Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain

Abstract

Transdermal fentanyl is an effective and well-tolerated treatment for cancer-related pain for patients regardless of whether they have previously received opioids. Previous guidelines have often advocated initial dose finding with short-acting opioids but this study demonstrates that such a complex titration and conversion schedule may not be necessary,and that treatment may be initiated directly with long-acting formulations such as transdermal fentanyl when previous analgesic therapy fails to provide adequate relief.

Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy

“…Other authors [23,24] found that, when switching to TF, the frequency of adverse events was slightly higher among opioid-naïve patients compared with the strong-opioid and weak-opioid groups. Moreover, the authors suggest that patients who require strong opioids for pain relief may receive transdermal fentanyl without a prior stabilization phase [23,24].…”

“…Moreover, the authors suggest that patients who require strong opioids for pain relief may receive transdermal fentanyl without a prior stabilization phase [23,24].…”

The Role of Fentanyl in Cancer-Related Pain

“…Fentanyl, a synthetic opioid, was developed in the 1960s and has been in clinical use for more than 30 years as a component of anesthetic regimens. 4 Initial limitations to its use included rapid onset of action and short duration of action. Newer transdermal and transmucosal routes of administration have lead to longer periods of analgesia.…”

Transdermal fentanyl: Pharmacology and toxicology

“…Several recent literature reports suggest that certain patients who are not tolerant to strong opioids, and even opioid-naïve patients, may safely receive a low-dose transdermal fentanyl device [84,85]. The approach of slowly escalating from a 12.5 or 25 μg/hour transdermal device should provide a degree of safety from opioid overdose.…”