Applying one-half a fentanyl patch

[justjoe]

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We have a script to apply 1/2 a fentanyl 25 mcg patch. The patient's insurance won't pay for the 12 mcg patch. We are instructed to tell the patient to just remove 1/2 the adhesive backing and leave the other half covered, so only one-half of the patch will be sticking to the skin. The patient has never had this before.

Has anyone ever seen this before?

 

[BidingMyTime]

No, I've never seen that done. That is going to give very rough, approximated dosing, at best. And what happens when the other half comes off when the passing is tossing and turning in their sleep, and then they either get the full dose if it sticks to their skin, or no dose if it sticks to their sheet? If the dosing isn't super critical for this particular patient....and they were allergic to every other pain medication (as if), then maybe, people do weird stuff to work with limited insurance coverage.

But, I would imagine in the vast majority of real-life scenarios, then either the full 25mcg patch should be used (back off on their IR pain medications), or their current ER pain medication dose should be upped in stead.

 

[Abby Atwood]

That sounds kind of dangerous. I would guess that the insurance just requires a prior authorization for the 12.5 mcg patch. I wonder if the providers office is just refusing to call or fax about it.

 

[Sine Cura]

This is dumb. Do not fill it.

BTW, the "breakthrough" regimen is ALWAYS filled in tandem with the long-acting regimen, every time, without fail, like clockwork.

 

[owlegrad]

That sounds kind of dangerous. I would guess that the insurance just requires a prior authorization for the 12.5 mcg patch. I wonder if the providers office is just refusing to call or fax about it.

There is no such thing as a 12.5 patch. It really is 12.

 

[mnoble]

Aren't most brands of fentanyl patches matrix, not reservoir, now? Could just cut it since matrix patches dose is proportional to area of patch. Obviously the responsible thing is still just get the 12's approved.

See: The danger with cutting medication patches

 

[CetiAlphaFive]

This is so incredibly dumb that it warrants a big, flat out "NO", and if the doctor calls, it warrants being rude.

We have a script to apply 1/2 a fentanyl 25 mcg patch. The patient's insurance won't pay for the 12 mcg patch. We are instructed to tell the patient to just remove 1/2 the adhesive backing and leave the other half covered, so only one-half of the patch will be sticking to the skin. The patient has never had this before.

Has anyone ever seen this before?

Aren't most brands of fentanyl patches matrix, not reservoir, now? Could just cut it since matrix patches dose is proportional to area of patch. Obviously the responsible thing is still just get the 12's approved.
See: The danger with cutting medication patches

... Can you name and spot the brands that *aren't* matrix?

 

[mnoble]

... Can you name and spot the brands that *aren't* matrix?

Yes its pretty easy. But surely still not a great idea to encourage.

 

[Abby Atwood]

There is no such thing as a 12.5 patch. It really is 12.

Okay 🙂 but it delivers 12.5 mcg/hr

Addendum: This is just to clarify in case there is actual confusion out there. The 12 mcg patch is actually a 12.5 mcg patch. The box reads 12 mcg vs 12.5 mcg to prevent med errors. Package insert clarifies that the patent is receiving a 12.5 mcg/hr dose.

 

[Rockinacoustic]

Anyone who is okay dispensing this needs to retroactively fail pharmaceutics.

The prescriber's office can call and get the authorization for the 12mcg/hr patch.

 

[maria1oh]

Tell the doctors office to call insurance for appeal to get 12 mcg covered. Or use goodrx or discount card to replace insurance

 

[ldiot]

Just remove 1/2 of the adhesive backing and stick the whole thing on? That's the dumbest thing I've ever heard.

 

[lord999]

Guess that physician hasn't figured out Fick's law yet. What a bonehead.

General observation: You should never (and yes, never) cut a transdermal patch as it really does affect drug delivery in really unpredictable ways. Open your Ansel's for why, but there's some real controversy over the years over the effectiveness of transdermals on different skin thicknesses much less cutting the system open. However, it is possibly safe to cut certain topical patches that only have epidermal or up to dermal release (so lidocaine and other topical pain relief may be cut given the package insert instructions) as there is no systemic release and that the drug does not well up.

And @idiot, I hope you're recovered some sanity and morale from being overexposed to drinking from the UF firehose.

 

[owlegrad]

Guess that physician hasn't figured out Fick's law yet. What a bonehead.

General observation: You should never (and yes, never) cut a transdermal patch as it really does affect drug delivery in really unpredictable ways. Open your Ansel's for why, but there's some real controversy over the years over the effectiveness of transdermals on different skin thicknesses much less cutting the system open. However, it is possibly safe to cut certain topical patches that only have epidermal or up to dermal release (so lidocaine and other topical pain relief may be cut given the package insert instructions) as there is no systemic release and that the drug does not well up.

And @idiot, I hope you're recovered some sanity and morale from being overexposed to drinking from the UF firehose.

There is one patch on the market that the package insert says can be cut depending on the size of the affected area. As far as I know, lidocaine patches are the one exception to the rule.

 

[lord999]

There is one patch on the market that the package insert says can be cut depending on the size of the affected area. As far as I know, lidocaine patches are the one exception to the rule.

Right (the second part of the observation), because lidocaine is topical and specifically NOT systemic (that'd be a real problem for the patient if lidocaine ever got systemic from a patch due to its IB effect on rhythm.) You can cut methol patches as well to size for the same reason, and it's in the package insert. What you're not supposed to do with a lidocaine patch is attach it to a patch of broken skin with exposed vasculature for the same reasons that you can cut it.