Transdermal System

Analgesia. Adults, usual initial: 25 mcg/hr unless the client is tolerant to opioids (Duragesic-50, -75, and -100 are intended for use only in clients tolerant to opioids). Initial dose should be based on (1) the daily dose, potency, and characteristics (i.e., pure agonist, mixed agonist/antagonist) of the drug the client has been taking; (2) the reliability of the relative potency estimates used to calculate the dose as estimates vary depending on the route of administration; (3) the degree, if any, of tolerance to narcotics; and (4) the general condition and status of the client.

To convert clients from PO or pa-renteral opioids to the transdermal system, the following method should be used: (1) the previous 24hr analgesic requirement should be calculated; (2) convert this amount to the equianalgesic PO morphine dose; (3) find the calculated 24-hr morphine dose and the corresponding transdermal fentanyl dose using the table provided with the product; and (4) initiate treatment using the recommended fentanyl dose. The dose may be increased no more frequently than 3 days after the initial dose or q 6 days thereafter. The ratio of 90 mg/24 hr of PO morphine to 25 mcg/hr increase in transdermal fenta-nyl dose should be used to base appropriate dosage increments on the daily dose of supplementary opi-oids.

If the dose of the fentanyl transdermal system exceeds 300 mcg/hr, it may be necessary to change clients to another narcotic analgesic. In such cases, the transdermal system should be removed and treatment initiated with one-half the equianalgesic dose of the new opioid 12-18 hr later. The dose of the new analgesic should be titrated based on the level of pain reported by the client.

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