Fentanyl (Transdermal-Systemic)

Brand Names : Duragesic

Before Using This Medicine

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your health care professional will make. For fentanyl, the following should be considered:

Allergies - Tell your health care professional if you have ever had any unusual or allergic reaction to fentanyl, alfentanil (e.g., Alfenta), or sufentanil (e.g., Sufenta). Also tell your health care professional if you are allergic to any other substances, including the adhesives that keep stick-on bandages in place.

Pregnancy - Although studies on birth defects with fentanyl have not been done in pregnant women, it has not been reported to cause birth defects. However, using any narcotic regularly during pregnancy may cause physical dependence in the fetus. This may lead to withdrawal side effects after birth. Also, use of this medicine near the end of pregnancy may cause drowsiness and breathing problems in newborn babies.

Breast-feeding - Fentanyl passes into the breast milk. Nursing babies whose mothers are using this medicine regularly may receive enough of it to cause unwanted effects such as drowsiness, breathing problems, and physical dependence. Similar effects may also occur with some other narcotics if they are taken regularly in large amounts. A mother who wishes to breast-feed and who needs treatment for continuing pain should discuss the risks and benefits of different pain treatments with her health care professional.

Children - Studies with the fentanyl skin patch have been done only in adult patients, and there is no specific information comparing the use of this medicine in children with use in other age groups.

Adolescents - Studies with the fentanyl skin patch have been done only in patients 18 years of age and older. There is no specific information comparing the use of this medicine in teenagers with use in other age groups.

Older adults - Elderly people are especially sensitive to the effects of narcotic analgesics. This may increase the chance of side effects, especially breathing problems, during treatment. Your health care professional will take this into consideration when deciding on the amount of transdermal fentanyl you should receive.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your health care professional may want to change the dose, or other precautions may be necessary. When you are using fentanyl, it is especially important that your health care professional know if you are taking any of the following:

• Buprenorphine (e.g., Buprenex) or
• Dezocine (e.g., Dalgan) or
• Nalbuphine (e.g., Nubain) or
• Pentazocine (e.g., Talwin) - Like all narcotic analgesics, these medicines may add to the effects of fentanyl, which may increase the chance of side effects or overdose. However, buprenorphine, dezocine, nalbuphine, and pentazocine sometimes decrease the effects of fentanyl, so that fentanyl might be less effective in relieving pain. Also, these medicines can cause withdrawal side effects if they are given to someone who is physically dependent on fentanyl

• CYP3A4 (an isoenzyme that breaks down fentanyl in the body) inducers such as:
  • Carbamazepine (e.g., Tegretol) or
  • Phenytoin (e.g., Dilantin) or
  • Rifampin (e.g., Rifadin) - Giving these medicines with fentanyl will decrease the pain-relieving effects of fentanyl.

• CYP3A4 inhibitors such as:
  • Azole antifungal agents (e.g., ketoconazole (Nizoral)) or
  • Macrolide antibiotics (e.g., erythromycin or
  • Protease inhibitors (ritonavir (Norvir)) - Giving these medicines with fentanyl may cause too much fentanyl in your blood.

• Central nervous system (CNS) depressants (medicines that cause drowsiness), including other narcotics, or
• Tricyclic antidepressants - These medicines may add to the effects of fentanyl. This may increase the chance of serious side effects

• Naltrexone (e.g., Trexan) - Fentanyl will not be effective in people taking naltrexone

Other medical problems - The presence of other medical problems may affect the use of fentanyl. Make sure you tell your health care professional if you have any other medical problems, especially:

• Alcohol abuse, or history of, or
• Drug dependence, especially narcotic abuse or dependence, or history of, or
• Emotional problems or
• Kidney disease or
• Liver disease or
• Underactive thyroid - The chance of side effects may be increased

• Brain tumor or
• Diarrhea caused by antibiotic treatment or poisoning or
• Emphysema, asthma, or other chronic lung disease or
• Enlarged prostate or problems with urination or
• Gallbladder disease or gallstones or
• Intestinal problems such as colitis or Crohn's disease - Some of the side effects of fentanyl can cause serious problems in people who have these medical problems

• Slow heartbeat - Fentanyl can make this condition worse