Refer to Tables 1 and 2 below for equi-analgesic doses of opiates. The dose should not be titrated more frequently than every three days after the initial dose. Patients will require a new patch every 72 hours. The APS also recommends the addition of a short-acting opioid dosed prn to manage breakthrough pain. Disposal of the patch is an important concern because active drug exists in the patch after 72 hours of patient wearing.
Proper disposal is crucial to prevention of any potential diversion.
Manufacturer's recommendations for disposal include removal of patch from the patient and then folding the patch in on itself with the adhesive sides touching. This will prevent any drug from being absorbed by someone handling the discarded patch. It should be disposed of in a sharps container or flushed down the toilet to prevent any accidental exposure to the drug. If any of the clear gel should get upon the skin, the recommendation is to wash the area with cold water immediately to prevent any unwanted absorption of the drug. Patients are checked Q shift to ensure patch is present.