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5 Medication Mistakes – Medication Patches

In geriatrics, I see a lot of patches being used.  There is definitely some convenience associated with the use of patches as we can avoid the GI tract.  I have seen my fair share of mistakes as well.  Here’s a breakdown:

  1. Fentanyl patches get into systemic circulation and are meant to do so.  You do NOT place the patch at the site of the pain!
  2. I’ve seen a few cases of providers and patients not understanding that Lidoderm patches should be removed for a period of time (recommended dosing is 12 hours on/12 hours off).  The risk of leaving the patches on for 24 hours is accumulation of lidocaine in the systemic circulation.
  3. Patches are advantageous in the fact that you may not have to change them very often.  However, you need to know the recommended timing of patch change!  Here’s 5 common medications with patch formulations that I see in my practice.
    1. Clonidine – change weekly
    2. Fentanyl – change every 3 days (rare cases may require 2 days)
    3. Lidoderm – daily with 12 hours on/12 hours off
    4. Oxybutynin – twice weekly
    5. Exelon – daily
  4. Lidoderm patches are intended to benefit the patient locally.  Lidoderm (lidocaine) patches you SHOULD place at the site of pain.
  5. Of the 5 patches listed above, they all get into systemic circulation to exert their activity (except Lidoderm).

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Written By Eric Christianson

December 6, 2015

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