Unusual case of transdermal fentanyl in cachexia

Lam, Deborah; Kay, Samantha; Pickard, Jennie; Harrison, Sophie

doi:10.1136/bmjspcare-2018-001652

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“…A case report described TFP use for pressure ulcer-related severe pain by a female patient with anorexia nervosa, body weight <32 kg and cachexia 5. She was unresponsive with respiratory suppression 1 day after application of ten TFP 100 µg/hour.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transdermal fentanyl to parenteral morphine route switch and drug rotation in refractory cancer cachexia

Alsirafy¹,

Alabdullateef

Elyamany³

et al. 2019

BMJ Support Palliat Care

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It is recommended not to use transdermal fentanyl (Fe) patches (TFP) in cancer cachexia but TFP may be the only available option for pain. Limited evidence suggests lower Fe absorption from TFP in cachexia. We describe a case of metastatic breast cancer with refractory cachexia. Her pain was uncontrolled on TFP and was route switched and drug rotated to intravenous morphine (M). We were conservative and did not use the 1:100 TFP to oral M conversion ratio. Assuming opioid needs were similar before and after switch/rotation, the suitable conversion ratio in this case was about 1:25. Absent clear guidelines on converting from TFP in cachexia, it is better to avoid TFP. When essential to use TFP in cachexia, caution should be taken when switching from TFP to avoid overdose.

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Section: Discussionmentioning

confidence: 99%

“…This did not result in opioid withdrawal. The authors questioned the Fe absorbability from TFP in cachexia 5…”

Section: Discussionmentioning

confidence: 99%