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:
- Fentanyl patches get into systemic circulation and are meant to do so. You do NOT place the patch at the site of the pain!
- 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.
- 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.
- Clonidine – change weekly
- Fentanyl – change every 3 days (rare cases may require 2 days)
- Lidoderm – daily with 12 hours on/12 hours off
- Oxybutynin – twice weekly
- Exelon – daily
- Lidoderm patches are intended to benefit the patient locally. Lidoderm (lidocaine) patches you SHOULD place at the site of pain.
- Of the 5 patches listed above, they all get into systemic circulation to exert their activity (except Lidoderm).
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