Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

Abstract

Opioids continue to be first-line pharmacotherapy for patients suffering from cancer pain. Unfortunately, subtherapeutic dosage prescribing of pain medications remains common, and many cancer patients continue to suffer and experience diminished quality of life. A large variety of therapeutic options are available for cancer pain patients. Analgesic pharmacotherapy is based on the patient’s self-report of pain intensity and should be tailored to meet the requirements of each individual. Most, if not all, cancer pain patients will ultimately require modifications in their opioid pharmacotherapy. When changes in a patient’s medication regimen are needed, adequate pain control is best maintained through appropriate dosage conversion, scheduling immediate release medication for withdrawal prevention, and providing as needed dosing for breakthrough pain. Transdermal opioids are noninvasive, cause less constipation and sedation when compared to oral opioids, and may improve patient compliance. A relative potency of 100:1 is recommended when converting the patient from oral morphine to transdermal fentanyl. Based on the limited data available, there is significant interpatient variability with transdermal buprenorphine and equipotency recommendations from oral morphine of 75:1–110:1 have been suggested. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75–100:1 potency ratio. This review outlines the prescribing of transdermal fentanyl and transdermal buprenorphine including how to safely and effectively convert to and use them for those with cancer pain.

Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

“…1,2001, to Mar. 31, 2013, we identified 267 958 prescriptions for transdermal fentanyl patches dispensed to 17 102 distinct pa-tients.…”

“…1 Although available in a variety of forms, the most common form for outpatient use in Canada is the transdermal patch, which provides 3-day continuous delivery of the drug. Fentanyl was initially available in 25-, 50-, 75-and 100-μg/h patches.…”

Transdermal buprenorphine and fentanyl patches in cancer pain: a network systematic review

“… 11 , 18 , 19 , 23 While oral opioids are generally the first choice, 1 , 26 TD medications are recommended by guidelines for ongoing care of patients with cancer pain 1 and are preferred by many patients because they are noninvasive, easy to use, and their interference with daily activities is minimal. 18 , 24 , 27 TD buprenorphine and TD fentanyl are usually the treatment of choice for patients who are unable to swallow, patients with poor tolerance to morphine, and patients with poor compliance. 1 , 7 , 9 , 11 , 18 , 26 , 27 …”

Noninterventional Study of Transdermal Fentanyl (Fentavera) Matrix Patches in Chronic Pain Patients: Analgesic and Quality of Life Effects

“…In prolonged opioid treatment, maintaining analgesia with minimal adverse effects requires minimal variation in opioid plasma levels. In this regard, slow transdermal opioid delivery from transdermal patches allows more effective analgesia and fewer adverse events than with oral or parenteral opioids, with lower rates of constipation, nausea, and sedation [ 17 ]. A meta-analysis of data derived from 8 prospective clinical studies, published between 1996 and 2004, and including 1,220 patients with cancer ( n = 657) or noncancer pain ( n = 563) showed that both fentanyl and morphine are effective by transdermal application [ 18 ], with improved pain scores after 28 days of treatment.…”