Introduction

Name

• Duragesic® fentanyl transdermal system.

Class of drug

• Analgesic.
• Opioid analgesic (narcotic).
• Phenylpiperidene derivative.
• Controlled substance - Schedule II controlled drug (UK), Class II opioid (US) (requires DEA controlled drug license, ordering forms and all required documentation).
• After use, the patch must be disposed of according to DEA regulations for a schedule II drug.

Description

Chemical name

• N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]propanamide.

Molecular formula

• C22H28N2O

Molecular weight

• 336.47

Physical properties

• Product is transdermal system designed to deliver 12, 25, 50, 75 or 100 micrograms fentanyl/h through human skin.

Storage requirements

• Store up to 25°C (77°F); excursions permitted to 15-30°C (59-86°F).
• Store together with product information.
• Store in accordance with a Schedule II controlled drug Controlled drugs: legal requirements for storage, prescription and supply.

Uses

Indications

• Not approved for veterinary use.
• Management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
• Used in veterinary medicine for alleviation of acute pain following trauma or surgery.
• Can be used for chronic pain management Pain: management , for example in cancer patients.

Ovariohysterectomy Ovariohysterectomy

• Transdermal fentanyl (applied 20 hours before surgery) was as effective as intramuscular oxymorphone Oxymorphone (given pre-operatively and at 6, 12 and 18 hours after surgery), for control of post-operative pain. The dogs with fentanyl patches were less sedate in the post-operative period.

Orthopedic surgery

• Transdermal fentanyl was compared to epidural morphine Morphine (0.1 mg/kg) in dogs undergoing total hip arthroplasty. Transdermal fentanyl was found to provide equal or greater analgesia than provided by epidural morphine.
• Transdermal fentanyl (50 micrograms/hour patch applied preoperatively) was compared to 3 doses of meloxicam at 24 hour intervals:
  • 1. 0.2 mg/kg (0.09 mg/lb) intravenously.
  • 2. 0.1 mg/kg (0.045 mg/lb) intravenously, and
  • 3. 0.1 mg/kg orally in dogs undergoing osteotomy of the tibia and fibula and placement of a uniplanar external distraction device. Transdermal fentanyl was found to provide similar postoperative analgesia based on total pain scores and lameness scores to that provided by meloxicam Meloxicam.
• As with all analgesics the animal must be monitored for comfort and level of pain must be frequently assessed. In some cases additional analgesics will be needed to achieve effective analgesia.

Administration

Precautions

Interactions

with other drugs

• Use with caution in conjunction with morphine or other opioid type analgesics.
• May have additive effects with other CNS depressants such as sedatives, anesthetics, antihistamines, or seizure medication.
• Do not use fentanyl for 14 days after using isoniazid, amitraz Amitraz or monoamine oxidase inhibitors, such as selegiline Selegiline hydrochloride (deprenyl).
• After effective fentanyl plasma levels have been achieved, the use of other pure opioid agonists may result in an additive effect. In contrast, administration of agonist-antagonist drugs (ie butorphanol Butorphanol tartrate ) has the potential to antagonize the actions of fentanyl.

Adverse Reactions

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Kukanich B, Clark T P (2012) The history and pharmacology of fentanyl: relevance to a novel, long-acting transdermal fentanyl solution newly approved for use in dogs. J Vet Pharmacol Ther 35 (Suppl 2), 3-19 PubMed.
• Reed F, Burrow R, Poels K L et al (2011) Evaluation of transdermal fentanyl patch attachment in dogs and analysis of residual fentanyl content following removal. Vet Anaesth Analg 38 (4), 407-412 PubMed.
• Pekcan Z, Koc B (2010) The post-operative analgesic effects of epidurally administered morphine and transdermal fentanyl patch after ovariohysterectomy in dogs. Vet Anaesth Analg 37 (6), 557-565 PubMed.
• Schmiedt C W, Bjorling D E (2007) Accidental prehension and suspected transmucosal or oral absorption of fentanyl from a transdermal patch in a dog. Vet Anaesth Analg 34 (1), 70-73 PubMed.
• Wilson D, Pettifer G R, Hosgood G (2006) Effect of transdermally administered fentanyl on minimum alveolar concentration of isoflurane in normothermic and hypothermic dogs. J Am Vet Med Assoc 228 (7), 1042-1046 PubMed.
• Lafuente M P, Franch J, Durall I et al (2005) Comparison between meloxicam and transdermally administered fentanyl for treatment of postoperative pain in dogs undergoing osteotomy of the tibia and fibula and placement of a uniplanar external distraction device. J Am Vet Med Assoc 227 (11), 1768-1774 PubMed.
• Pettifer G R, Hosgood G (2004) The effect of inhalant anesthetic and body temperature on peri-anesthetic serum concentrations of transdermally administered fentanyl in dogs. Vet Anaesth Analg 31 (2), 109-120 PubMed.
• Gilbert D B, Motzel S L, Das S R (2003) Postoperative pain management using fentanyl patches in dogs. Contemp Top Lab Anim Sci 42 (4), 21-26 PubMed.
• Robinson T M, Kruse-Elliot K T, Markel M D et al (1999) A comparison of transdermal fentanyl versus epidural morphine for analgesia in dogs undergoing major orthopedic surgery. J Am Hosp Assoc 35 (2), 95-100 PubMed.
• Egger C M, Duke T, Archer J et al (1998) Comparison of plasma fentanyl concentrations by using three transdermal fentanyl patch sizes in dogs. Vet Surg 27 (2), 159-166 PubMed.
• Kyles A E, Hardie E M, Hansen B D et al (1998) Comparison of transdermal fentanyl and intramuscular oxymorphone on post-operative behavior after ovariohysterectomy in dogs. Res Vet Sci 65 (3), 245-251 PubMed.
• Kyles A E, Papich M, Hardie E M (1996) Disposition of transdermally administered fentanyl in dogs. Am J Vet Res 57 (5), 715-719 PubMed.

Other sources of information

• Janssen Pharmaceutica Products, website: http://www.duragesic.com/prescribing-information.html.