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).

Schedule

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).

Side Effects

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

Side effect videos
ConstipationFatigue Nausea and Vomiting

Monitoring

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.

Questions to Ask Your...

A better understanding of your treatments will allow you to ask more questions of your healthcare team. We then hope that with the answers, you will get better results and have greater satisfaction with your care. Because we know it's not always easy to know what questions to ask, we've tried to make it easy for you!

Choose any healthcare provider below to see common questions that you may want to ask of this person. Then, either print each list to bring to your clinic visits, or copy the questions and send them as a message to your healthcare team through your electronic medical record.

Questions to ask your Doctor Nurse Pharmacist

Questions to ask your Nurse Doctor Pharmacist

Questions to ask your Pharmacist Doctor Nurse

ChemoExperts Tips

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

Created: March 27, 2020 Updated: April 19, 2020

What is Pain?

What is pain?

Pain is the body’s way of signaling that something is wrong. It can happen when tissues are injured, inflamed, stretched, or irritated. In patients with cancer, pain may be caused by the cancer itself, cancer treatment, tests, or procedures.

Pain can be acute or chronic. Acute pain starts suddenly and often lasts a short time, such as pain after surgery or a procedure. Chronic pain lasts longer and may continue during or after cancer treatment.

What does pain look like?

Pain can feel very different from person to person. It may be sharp, dull, aching, throbbing, burning, shooting, cramping, or stabbing. Some pain stays in one place, while other pain may spread or travel to another area.

Pain can also affect more than just the body. A person with pain may have trouble sleeping, moving around, concentrating, eating, or enjoying daily activities. Pain can also affect mood and emotions, and stress or depression can make pain feel worse.

Who gets pain?

Pain is one of the most common symptoms in patients with cancer. Pain may come from a tumor pressing on nerves, bones, or organs. It may also occur because of surgery, radiation, or a side effect of cancer therapy.

How is pain prevented?

Pain cannot always be fully prevented, but in certain situations, some measures may be taken to help prevent or lessen pain. For instance, the care team may give medicine before a painful procedure or recommend non-drug methods early to help prevent pain or keep it from worsening.

How is pain treated?

Pain treatment depends on the cause, type, and severity of the pain. For mild pain, treatment may include non-opioid medicines such as:

Acetaminophen (Tylenol®)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Meloxicam (Mobic®)
- Diclofenac (Voltaren®)
- Celecoxib (Celebrex®)
- Ketorolac (Toradol®)

For moderate to severe cancer pain, opioids may be offered unless there is a reason they should not be used. Opioids are typically started as needed at the lowest effective dose and then adjusted based on pain control and patient goals. Some commonly used opioid medications include:

Codeine
Tramadol (Ultram®)
Morphine (MSIR®, MS Contin®)
Hydrocodone (Hysingla®, Vicodin®, Lortab®)
Oxycodone (Roxicodone®, Percocet®, OxyContin®, Xtampza®)
Hydromorphone (Dilaudid®)
Fentanyl (Duragesic®)
Oxymorphone (Opana®)
Methadone

Some types of pain may also require adjuvant medications, which are drugs used for specific pain types. For example, nerve pain may be treated differently than bone pain or cramping pain. In addition to medicines, non-drug treatments such as physical therapy, relaxation, acupuncture, counseling, and other supportive approaches may also help.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What is an opioid medication?

Opioids are a class of medications that are similar in structure to opium and are commonly used to treat pain. These medications are very effective at treating pain symptoms, but should be used at the lowest dose necessary as directed by your doctor to relieve pain as these medications can lead to misuse, abuse, and addiction.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is a Schedule II medication?

Schedule II medications, as designated by the FDA, are medications that are considered to have a high abuse potential and have an increased risk of misuse or diversion. These medications can only be prescribed with a written prescription and have limitations on how many days supply can be dispensed at once. Schedule II medications cannot be refilled as well and must have a new prescription for every single fill.