Inappropriate use of Fentanyl Patches

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!

Written By Eric Christianson

May 25, 2014

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