Avoiding Fatal Overdoses with Fentanyl Patches (Oct. 2005)

FDA has issued a public health advisory about deaths and serious injuries that have occurred when pain-relieving transdermal patches containing fentanyl, such as Duragesic, were misused. This has caused fatal overdoses of the drug.

The Institute for Safe Medication Practices describes an incident where a patient's caregiver placed the fentanyl patch on the patient's buttock, which was the site of her pain. When the patient went to bed, she also used a heating pad at the same place. The patient was discovered dead two days later. According to ISMP, neither the prescribing physician nor the pharmacist had counseled her on how to use the patch properly, and they hadn't told her to avoid applying heat over the patch.

There have also been cases where children have gotten hold of the patches, with tragic results. In one case, a mother found her 4-year old son dead next to an overturned trash can that held torn wrappers and used patches. The boy had applied a patch to his body, either a discarded one from the trash, or one he opened from a box of new patches. ISMP also describes a case where a child was accidentally exposed to a patch that fell off a family member, and another one where a child removed his grandmother's patch and applied it to himself.

It's important to instruct patients how to safely store and dispose of the patches. Used patches, or those that are no longer needed, should be folded in half so that the sticky side of the patch sticks to itself, then flushed down the toilet. And of course, warn patients to keep the patches out of the reach of children.

Absorption of the drug can also be increased by exposing the patch to heat sources such as heating pads, electric blankets or long, hot baths. A high fever can also increase absorption. In addition, using other CNS depressants, including alcohol, can have an additive effect on a patient using fentanyl.

The advisory says to counsel patients and their caregivers to recognize the signs of fentanyl overdose. These include trouble breathing, extreme sleepiness, or the inability to think, talk or walk normally. If these signs occur, patients or their caregivers should get medical help right away.

It's important to recognize that the indications for these patches are somewhat limited. The advisory reminds practitioners that these patches should only be used by patients who have chronic pain that's not well controlled with shorter-acting painkillers, and who are tolerant to opiates. Fentanyl patches should NOT be used to treat short-term, intermittent, or post-operative pain. And they should always be prescribed at the lowest dose needed for pain relief.

Additional Information:

ISMP Medication Safety Alert - New fentanyl warnings: more needed to protect patients. August 11, 2005.
http://www.ismp.org/MSAarticles/20050811.htm

FDA MedWatch Safety Alert -- Fentanyl Transdermal Skin Patch.
http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Fentanyl

FDA MedWatch Safety Alert -- Duragesic (fentanyl transdermal system).
http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#Duragesic

Category:

News & Politics

Tags:

• Fentanyl
• Transdermal
• Patch
• Overdose
• Patient
• Death
• Drug
• Reactio
• FDA
• Safety
• Duragesic

[cubbycab]

i am only afraid of fentanyl out of all the opiates- scary med!

[skoek]

I'm sorry, but I use fentanyl patches. "The pharmacist didn't counsel..."

If you are a caregiver, it is your responsibility to be informed about the medicine you are giving someone. In all four brands of fentanyl patch it is clearly stated that heat potentiates the mechanism of delivery and to avoid it.

[upplsuckimcool16]

All you need is heat to make it stronger? Nice to know THANKS GUYS!

[TheAna101]

This should be the death patch. My brother used it and he showed all these signs and no one paid much attention. The next thing we know he falls asleep and if it wasn't for me checking up on him he would of been Dead! Scariest shit ever. He wasn't moving nor talking when I shook him, scream and turn on light and he is pale as hell and turning blue and stiff. I thought he was dead! callled 911 and they got there and thought he was dead to, they revived him. Thought I really lost him, sad.

[scarletsmith]

Do NOT throw patches away in the garbage--flush 'em down the toilet. Or wrap 'em in the original bag before tossing.

[jposh707]

I know, I'm terrified of it now, too. Like, what if I had a fever but didn't know it, and put the patch on? Ah! It must be too strong.

[macmitchdog]

All you have to do is read the info on the patch. It states not to use a heat pad. Sorry to ear about the child but disposal is also stated in the information..

[x7r00p3r]

well with a fentanyl patch 50 whatever, I cut it in half chewed on it, and was pretty relieved of all my issues with some hallucinations ha, but it's very potent and very susceptible to overdose if used carelessly, but anyways it's amazing and works wonders it's only 100x stronger than morphine :]