old for selected conditions, precautions do apply.

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
• Low adrenal gland function—nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Nausea
• Vomiting

Keep out of the reach of children and pets. This medication can be abused. Keep it in a safe place to protect it from theft. Do not share it with anyone. It is only for you. Selling or giving away this medication is dangerous and against the law.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Keep this medication in the original packaging until you are ready to take it. Get rid of any unused medication after the expiration date.

This medication may cause harm and death if it is taken by other adults, children, or pets. It is important to get rid of the medication as soon as you no longer need it, or it is expired. You can do this in two ways:

• Take the medication to a medication take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medication, flush it down the toilet.

They need to know if you have any of these conditions:

• Brain tumor
• Frequently drink alcohol
• Head injury
• Heart disease
• Kidney disease
• Liver disease
• Lung or breathing disease, such as asthma
• Seizures
• Stomach or intestine problems
• Substance use disorder
• Taken an MAOI such as Marplan, Nardil, or Parnate in the last 14 days
• An unusual or allergic reaction to fentanyl, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breastfeeding

Do not take this medication with any of the following:

• Mifepristone
• Safinamide
• Samidorphan

This medication may also interact with the following:

• Alcohol
• Antihistamines for allergy, cough, and cold
• Atropine
• Certain antibiotics, such as clarithromycin, erythromycin, linezolid, rifampin
• Certain antivirals for HIV or hepatitis
• Certain medications for anxiety or sleep
• Certain medications for bladder problems, such as oxybutynin, tolterodine
• Certain medications for depression, such as amitriptyline, fluoxetine, sertraline, mirtazapine, trazodone
• Certain medications for fungal infections, such as ketoconazole, itraconazole, posaconazole
• Certain medications for migraine headache, such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
• Certain medications for nausea or vomiting, such as dolasetron, granisetron, ondansetron, palonosetron
• Certain medications for Parkinson disease, such as benztropine, trihexyphenidyl
• Certain medications for seizures, such as carbamazepine, phenobarbital, phenytoin, primidone
• Certain medications for stomach problems, such as dicyclomine, hyoscyamine
• Certain medications for travel sickness, such as scopolamine
• Diuretics
• General anesthetics, such as halothane, isoflurane, methoxyflurane, propofol
• Ipratropium
• MAOIs, such as Marplan, Nardil, and Parnate
• Medications that relax muscles
• Methylene blue
• Other opioid medications for pain or cough
• Phenothiazines, such as chlorpromazine, mesoridazine, prochlorperazine, thioridazine

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

Tell your care team if your pain does not go away, if it gets worse, or if you have new or a different type of pain. You may develop tolerance to this medication. Tolerance means that you will need a higher dose of the medication for pain relief. Tolerance is normal and is expected if you take this medication for a long time.

Taking this medication with other substances that cause drowsiness, such as alcohol, benzodiazepines, or other opioids can cause serious side effects. Give your care team a list of all medications you use. They will tell you how much medication to take. Do not take more medication than directed. Call emergency services if you have problems breathing or staying awake.

Children may be at higher risk for side effects. Stop giving this medication and call emergency services right away if your child has slow or noisy breathing, has confusion, is unusually sleepy, or not able to wake up.

Long term use of this medication may cause your brain and body to depend on it. This can happen even when used as directed by your care team. You and your care team will work together to determine how long you will need to take this medication. If your care team wants you to stop this medication, the dose will be slowly lowered over time to reduce the risk of side effects.

Naloxone is an emergency medication used for an opioid overdose. An overdose can happen if you take too much of an opioid. It can also happen if an opioid is taken with some other medications or substances such as alcohol. Know the symptoms of an overdose, such as trouble breathing, unusually tired or sleepy, or not being able to respond or wake up. Make sure to tell caregivers and close contacts where your naloxone is stored. Make sure they know how to use it. After naloxone is given, the person giving it must call emergency services. Naloxone is a temporary treatment. Repeat doses may be needed.

This medication may affect your coordination, reaction time, or judgment. Do not drive or operate machinery until you know how this medication affects you. Sit up or stand slowly to reduce the risk of dizzy or fainting spells. Drinking alcohol with this medication can increase the risk of these side effects.

This patch is sensitive to body heat changes. If your skin gets too hot, more medication will come out of the patch and can cause an overdose. Call your care team if you get a fever. Do not take hot baths. Do not sunbathe. Do not use hot tubs, saunas, hairdryers, heating pads, electric blankets, heated waterbeds, or tanning lamps. Do not engage in exercise that increases your body temperature.

If you are going to need surgery, an MRI, CT scan, or other procedure, tell your care team that you are using this medication. You may need to remove the patch before the procedure.

This medication will cause constipation. If you do not have a bowel movement for 3 days, call your care team.

Your mouth may get dry. Chewing sugarless gum or sucking hard candy and drinking plenty of water may help. Contact your care team if the problem does not go away or is severe.

Talk to your care team if you may be pregnant. Prolonged use of this medication during pregnancy can cause temporary withdrawal in a newborn.

Talk to your care team before breastfeeding. Changes to your treatment plan may be needed. If you breastfeed while taking this medication, seek medical care right away if you notice the child has slow or noisy breathing, is unusually sleepy or not able to wake up, or is limp.

Long-term use of this medication may cause infertility. Talk to your care team if you are concerned about your fertility.