ABSTRACT
Recently, the use of transdermal fentanyl (TDF) has been increasing at our hospital owing to its convenience. Furthermore, TDF tends to be increasingly used for patients who have never used opioids. However, the appropriate criteria for indicating TDF have not been established yet. Therefore, we examined how TDF was prescribed in practice and determined its effective dosage. In 43 cases, the reasons, effects, and side effects of TDF were investigated retrospectively. Of the patients, 60% continued using TDF for 30 days. Meanwhile, approximately 25% of them terminated TDF therapy within 8 days. Of those who discontinued TDF therapy, some entirely stopped taking TDF and others chose other opioids instead because of poor pain control. Before receiving TDF therapy, 17 patients (45%) used oxycodone and 14 (37%) never used opioids. In addition, the main reason for starting TDF in opioid-naive patients was gastrointestinal condition. Between opioid-naive and opioid-using groups, no significant differences were observed in usage duration and incidence of side effects. The side effects included somnolence in 6 patients, delirium in 2 patients, and nausea and vomiting, constipation, and breathing restraint in 1 patient each. TDF was considered as an effective treatment regardless of the previous use of opioids. Nonetheless, careful deliberation is necessary because of the slow effects and difficulty with dosage adjustment.
Subject(s)
Analgesics, Opioid/therapeutic use , Fentanyl/therapeutic use , Neoplasms/complications , Pain/drug therapy , Administration, Cutaneous , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Female , Fentanyl/administration & dosage , Humans , Male , Middle Aged , Pain/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
Patients endure the switching of opioids from fentanyl patch to morphine injection to improve inadequate pain relief. We retrospectively examined the differences between the maintenance dose of morphine injection after switching, its estimated dose prior to switching, and some other factors. As a result, 8 out of 9 patients had pain control after switching. Also, patients who increased the dose of the fentanyl patch more than twice in a month before switching required a significantly lower maintenance dose for the estimated dose after switching (p < 0.05) than those who took less. In conclusion, switching opioids to morphine injection is very effective, both from the viewpoint of pain control and the reduction of the amount of opioids used for patients with poor pain control, who frequently increase their use of the fentanyl patch.
