1 What is Duragesic?

Brand: Duragesic, Ionsys

Generic: Fentanyl (Transdermal Route)

Brand name:

Duragesic, Ionsys.

The fentanyl skin patch (transdermal) is used to treat severe pain. It may be used in a hospital or home for severe chronic pain. It is a narcotic drug used as an analgesic for management of pain. It acts on the central nervous system for relieving pain. Duragesic skin patch should never be used for short term management of pain such as during a dental surgery or tonsil surgery. Never use the patch for mild pain or pain that occurs only once in a while. When a narcotic is used for a loner time, it may become a habit forming, causing a mental or physical dependence.

However, fear of dependence must not be the basis for not using the drug which is also a narcotic. Mental dependence (addiction) is also not likely to occur when narcotics are used for this purpose. Physical dependence may lead to the withdrawal side effects. When treatment is stopped suddenly, adverse effects may be prevented by gradually reducing the dose. This medicine is available only with the doctor’s prescription.

2 What to Know Before Using

The decision to use this medicine needs to be weighed against the good the medicines can do. This decision is reached by the consultation of both you and your doctor. At this time, inform your doctor if you have any form of allergic reactions to this medicines or any other form of medicines.

In addition, inform your doctor if you have any form of allergies to food, dyes, preservatives or animals and their products. In the case of non prescription drugs, reads the label or package to evaluate the ingredients carefully. This medicine may induce certain side effects in the pediatrics such as muscles spasms of the face, neck, back, tac like or twitching movements, inability to move the eyes, twisting of the body, or weakness of the arms and legs, are more likely to occur.

The children are more sensitive than adults to some of the side effects of Fentanyl. Fentanyl needs to be used with caution when used on children suffering from depression. It has been demonstrated to promote suicidal thinking in children or attempted suicides in clinical trials subjects using Fentanyl. More studies are required to understand the safety and efficacy of fentanyl in children.

On the other hand, geriatric signs of confusion, vision problems, dizziness or fainting, drowsiness, dryness of mouth, constipation, problems in urinating, trembling of the hands and fingers, and symptoms of tardive dyskinesia (such as uncontrolled movements of the mouth, tongue, jaw, arms, and/or legs) are especially likely to occur. It is known that older patients are more sensitive than younger adults to the effects of Fentanyl.

Moreover, findings on the effect Fentanyl on breastfeeding are inadequate and inconclusive; the risk of infants when breast feeding from mothers using this medication has not been established. It is necessary to weigh the potential benefits against the risks before using this medication while breast feeding. Despite the facts that certain medications need not be used together at all. Certain medicines may still be used even with the risk of a possible interaction.

However, the doctors may change or vary the dosages used and take precautions as may be required. First, inform your doctor all the medicines that you are using. Then take note if you are using any of the medicines that are listed below.  The medicines listed are known and selected on the basis of the potential significance and not just on aspects of all-inclusiveness. Use of Fentanyl with any of these medicines is not allowed. 

Your personal doctor may however decide on how to use the medicine or not or change some of the medications you take.  These medications include:

  • Atazanavir
  • Boceprevir
  • Cobicistat
  • Lopinavir
  • Mifepristone
  • Naltrexone
  • Nelfinavir
  • Ritonavir
  • Saquinavir
  • Telaprevir
  • Tipranavir

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone
  • Acepromazine
  • Alefacept
  • Alfentanil
  • Almotriptan
  • Alprazolam
  • Amiodarone
  • Amisulpride
  • Amitriptyline
  • Amlodipine
  • Amobarbital
  • Amoxapine
  • Amprenavir
  • Anileridine
  • Aprepitant
  • Aripiprazole
  • Asenapine
  • Atorvastatin
  • Baclofen
  • Benperidol
  • Bicalutamide
  • Blinatumomab
  • Bromazepam
  • Brompheniramine
  • Buprenorphine
  • Buspirone
  • Butabarbital
  • Butalbital
  • Butorphanol
  • Carbamazepine
  • Carbinoxamine
  • Carisoprodol
  • Carphenazine
  • Ceritinib
  • Chloral Hydrate
  • Chlordiazepoxide
  • Chlorpheniramine
  • Chlorpromazine
  • Chlorzoxazone
  • Cimetidine
  • Ciprofloxacin
  • Citalopram
  • Clarithromycin
  • Clobazam
  • Clonazepam
  • Clorazepate
  • Clorgyline
  • Clozapine
  • Cocaine
  • Codeine
  • Conivaptan
  • Crizotinib
  • Cyclobenzaprine
  • Cyclosporine
  • Dabrafenib
  • Darunavir
  • Delavirdine
  • Desipramine
  • Desogestrel
  • Desvenlafaxine
  • Dexmedetomidine
  • Dextromethorphan
  • Diacetylmorphine
  • Diazepam
  • Dichloralphenazone
  • Dienogest
  • Difenoxin
  • Dihydrocodeine
  • Diltiazem
  • Diphenhydramine
  • Diphenoxylate
  • Dolasetron
  • Donepezil
  • Doxepin
  • Doxylamine
  • Droperidol
  • Drospirenone
  • Duloxetine
  • Eletriptan
  • Enflurane
  • Enzalutamide
  • Erythromycin
  • Escitalopram
  • Estazolam
  • Estradiol
  • Eszopiclone
  • Ethchlorvynol
  • Ethinyl
  • Estradiol
  • Ethopropazine
  • Ethylmorphine
  • Ethynodiol
  • Etonogestrel
  • Flibanserin
  • Fluconazole
  • Flunitrazepam
  • Fluoxetine
  • Fluphenazine
  • Flurazepam
  • Fluspirilene
  • Fluvoxamine
  • Fosamprenavir
  • Fosaprepitant
  • Fosphenytoin
  • Fospropofol
  • Frovatriptan
  • Furazolidone
  • Ginkgo
  • Biloba
  • Goldenseal
  • Golimumab
  • Granisetron
  • Halazepam
  • Haloperidol
  • Halothane
  • Hexobarbital
  • Hydrocodone
  • Hydromorphone
  • Hydroxytryptophan
  • Hydroxyzine
  • Idelalisib
  • Imatinib
  • Imipramine
  • Indinavir
  • Iproniazid
  • Isocarboxazid
  • Isoflurane
  • Isoniazid
  • Itraconazole
  • Ketamine
  • Ketazolam
  • Ketobemidone
  • Ketoconazole
  • Levomilnacipran
  • Levonorgestrel
  • Levorphanol
  • Linezolid
  • Lithium
  • Lomitapide
  • Lorazepam
  • Lorcaserin
  • Lumacaftor
  • Meclizine
  • Melperone
  • Meperidine
  • Mephobarbital
  • Meprobamate
  • Meptazinol
  • Mesoridazine
  • Mestranol
  • Metaxalone
  • Methadone
  • Methdilazine
  • Methocarbamol
  • Methohexital
  • Methotrimeprazine
  • Methylene Blue
  • Miconazole
  • Midazolam
  • Milnacipran
  • Mirtazapine
  • Moclobemide
  • Molindone
  • Moricizine
  • Morphine
  • Morphine Sulfate Liposome
  • Nalbuphine
  • Naratriptan
  • Nefazodone
  • Nialamide
  • Nicardipine
  • Nicomorphine
  • Nifedipine
  • Nilotinib
  • Nitrazepam
  • Nitrous Oxide
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Nortriptyline
  • Olanzapine
  • Opium
  • Opium Alkaloids
  • Orphenadrine
  • Osimertinib
  • Ospemifene
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Palonosetron
  • Papaveretum
  • Paregoric
  • Pargyline
  • Paroxetine
  • Pazopanib
  • Pentazocine
  • Pentobarbital
  • Perazine
  • Periciazine
  • Perphenazine
  • Phenelzine
  • Phenobarbital
  • Phenytoin
  • Pimozide
  • Piperacetazine
  • Piperaquine
  • Pipotiazine
  • Piritramide
  • Posaconazole
  • Prazepam
  • Primidone
  • Procarbazine
  • Prochlorperazine
  • Promazine
  • Promethazine
  • Propofol
  • Propoxyphene
  • Quazepam
  • Quetiapine
  • Ramelteon
  • Ranitidine
  • Ranolazine
  • Rasagiline
  • Regorafenib
  • Remifentanil
  • Remoxipride
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rizatriptan
  • Safinamide
  • Secobarbital
  • Secukinumab
  • Selegiline
  • Sertindole
  • Sertraline
  • Sibutramine
  • Siltuximab
  • Sodium Oxybate
  • St John's Wort
  • Sufentanil
  • Sulpiride
  • Sumatriptan
  • Suvorexant
  • Tapentadol
  • Telithromycin
  • Temazepam
  • Thiethylperazine
  • Thiopental
  • Thiopropazate
  • Thioridazine
  • Ticagrelor
  • Tilidine
  • Tizanidine
  • Tolonium Chloride
  • Toloxatone
  • Topiramate
  • Tramadol
  • Tranylcypromine
  • Trazodone
  • Triazolam
  • Trifluoperazine
  • Trifluperidol
  • Triflupromazine
  • Trimeprazine
  • Troleandomycin
  • Tryptophan
  • Venlafaxine
  • Verapamil
  • Vilazodone
  • Voriconazole
  • Vortioxetine
  • Zaleplon
  • Zileuton
  • Ziprasidone
  • Zolmitriptan
  • Zolpidem
  • Zopiclone
  • Zotepine

When Fentanyl  is used with any of this medicines, it increases the risk of certain side effects but when used at the same time, it can be the best treatment for you.  When the medicine is prescribed together, the doctor may change the dose or how frequent the dose can be used or both medicines. This medicines include:

  • Azithromycin
  • Clotrimazole
  • Dirithromycin
  • Econazole
  • Josamycin
  • Mepartricin
  • Miokamycin
  • Nevirapine
  • Rokitamycin
  • Roxithromycin
  • Spiramycin

It is possible for other forms of interactions to occur. This is possible when they are used at almost the same time as eating or when food is required. On the other hand, using alcohol or tobacco with certain medicines may also cause interactions to occur. The forms of interactions are selected on the basis of their potential significance. In some cases, it may be unavoidable to use these medicines with alcohol or tobacco. However, when used together, the doctor may change the dose or how often the medicine may be used.

In addition, special instructions may also be provided with the use of food or alcohol or tobacco. Medical problems may also be a problem when using these medicines. Inform you doctor when any or other medical problems present. They include alcohol abuse, history of alcohol abuse, brain tumour, breathing problems, hypercapnia, hypoxia) or chronic obstructive pulmonary disease (COPD) or cor-pulmonale which is a serious heart condition or disease of the gall bladder or depression or history of drug dependence including the use of narcotics or illicit drug abuse or dependence, head injury, seizures, history of weakened physical conditions.

This medicine needs to be used with caution. Use of these medicines may also lead to more serious side effects. Allergy to cetylpyridinium chloride, history of or asthma, acute or severe or paralytic ileus (bowel bowels don’t move or blocked bowels) or respiratory depressions as a result of hypoventilation or slow breathing. Fentanyl must not be used in patients with these conditions.

Brady arrhythmia (slow heart rhythm) or Hypotension (low blood pressure) or Pancreatitis (inflammation of the pancreas), acute. The use of some of these drugs may cause the condition of liver and kidney disease to be worse and hence needs to be worse. The effects may be increased because of slower removal of the medicine from the body.

3 Proper Usage

These drug need to be used as instructed by the doctors. Never use more of this medicine or low than it is recommended by the doctor. This drug is also used only for opioid-tolerant patients. A patient is opioid-tolerant if oral narcotics have already been used for severe pain. Also, check with the medical doctor if you have a question that needs to be addressed by your doctor. The medicine also comes with a medication guide and patient instructions. It is advisable to read the instructions carefully. You will also receive Fentanyl skin patch while in hospital.

A nurse or other trained health professional will give you this medicine after surgery. You will be taught how to use this medicine in the hospital, but you will not use it at home. Do not leave the hospital with the patch on your skin. To use the fentanyl patch; follow the instructions provided by your doctor. This will only be able to work correctly when it has been applied as required. This medicine need not be used on the skin that has injuries. Never chew the patch in your mouth or swallow it. They are also packaged in sealed pouches. It must only be removed from the patch when ready to be applied.

Moreover, never touch the adhesive or sticky surface with your hands. The adhesive part of the system contains fentanyl, which is 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. Never use soap or cleansers. Also, never tear the patch or punch holes on it. Damage of the patch enhances the passage of fentanyl to your skin very fast. This may also promote an overdose of the medicine. Only apply the patch on a dry skin area on your upper arm, chest or back. It is preferable to select a skin surface that is not very oily and is free from scars, cuts, burns or irritation.

Similarly, never use this medicine in places that have received radiation therapy. Also, consider placing them on the regions of the body with no or little hair. Hair can however be clipped with scissors and must never be shaved off. Only use clean water in cleaning the places that the medicines need to be used. Never apply soaps, other cleansers, lotions or anything that has oils or alcohols. Ensure that the place is completely dry before applying the medicine.

First, remove the liner that covers the sticky patch on the side of the skin. Then the patch can be pressed at the place firmly using your hand for a minimum of 30 seconds. Ensure that the entire adhesive is attached to your skin and more especially around the edges. When the patch becomes loose, tape the edges with the first aid tape. When the patch falls off, it must be thrown away and a new patch applied in a different location. If one needs to apply more than 1 patch at a time. Wash your hands after the application of the patch. As usual, never use the soap and cleansers. The patch needs to be removed after 3 days or as directed by the medical doctor. Select a different location for the new patch.

When possible, use or place a patch on the other side of the body. Wait for a minimum of three days before applying the next patch to the same area again. When used on children or persons with decreases mental alertness, the patch need not be put on the upper part so as to lower the chance of the patch from being placed in the mouth. After a duragesic patch has been applied, fentanyl 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. Up to a full day (24 hours) may pass before the first dose begins to work.

Your doctor may need to adjust the dose during the first few weeks 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 fentanyl transdermal that you apply. Instead, check first with your doctor. You will probably need to take a faster-acting narcotic by mouth to relieve pain during the first few days of fentanyl transdermal treatment. You may also need another narcotic while your dose of fentanyl is being adjusted, and to relieve any "breakthrough" pain that occurs later on.

Be sure you do not take more of the other narcotic, and do not take it more often than directed. Taking 2 narcotics together can increase the chance of serious side effects. The dose of this medicine will be different for different patients. Follow your doctor 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. The amount of medicine that you take depends on the strength of the medicine.

Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For transdermal dosage form which is sold as a skin patch: To be used for relief of chronic pain: Adults, teenagers, and children 2 years of age and older, your doctor will decide on which dose of the patch you need based on your present daily narcotic dose. The patch is applied to the skin and left in place for 3 days (72 hours). The dose may be adjusted as needed. For children below the age of 2 years. It is advisable to use the dose as soon as possible. The dose used is determined by the medical doctor.

In case of missed doses. Put on a patch as soon as possible. However, when it is almost time for the next dose, wait until the time for the next dose. Remove the dose 3 days after applying it. Always store the medicine in a closed container at room temperature and away from heat, moisture and direct sunlight. Keep the medicine from freezing and out of reach of children. Always dispose the medicine that is no longer needed. Fentanyl may cause serious unwanted effects or fetal overdose when taken by children, pets, or adults who are not used to using strong narcotics for pain.

It is important to keep the medicine in a safe and prevent others from getting it. Dispose the medicine as required and fold the patch half to the inside. When the patch has not been used, take it out of the pouch and remove the liner that covers the sticky side on the patch before folding it in half. Flush it away into the toilet right away. Never flush the pouch or the protective liner down the toilet.  It is also best to be placed in a trash can.

4 Precautions to Take

Regular checkup for progress by your doctor allows you to make assessment on the use of the medicine. This will allow the medical doctors to make an evaluation of how best the medicine is working and whether the drug can continue to be used as normally. It is also advisable that one needs not to touch the sticky side of the patch or the gel. Fentanyl can be quickly absorbed through the eyes and mouth and which can lead to dangerous reactions within the body. When one touches the sticky side of the patch of the gel, inform your medical doctor right away and clean the areas with copious amounts of water. Never use soaps or other form of cleansers. Always check regularly on your doctor while using fentanyl so as to be able to record any side effects.

After using your medicine for a while, some breakthrough pain may be felt for a while and then more often than usual and it may not be relieved by the regular dose of the medicine. When this occurs, the amount of fentanyl transdermal or other narcotics that you are using without first checking with your medical doctor. Fentanyl also adds to the effects of alcohol and other CNS depressants which has an effect that can make you feel drowsy or less alert.

Example of CNS depressants are antihistamines or medicines for the management of hay fever, allergies, colds, sedatives, tranquilizer or sleeping medicine including other pain medicine or narcotics, medicines for seizures or barbiturates, muscles relaxants or anesthetics including dental anesthetics. One may be advised to take other pain relievers in case one still has some pain when using transdermal fentanyl.

Also check with your doctor before taking any of the medicines listed while you are using this medicine. The fentanyl patch must be removed before a procedure called a magnetic resonance imaging (MRI). This may cause skin burns when left in place during a procedure. The fentanyl patch may cause other serious skin reactions. Always inform your doctor right away of you are blistering, lesions, a rash, redness or swelling of the skin, more especially at the site of the application.

Some people become drowsy, lightheaded or feel a false sense of well-being. It is important to know how you react to this medicine before you drive, use machines or do anything else that can put your life in danger when you are dizzy or not alert and clear headed. The effects may go away after a few days of treatment when your body gets used to the medicine. But, one will need to check with your doctor in case of sign of drowsiness that was severe to interfere with your activities for a number of days.

Sign of dizziness, lightheadedness or even fainting may occur when you get up suddenly from lying or sitting positions.  It is advisable that you will need to get up slowly as a solution to the problem. One can lie down for a while may relieve the dizziness or lightheadedness. Nausea or vomiting may also occur especially during the first several days of treatment. When the medicine becomes bothersome or if they continue for more than a few days, check with your doctor. One may be able to take other medicine which can help you prevent other problems. When one uses narcotics for a longer period of time, may cause severe constipation. To prevent this, you doctor may direct you to take laxatives, drink a lot of the fluids or increase the amount of fiber in your diet.

Also, follow the directions carefully because continuing constipation can lead to more serious problems. Heat can also cause fentanyl in the patch to be absorbed into the body faster. This may also increase the chances of side effects from an overdose when using this medicine. Never use this medicine with a heating pad, electric blanket, heating or tanning lamps, sauna, a sunlamp or a heated water bed and do not sun bathe or take long baths or showers in hot water bed and do not sun bathe or take long baths or showers in hot water. In case you also develop some fever, check on your doctor.

As a result, one needs to be careful on letting other people come in contact with the patch. The patch can also stick to someone else. This can occur when one is hugged or when someone helps you put the patch on. When the medicine gets on another person, wash the medicine off right away with clear water and before having any kind of surgery, such as having dental surgery, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine.

Some of the serious side effects of the medicine may also occur that your doctor or dentist gives you certain or other medicines without knowing that you are using fentanyl. One may also bathe, shower, shower, swim while wearing a fentanyl skin patch. However, be careful to wash and dry the area around the patch gently. Constant rubbing may cause the patch to get loose or come off. When this occurs, throw away the patch and apply a new one in a different place.

Make sure the area is completely dry before applying the new patch. If you have been using this medicine regularly for several weeks or more, do not suddenly stop using it without first checking with your doctor,  You may also be directed gradually re duce the amount your using before stopping treatment completely to lessen the chance of withdrawal side effects. Too much of the transdermal fentanyl or taking too much of another narcotic with transdermal fentanyl may cause an overdose. If this happens, gets an emergency help right away. An overdose can cause severe breathing problems, unconsciousness and death.

Serious signs of an overdose include slow breathing and drowsiness that is so severe making one unable to respond to or when a sleep, cannot be woken up. Other signs of an overdose include cold, clam skin, low blood pressure, pin point pupils of the eyes, and slow heartbeat.  It is also advisable that one need to be accompanied by a family member or  a friend who can be able to check on you several times in a day when using a narcotic and whenever the dose is increased so that he or she can get help for you if you cannot do it yourself.

Never use fentanyl patch if you have taken a monoamine oxidase (MAO) inhibitor in the previous 2 weeks. Example of MAO inhobitors are isocarboxazid, phenelzine (Nardil), selegiline (Eldepryl), and tranylcypromine (Parnate). When you use the 2 medicines close together it may cause serious side effects like confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high temperature, an extremely high blood pressure, or severe convulsions. Using this medicine while you are pregnant may cause serious unwanted effects in your newborn baby.

Always inform your doctor right away when you think you are pregnant or if you plan to become pregnant while using this medicine. Grapefruit and grapefruit juice may increase the effects of transdermal Oxymetazoline by increasing the amount of the medicine in your body. You should not consume grapefruit products while you are using this medicine. Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.


5 Potential Side Effects

Not all the side effects occur and when they do, they require medical attention. It is important that you check with your medical doctor in case of any signs of side effects. The common signs of the disease is characterized by decrease in the amount of urine or urination. Hallucination may be experienced during the process. The least common signs and symptoms of side effects of the condition include:

  • Chest pains
  • Difficulty in speaking
  • Fainting
  • Mood or Mental change
  • Problems with walking
  • Redness, Swelling, Itching, Bumps on the skin at the place of application of the spitting blood

Some of the incidence that are not known to occur in people after using this medicine include:

  • Bloating or Swelling or the face, hands, lower legs or feet
  • Fasts or Pounding heartbeat, pulse
  • Rapid weight gain

It is also advisable to get emergency help immediately when any of the following symptoms of drug overdose occurs. Drug overdose is characterized by cold, clammy skin, convulsions (seizures) drowsiness that is so severe you are not able to answer when spoken to or, if asleep, cannot be awakened, pinpoint (small) pupils in the eyes, slow heartbeat, very slow (fewer than 8 breaths a minute) or troubled breathing. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

Moreover, your medical doctor may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them. More common abdominal or stomach pain that was not present before treatment, confusion, constipation, diarrhea, dizziness, drowsiness, or lightheadedness false sense of well-being feeling anxious headache indigestion loss of appetite nausea or vomiting sweating weakness. The common side effects include:

  • Feeling anxious and restless at the same time
  • Feeling of crawling, tingling, or burning of the skin
  • Memory loss
  • Unusual dreams

Some of the incidences are not known and include change or problems with discharge of semen, reduced sexual drive, desire and performance. Inability to have or keep an erection, loss of sexual ability, desire, not to have an orgasm, weight loss. When use of this medicine has stopped, it may still be able bring some of the side effects, pay close attention and seek help immediately. Check with your doctor immediately when you notice some of the side effects.

Other side effects not listed may also occur in some of the patients. When any of the side effects are noticed. Other side effects which may not be listed may occur in some patients. When new side effects are noticed, please consult your medical professional. Call your medical doctor for medical advice. You can also report the side effects to the FDA at 1-800-FDA-1088.