Fentanyl Transdermal Patch (Elderly Chronic Pain)

How it works

Fentanyl is a synthetic mu-opioid receptor agonist that produces analgesia by acting on opioid receptors in the central nervous system.

Prescribing in practice

• Transdermal fentanyl must not be used in opioid-naive patients because its potency carries a high risk of fatal respiratory depression, a risk increased in the elderly.
• It is unsuitable for acute or rapidly changing pain owing to its slow onset and prolonged offset, and a depot persists in the skin after patch removal.
• Fever, external heat sources and damaged skin can accelerate absorption and precipitate overdose.

Monitoring

Monitor for sedation, respiratory depression, confusion, constipation and adequacy of analgesia, especially during initiation and dose change in older patients.

Counselling the patient

• Do not expose the patch or the area to direct heat such as hot baths, heat pads or electric blankets.
• Fold used patches closed and dispose of them safely away from children, as they still contain medicine.
• Report excessive drowsiness or slow or shallow breathing urgently.

Evidence & guidelines

Transdermal fentanyl is an established option for stable chronic pain, with safe use in the elderly guided by MHRA and UK prescribing references.