Canterbury DHB
This drug is available in New Zealand on special authority for stable pain in patients with ‘terminal illness’ in the transdermal form (Durogesic™ patches). See pharmac website http://www.pharmac.co.nz or check with the hospital pharmacist (relevant specialist only).
Patches are available in different dose rates: 12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, and 100 mcg/hr. (Durogesic™ 12 (12.5 mcg/hr) patch was introduced in 2007 and is not currently funded however funding status may change).
IV or subcut fentanyl may occasionally be used under supervision of the Acute Pain Team or Palliative Care Team.
Indications for use include;
Fentanyl is a potent opioid and breakthrough opioids must be available. The ‘oral morphine equivalent’ dose should always be calculated for patients already established on Durogesic™ and an appropriate oral dose of morphine elixir, SevredolTM or OxyNormTM be prescribed.
Recommendation on choosing a starting dose of Durogesic™:
Oral 24-hour morphine |
Durogesic™ Dose |
< 60 60-134 135 - 224 225 - 314 315 - 404 405 - 494 495 - 584 585 - 674 675 - 764 765 - 854 855 - 944 945 - 1034 1035 - 1124 |
12 25 50 75 100 125 150 175 200 225 250 275 300 |
If fentanyl is used in an infusion, it must be diluted with normal saline and used as a sole agent in the pump. It needs to be in a 50 ml syringe and therefore cannot be used in a Graseby pump.
If considering using fentanyl, a Palliative Care referral is strongly recommended.
See also:
Topic Code: 4059