How to Use Fentanyl Patches

Fentanyl (also called Duragesic®) is a medicine called an opioid or a narcotic. It is used to reduce pain. The fentanyl patch is a way of giving your child this pain medicine. When the patch is put on your child's skin, a small amount of the fentanyl is absorbed continuously through the skin.

The reason to give medicine through a patch is that your child will get the medicine continuously without having to swallow it or have an intravenous (IV) line.

Fentanyl patches are made with different dosages. Be sure you know the dose your child is prescribed.

You will need to change the patch every 72 hours (3 days). After 72 hours the patch stops giving enough of the fentanyl through the skin to relieve your child’s pain.

Some effects of the patch will continue for 18 hours after it is removed because the medicine has already been absorbed into the skin.

Remove the old patch

1. Remove the old patch and try not to touch the gel.
2. Fold the patch in half so the sticky side sticks to itself. Dispose of the patch right away. Follow the instructions given by your pharmacist.
3. Wash hands thoroughly after handling the patch.
4. Inspect the skin where the old patch was attached. Any redness in this area should go away within 1 to 2 days after removing the patch. If this redness does not go away in that period of time, report it to your child’s doctor as soon as possible.

Put on the new patch

1. Each fentanyl patch is sealed in its own protective pouch. Do not remove it from the pouch until you are ready to apply it.
2. Choose the area of skin where you will place the patch.
   • You do not need to put the patch over the area of pain.
   • The best site for the patch is where your child will not have a lot of movement, such as the upper back or chest. Only put the patch on an area of normal skin. Do not put the patch on skin that is red, swollen, or sore, or on skin that has been treated with radiation.
   • If the area of skin where you need to place the patch is hairy, you can clip the hair close to the skin with scissors. Do not shave the hair.
3. Put the patch on clean, dry skin. If you need to clean the skin before you put on the new patch, use only water. Soaps or lotions may irritate the skin under the patch. Let the skin dry completely before putting on the patch.
4. When you are ready to put on the new patch, tear open the pouch at the small notch found on the edge. A paper liner protects the part of the patch that will stick to the skin.
5. Pull off the liner by holding it at the tab that sticks out from the patch. Try not to touch the sticky edges or the gel on the patch.
6. Place the patch on the skin, gel side down.
7. Press the patch firmly in place with the palm of your hand for 10 to 20 seconds, making sure that there are no gaps in the edges.
8. Throw the liner away in the trash.
9. Write the date and time on a small piece of white tape. Put the tape on the new patch. This will help you remember when to change the patch.

Put a new patch on a new area of skin every 72 hours (about 3 days). Change the patch at about the same time of day each time to give your child better pain control.

If a fentanyl patch falls off before the time to change it, replace it with a new patch. Remove it, fold the patch in half so the sticky side sticks to itself and dispose as instructed. If an existing patch is loose, follow the instructions to remove the old patch and replace it with a new one.

If you get some of the gel from the patch on your skin, wash your skin right away with running water. Do not use soap or alcohol to remove the gel, because that may make it easier for your skin to absorb the medicine. If you have any concerns about the medicine getting on your skin, call your doctor, nurse, or pharmacist.

Side effects of a fentanyl patch

All medicines have side effects. Some mild side effects of the fentanyl patch include:

• Feeling drowsy
• Pupils of the eyes may appear smaller than usual
• Dry mouth

More serious side effects include:

• Hallucinations (seeing things that are not there)
• Nausea and vomiting
• Trouble urinating
• Feeling dizzy, especially if standing up or sitting up quickly
• Constipation (ask your doctor about a stool softener)

Contact your doctor if you notice any of the above symptoms.

Fentanyl patch safety

Being exposed to fentanyl by accident can lead to harm or even death. Young children are at greatest risk. Patches must always be stored and used properly to prevent harm.

Follow these guidelines to protect everyone from fentanyl dangers:

• Keep all patches (used and unused) out of the reach of children, and secure.
• If anyone touches the gel from a patch, have them wash their skin right away with running water.
• Never cut a new patch before applying it to the skin. Only apply whole patches to the skin.
• Fevers may increase the absorption of fentanyl. Inform your doctor if your child has a fever to decide if any pain medicine must be changed.
• Do not use a heating pad over the patch area.
• Your child may take a bath or shower while wearing a fentanyl patch. Try to avoid very warm or hot water. Be careful not to rub the skin around the patch so strongly that the patch comes off while washing.
• Talk to the doctor first before letting your child swim.
• Do not allow your child to use a hot tub because this will lead to a large amount of the drug released from the patch into your child’s blood stream. This could cause an overdose and is life-threatening.
• Fentanyl can increase the risk of falls.
• If your child is old enough to drive, fentanyl or the medicines listed above may impair their ability to drive or use heavy machinery. Your child should not do either if they are even slightly sleepy, drowsy, or not feeling alert.

Using the fentanyl patch with other medicines

• For unexpected increases in pain, a short-acting pain medicine such as morphine or oxycodone will be prescribed along with the fentanyl patch.
• Skin absorbs fentanyl slowly, so your child's pain may not be relieved during the first few hours that the first patch is in place. You will need to give your child the other pain medicines prescribed by the doctor during this time.
• Do not give your child any of the following medicines while they are wearing a fentanyl patch unless your child’s doctor says otherwise:
  • Any narcotics (morphine, hydromorphone, meperidine, codeine) other than the short-acting pain medicine prescribed by your child’s doctor.
  • Sedatives (medicines to help your child sleep)
  • Tranquilizers (tension or anxiety medicines)
  • Muscle relaxants
  • Antihistamines (such as Benadryl®)
  • Cold medicines (may contain alcohol)
• When your child no longer needs a fentanyl patch, they will need to be tapered off the dose over a few days using other opioids. This will prevent symptoms of withdrawal. Let your doctor know if these symptoms occur:
  • Stomach cramping
  • Jitters
  • Sweating
  • Diarrhea

Safe storage and disposal

• Keep all medicines out of the reach of children and pets.
• The box of fentanyl patches does not need to be refrigerated. However, do not store the box in hot places such as a car in the summer.
• To dispose of a used patch, fold the patch in half so the sticky side sticks to itself. Dispose of the patch right away as it can be a safety hazard to other people, especially children. Check with your pharmacist on how to dispose of the patch safely.
• When your child no longer needs this medicine, dispose of any patches left over from your child’s prescription as soon as possible. Do not save unused patches. Keep the medication secure and out of the reach of children until properly disposed of. Follow instructions for safe disposal and talk to your pharmacist if you have questions. Many areas have return programs to allow medicines to be brought to the pharmacy or another location rather than discarding them into the garbage.

Find more information on safe storage and disposal of medicines.

Always follow the instructions given by your care team. If you have questions about fentanyl patches, please talk to your child’s doctor, nurse, or pharmacist.