Fentanyl, Transdermal

What are other names for this medicine?

Type of medicine: narcotic analgesic (painkiller)

Generic and brand names: fentanyl transdermal system; Duragesic

What is this medicine used for?

This medicine is a patch that is put on skin to relieve chronic pain in people who have taken narcotic painkillers before. The patch allows the medicine to be absorbed slowly and constantly through the skin.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a head injury or brain tumor
• breathing problems or a lung disease such as asthma or COPD
• diabetes
• heart disease or heart rhythm problems
• kidney or liver disease
• intestinal disease or severe diarrhea or constipation
• mental problems such as depression or hallucinations (seeing or hearing things that are not there)
• pancreatitis or biliary tract disease
• problems with drug or alcohol abuse
• seizures
• thyroid problems

Tell your provider if you have taken narcotic pain medicines before. This medicine is to be used only by those who have taken narcotic painkillers before.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant while using this medicine. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while using this medicine without your healthcare provider's approval.

How do I use it?

These patches come in several different strengths. Your healthcare provider will work with you to find the correct strength for you. Check the label on the medicine for directions about your specific dose. You may need to apply more than one patch at a time. Follow your healthcare provider's instructions exactly. Do not use more patches or use them longer than directed by your healthcare provider because this medicine may be habit-forming. Also, read the information sheet that comes with the product. When you first apply the patch, you may need to take other pain medicine, especially in the first 24 hours.

Do not use a patch if the seal is broken, or if it is cut or damaged in any way.

Wash your hands before using this medicine. Clip away hair (do not shave) before applying the patch. Use only water (no soap, oil, or alcohol) to clean the area where you put the patch. Allow the skin to dry completely before putting on the patch. Put the sticky side of the patch containing the medicine on a flat surface of the upper body.

Do not put the patch on skin that is broken or irritated. You may bathe, swim, or shower while wearing the patch, However, do not use a heating pad, electric blanket, heat lamp, hot tub, or other direct heat where you apply the patch. These may increase the amount of medicine released from the patch and could result in an overdose.

To dispose of a used patch, fold it so that it sticks to itself with the medicine inside. Then dispose of it safely away from children and pets.

If you forget to change the patch, change it as soon as you remember. Do not apply extra patches to make up for a missed dose. If the patch falls off, put a new patch on clean, dry skin. If you are not sure of what to do, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: trouble breathing or shallow breathing, tiredness, extreme drowsiness, lightheadedness, dizziness, confusion, trouble thinking, trouble talking or walking.

What should I watch out for?

This drug is only for people who have taken narcotic painkillers before. It is a controlled substance. It is illegal for you to give it to anyone else. Only healthcare providers experienced with this drug should prescribe it.

This is a very strong medicine used only to control cancer pain. This medicine may be habit-forming. Take it exactly as directed by your healthcare provider. Do not take more of it or take it more often than directed. Taking too much of this medicine will increase the chances of side effects. Contact your healthcare provider if your pain does not improve in a few days or if it gets worse.

This medicine may cause serious or life-threatening breathing problems, especially during the first few days. If you have any trouble breathing, contact your healthcare provider right away. If you are unable to reach your provider right away, get emergency medical care or call 911 for help.

This medicine is very strong and may be fatal to children. Be very careful to keep patches out of reach of children.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

Do not stop taking this medicine without your healthcare provider's approval. You may have to reduce your dosage gradually.

If you develop a fever or skin irritation while wearing this patch, contact your healthcare provider right away.

Do not use this medicine for any other condition unless it is approved by your healthcare provider.

This medicine may cause dizziness or blurred vision. Do not drive or operate machinery unless you are alert and can see clearly.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicine unless your healthcare provider approves.

This medicine may make you constipated. You may need to take a laxative or stool softener while taking this medicine. Talk with healthcare provider or pharmacist about this.

Your mouth may get dry. Drinking plenty of water, chewing sugarless gum, or sucking on hard sugarless candy may help to relieve dry mouth symptoms.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Fast or slow heartbeat; cold, clammy skin; blue lips, fingernails, or skin; slow or trouble breathing; hallucinations (seeing or hearing things that are not there); seizures; feeling faint; pinpoint pupils of the eyes; severe confusion, drowsiness, nervousness, restlessness, or weakness.

Other: Drowsiness, dizziness, blurred vision, nausea, vomiting, constipation, sweating, throat spasms, inability to urinate, stomach pain, headache, dry mouth, loss of appetite, gas, skin irritation where you put the patch.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antianxiety medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), triazolam (Halcion), temazepam (Restoril), flurazepam (Dalmane), and oxazepam
• antiseizure medicines such as phenytoin (Dilantin), carbamazepine (Tegretol), primidone (Mysoline), fosphenytoin (Cerebyx), ethotoin (Peganone), gabapentin (Neurontin), felbamate (Felbatol), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), oxcarbazepine (Trileptal), tiagabine (Gabitril), and valproic acid (Depakote, Depakene, Depacon)
• antifungals such as fluconazole (Diflucan), itraconazole (Diflucan), and ketoconazole (Nizoral)
• antihistamines or medicine for hay fever, allergies, or colds such as diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), brompheniramine (Dimetane), and hydroxyzine (Atarax, Vistaril)
• antinausea medicines such as aprepitant (Emend), prochlorperazine (Compazine), and promethazine (Phenergan)
• antipsychotic medicines such as chlorpromazine (Thorazine), fluphenazine (Prolixin), perphenazine, thioridazine, haloperidol (Haldol), clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), and trifluoperazine (Stelazine)
• barbiturates such as phenobarbital, butabarbital (Butisol), and pentobarbital (Nembutal)
• heart medicines such as amiodarone (Cordarone; Pacerone), diltiazem (Cardizem, Dilacor, Tiamate, Tiazac), quinidine (quinidine sulfate, quinidine gluconate), and verapamil (Calan, Covera, Isoptin)
• herbs with sedative effects such as kava, gotu kola, valerian, and St. John's wort
• macrolide antibiotics such as clarithromycin (Biaxin), azithromycin (Zithromax), and erythromycin (Ery-Tabs, E.E.S., E-Mycin)
• MAO inhibitors such as phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl), and tranylcypromine (Parnate) (Do not take an MAO inhibitor and this medicine within 14 days of each other.)
• medicines that block or may partially block the effect of other narcotics such as naltrexone (ReVia), buprenorphine (Buprenex, Subutex), butorphanol (Stadol), nalbuphine (Nubain), and pentazocine (Talwin)
• muscle relaxants such as cyclobenzaprine (Flexeril), baclofen (Lioresal), carisoprodol (Soma), tizanidine (Zanaflex), methocarbamol (Robaxin), and dantrium sodium (Dantrium)
• other pain medicines such as codeine, hydrocodone (Vicodin, Lortab), oxycodone (Percocet, Tylox, OxyContin), morphine (MS Contin, Oramorph SR, Kadian, MSIR), propoxyphene (Darvocet N-100), pentazocine (Talwin) methadone (Dolophine), hydromorphone (Dilaudid), fentanyl oral (Actiq, Fentora), and meperidine (Demerol)
• anti-HIV medicines such as ritonavir (Norvir), saquinavir (Invirase), nelfinavir (Viracept), amprenavir (Agenerase), fosamprenavir (Lexiva), and indinavir (Crixivan)
• rifampin (Rifadin)
• sibutramine (Meridia)
• sleeping pills such as zolpidem (Ambien), zaleplon (Sonata), and chloral hydrate
• SSRI antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), nefazodone, venlafaxine (Effexor), and fluvoxamine
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), desipramine (Norpramin), and doxepin (Sinequan)

Do not drink alcohol while taking this medicine.

The effects of this medicine may be increased if you take it with grapefruit or grapefruit juice. Talk with your healthcare provider about this.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store patches at room temperature in a closed container. Protect them from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.