Palliative Care: Fentanyl Patches

What is a Fentanyl patch?

Fentanyl is a strong painkiller and a type of opioid used to control pain that has not been controlled by weaker pain medicines. A Fentanyl patch is a sticky patch containing fentanyl, and when applied to your body gradually passes through your skin into your bloodstream. Once in your bloodstream, Fentanyl acts within your body to relieve pain.

There are many myths about strong painkillers. These can often cause fears and worries and may lead to pain not being well controlled. It can help to know some of the facts about these medicines. Our leaflet does not replace conversations with your doctor, nurse or pharmacist but reading it may help you decide what questions you want to ask.

Why have I been prescribed Fentanyl patch?

Fentanyl is most useful in patients with “stable” pain that does not require many changes in medication doses. It is also prescribed for patients who have difficulty swallowing tablets, cannot tolerate other strong painkillers well (such as morphine or oxycodone) or for those whose kidneys are not working well. 

How is Fentanyl taken?

Fentanyl patches come in a variety of strengths 12,25,50,75 and 100 microgram/hour. Individual dose is adjusted to your needs. You may need to wear more than one patch to make up the correct dose for you. It is not advisable to cut patches. Each patch remains in place for 3 days, always check the name and the dose on your medicine packet prior to application. 

There are different brands of Fentanyl patch available, e.g. Matrifen, Durogesic. Where possible you will be given the same brand each time. If you notice that your patches are different from those you are used to using, ask your doctor, nurse or pharmacist for advice.

What should I do if I still get pain whilst I have a Fentanyl patch on?

Fentanyl patches provide a continuous dose of fentanyl. However you may develop pain despite this, which may be referred to as “breakthrough pain”. In addition to the Fentanyl patch you will often be given quick or short acting medicine in a tablet or a liquid (such as morphine or oxycodone) for you to take that works quickly for pain and then wears off again. 

These medicines start to work in about 20-30 minutes and last approximately 4 hours.  Again there are different strengths which are adjusted depending on your individual needs.

Reasons why you might get pain 

When you first use Fentanyl patches, or if your dose is increased, it can take a day or more for you to feel maximum benefit. You may experience pain while doing a particular activity despite the patch e.g. washing or walking. If you know an activity is likely to cause you pain, you can take a dose of your quick or short acting pain relief medicine before you do the activity. Sometimes you may experience pain without an obvious cause.

How do I use a Fentanyl patch? 

Apply to dry non inflamed, non-irritated, clean, hairless skin to upper trunk or arm, avoiding areas with large scars. The patch should be pressed firmly in place for at least 30 seconds, wash your hands to remove any residue.  Where more than one patch is required, they may be applied to the same area of the body, as long as the edges do not touch.

Change your patch every 72 hours at roughly the same time of day e.g. if a patch is applied to the skin on Monday at 10am it should be replaced with a new patch on Thursday at 10am. All patches should be changed at the same time. Change the area where you stick the patch so that one area is not used twice in a row.

The following diagram may be helpful to remind you when you next need to change your patch. Mark the day on the diagram when you first put your patches on. Follow the arrow to the next day shown. This is the day when you should change your patch. Keep following the chart in a clockwise direction.

You might like to use this table to write the current brand and strength of patch:

What side effects should I look out for?

Constipation

These medicines can cause constipation in most people, although this is less that other strong painkillers. Eating more fruit, vegetables, brown bread, bran based cereals and drinking more fluid may help but most people will still need a regular laxative.

Feeling sick or vomiting

This can happen when you first take these medicines but it usually only lasts for a few days. Your doctor can give you something to stop this symptom.

Drowsiness

If you become unusually sleepy after starting on  Fentanyl patches, or after the dose has been changed, contact your GP/Palliative care nurse/district Nurse.

Skin rashes/irritation

Some people have an allergic reaction to the adhesive on the patch, please contact your healthcare professional who prescribed your patch.

If there is an increase in any of the above side effects contact your GP, Palliative care nurse/or District nurse.

External heat sources and/or increase in body temperature

Take care to avoid additional heat sources, e.g. hot water bottle, heated pad/blanket, tanning lamp, sauna, and hot tubs.  Heat can increase the rate of medication being released from the patch, which means you may get a higher dose than needed, which can be dangerous.

Storage, removal and disposal

Your Fentanyl patch needs to be kept in a safe place out of reach of children, vulnerable adults and pets.  Do not call the patches “stickers”, as this may be appealing to children.

Used patches should be disposed of firstly by folding them in half to stick firmly together. Unless instructed otherwise they can then be carefully placed in the household rubbish again being careful to keep out of reach of children, vulnerable adults and pets. Wash your hands after handling to remove any residue from the patch. Return any unused patches to the pharmacy for disposal. 

Frequently asked questions

What do I do if I forget to change my patch?

Put a new patch on as soon as you can. If there has been a long delay you may need to take extra doses of your quick or short acting pain medication, whilst waiting for the level of Fentanyl in your body to increase. 

What can I do if my patch falls off frequently?

It is advised to check your patch regularly to ensure it remains firmly attached. If the patch does not stick securely try clipping hairy skin (do not shave) and avoid using soaps, oils, creams or ointments. If problems persist contact your GP/District Nurse for advice.

Can I go for a swim or take a shower?

Yes. Patches are waterproof, however, having a hot bath wearing a patch is not recommended.

Can I take my medication abroad on holiday? 

Please consult your GP as you may require a letter. If you have any queries, please do not hesitate to contact your doctor, nurse or pharmacist.

Do Fentanyl patches work for all pain?

No. Not all pain is helped by Fentanyl patches, your health professional will discuss this with you. It may be necessary to take other painkillers at the same time that work in a different way e.g. paracetamol. 

Will I need a bigger and bigger dose to control the pain?

Not necessarily. However, many people do need to increase the dose from time to time particularly at the beginning of treatment in order to work out the right level of painkiller for you.

The dose is individually worked out according to your needs. This is often by increasing the dose gradually to match your pain.

Will I become addicted?

No. Fentanyl patches used for pain in palliative care will not make you become an addict. If another treatment can relieve the pain we may reduce the dose but this should be done in a controlled way. You should not stop without discussion with your doctor or nurse.

What if these drugs work for the pain but have a lot of side effects? 

Some of the side effects can be managed, however there are a number of other medications available. Your health professional may suggest changing to an alternative.

Can I drink alcohol?

Yes although be cautious and stick to small amounts of alcohol. Ideally wait until you are established on a stable oral opioid dose.

What about driving?

Please see separate leaflet on driving which has more information.

Remember – ultimately the risk lies with you. It is an offence to drive whilst your ability is impaired, if in doubt, you should not drive. It is suggested that you carry a copy of your prescription or a used medicine packet when driving. For more information go to https://www.gov.uk/drug-driving-law

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For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302