Title: Recommendations

Context:
Given the potential serious risks with starting fentanyl and challenges with tapering, clinicians intent on  prescribing transdermal fentanyl for chronic pain are encouraged to consult with other clinicians (e.g., pain  specialists, pharmacists) and to be familiar with the unique properties of fentanyl. Specific safety  precautions that all clinicians should be aware of regarding transdermal fentanyl include: Transdermal fentanyl should not be used in opioid-naïve patients; Patients need to be informed that: Heat (e.g., sun exposure, heating pad, febrile condition) can increase the rate and quantity  of absorption, Proper application includes: being sure to take old patch off; never applying damaged patch  or a patch to non-intact skin; proper disposal to avoid exposure to children and pets, and precautions taken against possible diversion of remaining drug in used patch; Adjusted dose (i.e., decreased patch size) should be used in patients with renal or hepatic  insufficiency and considered in elderly patients and those with febrile illness

Question: Which specific safety precautions should all clinicians be aware of regarding transdermal fentanyl?

Answer: Transdermal fentanyl should not be used in opioid-naïve patients; Patients need to be informed that: Heat (e.g., sun exposure, heating pad, febrile condition) can increase the rate and quantity  of absorption, Proper application includes: being sure to take old patch off; never applying damaged patch  or a patch to non-intact skin; proper disposal to avoid exposure to children and pets, and precautions taken against possible diversion of remaining drug in used patch; Adjusted dose (i.e., decreased patch size) should be used in patients with renal or hepatic  insufficiency and considered in elderly patients and those with febrile illness