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ISMP Safe Medicine July/August 2009, Volume 7, Number 4. ©2009 ISMP

Brand name medicines appear in green; generic medicines appear in red.

Fentanyl patches contain a very strong painkiller, so misuse can be deadly

Fentanyl is a very powerful pain reliever. It is only supposed to be prescribed for people with long-term (chronic) pain who have already been taking high doses of prescription opioid (narcotic) pain medicine for at least a week. Serious harm or death has resulted when this drug was taken in high doses by people who have not been taking other prescription opioid pain medicine for 7 days or more. 

In one case, a young man died after a well-meaning but misinformed doctor prescribed a starting dose fentanyl patch that was too high (50 mcg/hour). The man had been given a prescription for fentanyl patches to help reduce pain after surgery. Use of this medicine to treat pain related to the surgery itself is not safe. The man stopped breathing during his first night home after surgery.

nother patient who had surgery was given a prescription for a very high dose of fentanyl patches (75 mcg/hour). This man received morphine—another powerful pain medicine—right after surgery, and then he was sent home the same day with a prescription for fentanyl patches. He was also given a prescription for an oral pain medicine, oxycodone, to be taken as needed. The nurse placed a fentanyl patch on the patient before he left the hospital. Upon arriving home, the young man took one dose of the oral pain medicine, oxycodone. Sadly, the man died within 12 hours of leaving the hospital. He was not used to taking high doses of pain medicine, so he stopped breathing. He also had been treated for sleep apnea: a condition in which breathing repeatedly stops and starts during sleep. Fentanyl patches should not be prescribed for patients with sleep apnea or other serious breathing disorders. 

he US Food and Drug Administration (FDA) and companies that make fentanyl patches have sent out numerous warnings to doctors about incorrectly prescribing this drug to patients after surgery. Pain after an operation is acute pain, or short-term pain. Fentanyl should only be prescribed for patients who have long-term chronic pain. Patients with chronic pain have often taken other powerful pain medicines for at least 1 week and are more tolerant to the powerful pain reliever, fentanyl. People who are tolerant to other prescription pain relievers are much less likely to suffer from breathing problems when using a properly prescribed fentanyl patch.    

ollow the suggestions in Check it out! if your doctor prescribes fentanyl patches for you or a family member. Rest assured, this pain medicine works extremely well—but you want to make sure you are using the medicine patches safely.

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