Patient counselling
In 2008 and 2014 the MHRA issued a patient safety alert for fentanyl products following several reports of unintentional overdose due to dosing errors, accidental exposure (particularly in children) and exposure of the patch to a heat source.10,11
Healthcare professionals who prescribe or supply fentanyl patches should counsel the patient and/or their carer on the following:
Follow the prescribed dose and frequency of application.- Ensure old patches are removed before new ones are applied.
- Apply patches to a different body site each time.
- Do not use damaged or cut patches.
- Avoid touching the adhesive side of the patch and wash hands after application.
- Store unused patches safely and return patches that are no longer required to the pharmacy for disposal.
- Dispose of used patches by sticking the adhesive sides to each other and placing in the domestic waste or returning to the pharmacy.
- Site of application should be chosen carefully to ensure they are applied where they are unlikely to become detached and attached to another person.
- Patients should check the patches are stuck firmly to the skin.
- If patches are accidently transferred to another person it should be removed immediately and medical advice sought.
- If patches are swallowed medical advice should be sought.
In addition healthcare professionals were reminded of the need to exercise care because:
- increased body temperature, exposure of patches to external heat sources and concomitant use of CYP3A4 inhibitors may lead to potentially dangerous rises in serum fentanyl levels.
- concomitant use of other CNS depressants might potentiate adverse effects from fentanyl.
- healthcare professionals who prescribe or supply fentanyl patches must ensure that patients or their carers are aware of the signs of fentanyl overdose including trouble breathing, shallow breathing, tiredness, extreme sleepiness or sedation, inability to think, walk or talk normally and feeling faint, dizzy or confused.
- patients showing these signs should seek medical attention immediately if overdose if suspected.
- patients experiencing serious adverse effects should have the patches removed immediately and be monitored for up to 24 hours after patch removal.