TRANSDERMAL OPIOIDS

Useful in a number of cases

  • Patients have an opioid responsive pain.
  • Pain control is stable, and as an alternative to morphine, (i.e. a 2nd line strong opioid).
  • Where the patient is unable to tolerate morphine, and/or unable to take oral medication, e.g. dysphagia, vomiting.
  • Where drug compliance needs to be improved.

BUT NOT in situations where the pain is acute, and rapid dose titration is required.

When using transdermal opioid patches

When applying a new patch consider writing the date (and time) on the patch in order to identify when the next patch is due to be applied. This may be useful as an aide memoir or when the patient is moving between different care settings.

Cautions

  • If the patient has not had strong opioids previously.
  • In patients previously on doses of oral morphine (or equivalent opioid) less than 60mg/24hr.
  • In pyrexial patients where rate of absorption may be unpredictable.
  • With poor adherence of patches, e.g. patient with sweats or when applied to the chest wall of patients who are cachectic.
  • During the dying phase – seek specialist palliative care advice.

General notes

  • Laxatives may need to be reduced and titrated to need as transdermal fentanyl and buprenorphine are less constipating than other opioids.
  • Replace the patches at the same time of day (as indicated on the product information).
  • Vary the site of application with each change.
  • Apply to clean, dry, undamaged, non-hairy, flat areas of skin.
  • Never apply heat over the patch as this will increase absorption. Excessive heat should be avoided e.g. sauna, infra-red radiation.
  • Dispose of patches by folding in half, sticky side together, and putting in safe disposal unit e.g. sharps box.
  • Check that patches stick well. Sweating, crinkling and lifting at edges can make pain control inadequate.
  • Patients can shower or swim, but often a vapour-permeable film dressing needs to be placed over the patch to aid adhesion.

Use the links below for further information about Transdermal Opioids:

DISCLAIMER

This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.