fentanyl Duragesic 12mcg/hr (transdermal patch)
fentanyl Duragesic 12mcg/hr (transdermal patch) is a pain reliever. It is used to treat persistent, moderate to severe chronic pain. It is used only by people who have been taking an opioid or narcotic pain medicine for more than one week.
Class: Analgesic, Opioid; General Anesthetic
Indications: Injection: Relief of pain, preoperative medication, adjunct to general or regional
Transdermal patch (eg, Duragesic): Management of persistent moderate-to-severe chronic pain in opioid-tolerant patients when around-the-clock analgesia is needed for an extended period of time.
Available dosage form in the hospital:
Injection, solution, as citrate [strength expressed as
base]: 0.05 mg/mL (2 mL, 10 mL); 0.25 mg/ 5mL.
Patch, transdermal, as base: 12 [delivers 12.5 mcg/hr]; 50 [delivers 50 mcg/hr]; 100 [delivers 100 mcg/hr].
Pain management: Adults:
(unlabeled use): Bolus at start of infusion: 1-2 mcg/kg or 25-100 mcg/dose;
continuous infusion rate: 1-2 mcg/kg/hour or 25-200 mcg/hour.
Severe (unlabeled use): I.M, I.V.: 50-100 mcg/dose every 1-2 hours as needed; patients with prior opioid exposure may tolerate higher initial doses.
Patient-controlled analgesia (PCA) (unlabeled use):
Usual concentration: 10 mcg/mL.
Demand dose: Usual: 20 mcg; range: 10-50 mcg.
Lockout interval: 5-8 minutes.
Usual basal rate: ≤50 mcg/hour.
• metabolism hepatic, mostly CYP3A4
• one of our opioids of choice in renal failure
– transdermal 92 %
– intranasal 89 %
– buccal 50 %
– ingested 33 %
• injectable (50 ug/mL)
• transdermal patch
/ buccal tablet
• transmucosal film
Why Make a New Delivery Delivery System ?
• can give bigger doses
• can give more accurate doses
• aid mucosal adherence
• attenuate peak plasma concentration concentration
• can be patented
Interesting fact # 2
fentanyl: fentanyl: LD50 for monkeys monkeys = 0.03 mg/kg
(ie 600 ug of fentanyl will kill 50% of 20 kg monkeys)
LD50 for rats is 2 3. mg/kg iv, 1 0. mg/kg im
Fentanyl Fentanyl in (previous) (previous) Real Life
SC administration administration of 200ug fentanyl fentanyl
• Tmax – median 15 minutes (range 10‐30)
• Cmax – median 0 55 . ng/mL (range 0 28 . ‐0 87) .
• terminal ½ life = 10 hours (5.48 – 16.37h)
c/w: T½ 2.1 hours for morphine sc, 1.6 im
Tmax for im morphine = 20‐21 min
Tmax for sc morphine = 15‐16 min