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Canterbury DHB

Fentanyl

This drug is available in New Zealand on special authority for stable pain in patients with 'terminal illness' in the transdermal form (Durogesic patches). See pharmac website http://www.pharmac.co.nz or check with the hospital pharmacist (relevant specialist only).

Patches are available in different dose rates: 12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, and 100 mcg/hr. (Durogesic™ 12 (12.5 mcg/hr) patch was introduced in 2007 and is not currently funded however funding status may change).

IV or subcut fentanyl may occasionally be used under supervision of the Acute Pain Team or Palliative Care Team.

Indications for use include;

Fentanyl is a potent opioid and breakthrough opioids must be available. The 'oral morphine equivalent' dose should always be calculated for patients already established on Durogesic™ and an appropriate oral dose of morphine elixir, SevredolTM or OxyNormTM be prescribed.

Recommendation on choosing a starting dose of Durogesic™:

Oral 24-hour morphine
(mg/day)

Durogesic™ Dose
(micrograms/hour)

< 60

60-134

135 - 224

225 - 314

315 - 404

405 - 494

495 - 584

585 - 674

675 - 764

765 - 854

855 - 944

945 - 1034

1035 - 1124

12

25

50

75

100

125

150

175

200

225

250

275

300

If fentanyl is used in an infusion, it must be diluted with normal saline and used as a sole agent in the pump. It needs to be in a 50 ml syringe and therefore cannot be used in a Graseby pump.

If considering using fentanyl, a Palliative Care referral is strongly recommended.

See also:

Information about this Canterbury DHB document (4059):

Document Owner:

Palliative Care Service (see Who's Who)

Issue Date:

July 2009

Next Review:

July 2010

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

 

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Topic Code: 4059