Proper Use of This Medicine

Transdermal fentanyl comes with patient instructions. Read them carefully before using the product . If you do not receive any printed instructions with the medicine, check with your pharmacist.

To use:

• Use this medicine exactly as directed by your doctor . It will work only if it has been applied correctly.
• Fentanyl skin patches are packaged in sealed pouches. Do not remove the patch from the sealed pouch until you are ready to apply it .
• When handling the skin patch, be careful not to touch the adhesive (sticky) surface with your hand . The adhesive part of the system contains some fentanyl, which can be absorbed into your body too fast through the skin of your hand. If any of the medicine does get on your hand, rinse the area right away with a lot of clear water. Do not use soap or other cleansers .
• Be careful not to tear the patch or make any holes in it . Damage to a patch may allow fentanyl to pass into your skin too quickly. This can cause an overdose.
• Apply the patch to a dry, flat skin area on your upper arm, chest, or back. Choose a place where the skin is not very oily and is free of scars, cuts, burns, or any other skin irritations. Also, do not apply this medicine to areas that have received radiation (x-ray) treatment .
• The patch will stay in place better if it is applied to an area with little or no hair. If you need to apply the patch to a hairy area, you may first clip the hair with scissors, but do not shave it off .
• If you need to clean the area before applying the medicine, use only plain water. Do not use soaps, other cleansers, lotions, or anything that contains oils or alcohol . Be sure that the skin is completely dry before applying the medicine.
• Remove the liner covering the sticky side of the skin patch. Then press the patch firmly in place, using the palm of your hand, for a minimum of 30 seconds. Make sure that the entire adhesive surface is attached to your skin, especially around the edges.
• If the patch becomes loose, tape the edges with first aid tape.
• If the patch falls off after applying it, throw it away and apply a new patch in a different area.
• If you need to apply more than 1 patch at a time, place the patches far enough apart so that the edges do not touch or overlap each other .
• Wash your hands with a lot of clear water after applying the medicine. Do not use soap or other cleansers.
• Remove the patch after 72 hours (3 days), or as directed by your doctor. Choose a different place on your skin to apply the next patch . If possible, use a place on the other side of your body. Wait at least 3 days before using the first area again .

After a patch is applied, the fentanyl it contains passes into the skin a little at a time. A certain amount of the medicine must build up in the skin before it is absorbed into the body. Therefore, up to a day may pass before the first dose begins to work. Your health care professional may need to change the dose during the first several applications (each kept in place for 3 days) before finding the amount that works best for you. Even if you feel that the medicine is not working, do not increase the amount of transdermal fentanyl that you apply . Instead, check with your health care professional.

You will probably need to take a faster-acting narcotic to relieve pain during the first few days of transdermal fentanyl treatment. You may continue to need another narcotic while your dose of fentanyl is being adjusted, and also to relieve any "breakthrough" pain that occurs later on. Be sure that you do not take more of the other narcotic, and do not take it more often, than directed. Taking other narcotics together with fentanyl can increase the chance of an overdose .

Dosing—The dose of transdermal fentanyl will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

• For transdermal dosage form (stick-on patch):
  • For relief of severe, continuing pain:
    • Adults—If you have not already been using other narcotics regularly, your first dose will probably be one patch that releases 25 micrograms (mcg) of fentanyl every hour. If you have already been using other narcotics regularly, your first dose will depend on the amount of other narcotic you have been taking every day. If necessary, your health care professional will change the dose after 3 days, when the first patch is replaced. The size of the new dose will depend on how well the medicine is working and on whether you had any side effects during the first 3-day application. Other changes in dose may be needed later on. Some people may need to use more than one patch at a time.
    • Children—Use and dose must be determined by the doctor.

Missed dose—If you miss a dose of this medicine, apply it as soon as possible. Remove the new patch 3 days after applying it.

Storage—To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not keep outdated medicine or medicine no longer needed. To dispose of this medicine, first fold the patch in half, with the sticky side inside. If the patch has not been used, take it out of the pouch and remove the liner that covers the sticky side of the patch before folding it in half. Then flush it down the toilet right away.