ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Opioid Analgesic (Transdermal) Pregnancy: C

Fentanyl Patch (Burns Pain)

Brand names: Durogesic, Matrifen, Mezolar

Adult dose

Dose: 12–25 micrograms/hour patch; change every 72 hours; titrate to pain response
Route: transdermal patch
Frequency: every 72 hours
Max: Titrated to pain response (no absolute ceiling in cancer/chronic pain)
Only for stable chronic pain — NOT for acute or breakthrough pain; onset 12–24h; peak 24–72h; useful for burns patients unable to take oral opioids

Paediatric dose

Route: transdermal
Frequency: every 72 hours
Max: Specialist-guided titration
Concentration: 12, 25, 50, 75, 100 micrograms/hour patches micrograms/hour/ml
Paediatric use ≥2 years for opioid-tolerant children (already on ≥30 mg oral morphine equivalent/day); specialist palliative/pain service initiation only

Dose adjustments

Renal

No dose adjustment required (hepatic metabolism to inactive metabolites)

Hepatic

Reduce dose in severe hepatic impairment

Clinical pearls

  • Fever/external heat: increases absorption by 30% — warn patients about hot baths, heat pads, sunbeds
  • Not suitable for acute burns pain management — use IV morphine PCA for acute phase
  • Patch site: apply to non-burned, non-hairy, dry skin — avoid dressings over patch

Contraindications

  • Opioid-naïve patients without careful titration
  • Acute postoperative pain (unreliable absorption)
  • Fever >40°C (increased absorption)
  • Burns to patch application sites

Side effects

  • Respiratory depression
  • Sedation
  • Nausea
  • Constipation
  • Skin reactions at patch site
  • Pruritis
  • Urinary retention

Interactions

  • CNS depressants (enhanced sedation/respiratory depression)
  • MAOIs (dangerous — 14-day washout)
  • CYP3A4 inhibitors (increase fentanyl levels)
  • Benzodiazepines (respiratory depression)

Monitoring

  • Pain scores
  • Sedation level
  • Respiratory rate
  • Constipation management

Reference: BNFc; BNF 86; NICE NG46; British Burns Association guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators