Physicians' knowledge of transdermal fentanyl

Welsh, John; Reid, A.; Graham, Julie; Curto, Jorge; MacLeod, Karen; O’Neill, Claire

doi:10.1191/0269216305pm971oa

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…It has been shown recently that overall knowledge and confidence in using transdermal fentanyl generally is poor among GPs, hospital consultants and oncologists. 31 Inappropriate use of this drug can lead to harmful effects in a vulnerable population of patients. Although fentanyl has been proven to be a useful tool in the treatment of cancer pain, caution still needs to be exerted in prescribing this potentially harmful drug.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate use of high doses of transdermal fentanyl at admission to a palliative care unit

Botterman

Criel

2010

Palliat Med

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A retrospective study was conducted to determine the patterns of strong opioid use in patients admitted to a hospice inpatient unit, with special attention to the use of the transdermal fentanyl patch. This study was conducted to validate or negate the subjective feeling that many patients, treated at admittance with the fentanyl patch, received inappropriately high doses compared to patients treated with oral or parenteral opioids. The case notes of 1154 patients were reviewed and data collected on age, sex, diagnosis, care settings, opioid form and dose on referral, maximal dose during admission and opioid use during the last 24 hours of their life. At admission opioids had been prescribed for 47% of patients. Thirty-two percent of these patients received oral morphine. The median dose at admission of those patients was 60 mg (oral morphine equivalent (OME)). Thirty-six percent of the patients on opioids were using the fentanyl patch. The median dose at admission was triple that of the orally treated patients (median 180 mg OME). In the 199 patients using transdermal fentanyl at admission, in most patients the dose of the patch was gradually diminished and finally stopped in 58% of patients. Only 83 kept it until the last 24 hours. We would like to draw attention to the fact that (sometimes inappropriately) high doses of fentanyl were used at admission, probably due to lack of knowledge of the relative strength of the opioid involved and to the failure to recognize the phenomenon of opioid-induced hyperalgesia. In addition, in our experience the long action of the patch can be a disadvantage during the last days and weeks of life, due to the difficulty of dose adjustment and the risk for toxicity.

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Section: Discussionmentioning

confidence: 99%

Inappropriate use of high doses of transdermal fentanyl at admission to a palliative care unit

Botterman

Criel

2010

Palliat Med

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“…Lack of physician knowledge regarding pharmacokinetic properties of this preparation has been previously reported. 7 Despite the 2005 warning, significant adverse events and fatalities associated with the use of transdermal fentanyl continue to be reported, prompting the FDA to issue an updated warning in December 2007. 8 Fentanyl is metabolized in the liver by the cytochrome P450 system, mainly undergoing dealkylation to inactive metabolites by cytochrome P450 3A4.…”

Section: Commentmentioning

confidence: 99%

Opioid-Induced Respiratory Depression Resulting from Transdermal Fentanyl-Clarithromycin Drug Interaction in a Patient with Advanced COPD

Horton¹,

Barber

2009

Journal of Pain and Symptom Management

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Levomepromazine, also known as methotrimeprazine, is an antipsychotic drug. In addition to this use, it has a role in palliative care for the alleviation of nausea. It also has been used to manage terminal restlessness, although it can cause restlessness and akathisia.Drug-induced lupus is a condition that resembles a mild form of idiopathic systemic lupus erythematosus and is associated with drugs such as procainamide, hydralazine, minocycline, quinidine, chlorpromazine, isoniazide, and methyldopa. 1,2 It is a reversible condition, with the symptoms often resolving within days of stopping the offending medication. 1,3,4 Symptoms may develop up to one year after the drug is commenced. It is diagnosed when a patient has one or more symptoms of systemic lupus erythematosus, with positive ANA titer and no symptoms of lupus before starting the suspected drug. Table 1 shows the features that can be associated with drug-induced lupus. 5 Although there is no published literature directly pertaining to lupus secondary to levomepromazine, this drug has pharmacological activity similar to that of chlorpromazine, for which a published association with the onset of lupustype symptoms exists. 6 The combination of raised homogeneous ANA levels, features of lupus (Table 1), symptoms starting after months of treatment with levomepromazine and resolving within days of discontinuing it, all support the possibility of drug-induced lupus secondary to levomepromazine.Antihistone antibodies are raised in approximately 90% of cases of drug-induced lupus and would have certainly supported the

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“…Fentanyl is a lipid soluble synthetic opioid analgesic that has been used clinically as an adjunct in surgical anaesthesia and for chronic pain in cancer patients (1,2). Transdermal fentanyl is used as an alternative to oral morphine for patients requiring stable opioid dosing (3) for severe chronic pain (4) or with dysphagia associated with oesophageal and neck cancer (5). Using a transdermal membrane-controlled reservoir patch (Reservoir-TTS), continuous and controlled systemic delivery of fentanyl can be obtained for up to 72 h.…”

Section: Introductionmentioning

confidence: 99%

Validated LC coupled to ESI-MS/MS analysis for fentanyl in human plasma and UV analysis in applied reservoir transdermal patches using a simple and rapid procedure

Takashina

Naito

Mino

et al. 2009

Journal of Clinical Pharmacy and Therapeutics

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Physicians' knowledge of transdermal fentanyl

Abstract: The results show doctors who had previously prescribed TF are more confident and knowledgeable about the indications and pharmacology of TF than doctors who had never prescribed TF. Overall knowledge and confidence in using TF was poor.

Cited by 7 publications

References 8 publications

Inappropriate use of high doses of transdermal fentanyl at admission to a palliative care unit

Inappropriate use of high doses of transdermal fentanyl at admission to a palliative care unit

Opioid-Induced Respiratory Depression Resulting from Transdermal Fentanyl-Clarithromycin Drug Interaction in a Patient with Advanced COPD

Validated LC coupled to ESI-MS/MS analysis for fentanyl in human plasma and UV analysis in applied reservoir transdermal patches using a simple and rapid procedure

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