76 year old male had recently had a hip fracture with surgery and was in a substantial amount of pain. Upon discharge from the hospital, he was admitted to a long term care facility for rehab. Acute pain management was the highest on the priority list and the provider started Fentanyl patch 25 mcg as needed every three days. You could imagine my surprise when I saw this order 🙂 – So what’s wrong with a fentanyl patch as needed? Two major points: 1. Fentanyl patches are not meant for acute pain to begin with, they are meant for chronic pain. 2. Even more importantly, here’s a prime example why knowing and learning pharmacokinetics matters. The onset of a Fentanyl patch takes at least about 6 hours (per Lexicomp) to start having an effect which flies in the face of the premise of an as needed medication. As needed medications are meant to help treat a condition quickly. Would you want your patient in pain for at least 6 hours(probably much longer) before they started feeling any relief at all? The patient did request to use it as it was meant for their pain control, did not get any pain relief and the patch was discontinued. Substantial waste of money and time as well as not helping the patient!
Inappropriate use of Fentanyl Patches

6 Comments
Submit a Comment Cancel reply
This site uses Akismet to reduce spam. Learn how your comment data is processed.
Written By Eric Christianson
May 25, 2014
Looking for something?
Free PDF – Top 30 Medication Mistakes
Enjoy the blog? Over 6,000 healthcare professionals follow the blog, why aren't you? Subscribe now and get a free gift as well!
Recent Posts
Categories
Free PDF – Top 30 Medication Mistakes
Enjoy the blog? Over 6,000 healthcare professionals follow the blog, why aren't you? Subscribe now and get a free gift as well!
Buy on Amazon
Recent Posts
Archives
- January 2023
- December 2022
- November 2022
- October 2022
- September 2022
- August 2022
- July 2022
- June 2022
- May 2022
- April 2022
- March 2022
- February 2022
- January 2022
- December 2021
- November 2021
- October 2021
- September 2021
- August 2021
- July 2021
- June 2021
- May 2021
- April 2021
- March 2021
- February 2021
- January 2021
- December 2020
- November 2020
- October 2020
- September 2020
- August 2020
- July 2020
- June 2020
- May 2020
- April 2020
- March 2020
- February 2020
- January 2020
- December 2019
- November 2019
- October 2019
- September 2019
- August 2019
- July 2019
- June 2019
- May 2019
- April 2019
- March 2019
- February 2019
- January 2019
- December 2018
- November 2018
- October 2018
- September 2018
- August 2018
- July 2018
- June 2018
- May 2018
- April 2018
- March 2018
- February 2018
- January 2018
- December 2017
- November 2017
- October 2017
- September 2017
- August 2017
- July 2017
- June 2017
- May 2017
- April 2017
- March 2017
- February 2017
- January 2017
- December 2016
- November 2016
- October 2016
- September 2016
- August 2016
- July 2016
- June 2016
- May 2016
- April 2016
- March 2016
- February 2016
- January 2016
- December 2015
- November 2015
- October 2015
- September 2015
- August 2015
- July 2015
- June 2015
- May 2015
- April 2015
- March 2015
- February 2015
- January 2015
- December 2014
- November 2014
- October 2014
- September 2014
- August 2014
- July 2014
- June 2014
- May 2014
- April 2014
- March 2014
- February 2014
- January 2014
- December 2013
- November 2013
- October 2013
Categories
- BCACP Exam
- BCGP Exam
- BCMTMS Exam
- BCPS Exam
- Cardiovascular Case Studies
- Cardiovascular Medication and Disease State Clinical Pearls
- Career Advice for Pharmacy Students, Residents and New Pharmacists
- Clinical Guideline Updates For Pharmacists
- Clinical Pharmacy News and New Drug Updates
- Dermatology, ENT, Ophthalmology Case Studies
- Dermatology, ENT, Ophthalmology Medication and Disease State Clinical Pearls
- Drug Interaction Case Studies and Education For Pharmacists
- Educational Case Studies For Pharmacists
- Endocrine Case Studies
- Endocrine Medication and Disease State Clinical Pearls
- Free Clinical Practice Quizzes and Videos For Pharmacists
- Gastrointestinal Case Studies
- Gastrointestinal Medication and Disease State Clinical Pearls
- Hematology and Immunology Case Studies
- Hematology and Immunology Medication and Disease State Clinical Pearls
- Infectious Disease and Oncology Case Studies
- Infectious Disease and Oncology Medication and Disease State Clinical Pearls
- Long Term Care Consultant Pharmacist Education and Information
- Medication and Disease State Clinical Pearls For Pharmacists
- Medication Errors
- MPJE
- NAPLEX
- Neurology, Pain, and Musculoskeletal Case Studies
- Neurology, Pain, and Musculoskeletal Medication and Disease State Clinical Pearls
- Pediatrics Medication and Disease State Clinical Pearls
- Personal Stories From The Front Lines of Clinical Pharmacy
- Pharmacist Board Certification Information And Help
- Pharmacist Legislative Advocacy
- Pharmacogenomics and Pharmacokinetics Case Studies
- Pharmacogenomics and Pharmacokinetics Medication and Disease State Clinical Pearls
- Polypharmacy Cases And The Prescribing Cascade
- Psychiatry and Addiction Medication and Disease State Clinical Pearls
- Psychiatry and Addiction Medicine Case Studies
- Renal, Urology, and Electrolytes Case Studies
- Renal, Urology, and Electrolytes Medication and Disease State Clinical Pearls
- Respiratory Case Studies
- Respiratory Medication and Disease State Clinical Pearls
- Uncategorized
- Women’s and Men’s Health Case Studies
- Women’s and Men’s Health Medication and Disease State Clinical Pearls
- Writing Medication Recommendations For Pharmacists
Short and educating! Please, more! Thank you!!
Were there no short-acting oral opioids on the order? Hard to believe the patient was sent off without having his pain managed adequately! How did the MD come up with the conversion to Fentanyl 25? *puzzled*
Another important lesson in this gentleman’s care is that while not extremely elderly (i.e. age > 85) he is 76 yo and his body is showing signs of aging (he is in the hospital for surgical repair of a hip Fx …true we don’t know if he got this Fx jumping and playing with his grandkids or just getting out of his easy chair).
We must be very careful when giving pain medication to the elderly. We surely want and have to Tx their pain adequately but the elderly respond to opioids much more dramatically and a change in mental status could further c/o his recovery. Fentanyl patch, even though the references say that it takes 6 hrs for onset of pain relief, I am a chronic pain Pt as well as a physician and I got relief on my RSD skin within 20 minutes using the patches Q 48°. I think it varies with the Pt. Max is 6 hrs. As the article so well stated, Fentanyl patches are not for acute pain, only chronic.
Not necessarily 6 hours max onset time. Depends on tour of patch and person -I am a chronic pain patient and pharmacist and use duragesic 75mcg/hr patch and takes a good 8-12 hours for patch to kick in in I’ve mistaken change day or time.
jbb You are correct. I was not intending for the ‘6 hr max’ to apply to anyone but me I have RSD also called CRPS and the ionic flux of my skin may be dramatically different than nl. It was an anecdotal comment. I am so sorry that you too suffer from chronic pain. Have you ever considered a pain pump?
Thats right! Fentanyl not the first option for naive patients, and of course of chronic. Even if used in chronic, its not used as prn, cus of difficulty with dose adjustments, right??