Cutting Fentanyl patch?

[thecentral09]

Hey team,
I am helping wean a patient whose pain continues to improve with lower doses of fentanyl patch. She is mid 40s and was on 100mcg for long time, by the time she got to me she was weaned to 25mcg/hr patch and continues to do well. She went from 100-->25 patch relatively quickly, and now desires further decrease.
I am concerned due to her length of time on fentanyl + speed of taper, and want to continue but slow down. She does not want to take anything orally. They only make fentanyl patch in 12.5 and 25mcg/hr. Can I have her place 1.5 of the 12.5mcg/her patches?
The real question is can I have her cut them in half and use 1.5 of the 12.5? anyone with experince in cutting them in half?

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[DrMDAware]

Do not cut them. Not FDA approved. Cannot ensure proper dose is delivered. Half the patch may not be half the dose.

Package insert. See page 3 halfway down

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019813s044lblnew.pdf

 

[painfree23]

Hey team,
I am helping wean a patient whose pain continues to improve with lower doses of fentanyl patch. She is mid 40s and was on 100mcg for long time, by the time she got to me she was weaned to 25mcg/hr patch and continues to do well. She went from 100-->25 patch relatively quickly, and now desires further decrease.
I am concerned due to her length of time on fentanyl + speed of taper, and want to continue but slow down. She does not want to take anything orally. They only make fentanyl patch in 12.5 and 25mcg/hr. Can I have her place 1.5 of the 12.5mcg/her patches?
The real question is can I have her cut them in half and use 1.5 of the 12.5? anyone with experince in cutting them in half?

Can add a few norco per only 1 week for break through while on 12.5 and then cut those back .

 

[NJPAIN]

Back in the days when 25ug/hr hour was the lowest dose, we would deliver approximately 12.5ug/hr by cutting of 1/2 of the backing and only exposing 1/2 of the active part of the patch to the skin. Perhaps something similar is worth considering?

 

[lobelsteve]

Back in the days when 25ug/hr hour was the lowest dose, we would deliver approximately 12.5ug/hr by cutting of 1/2 of the backing and only exposing 1/2 of the active part of the patch to the skin. Perhaps something similar is worth considering?

You are nuts. FDA says no. Fentanyl. All over the news. What could go wrong? What if it is gel patch and not matrix patch?

 

[Ducttape]

i dont think that exposing half the patch really reduces the dose exactly in half. you got away with that in the past because those patches were from the company and had fentanyl embedded in to the matrix.

some of the newer patches are more like bags, and exposing half wouldnt necessarily reduce the dose in half.


and cutting them will cause the medication gel to leak out.



when you get to 12 mcg/hr, you can switch to butrans.

 

[kstarm]

Some options: rotate to butrans if you want to go slower. Another option would be to just stop and manage withdrawal. If on 12.5 for weeks to months, stopping should lead to minimal withdrawal especially if you provide meds to help with any symptoms.

 

[deleted875186]

if on 25 mcg/he now every 3 days, would recommend going to 12.5 mcg/hr every two days, 15 patch’s for 30 days, then decrease to 12.5 mcg/hr every 3 days next month. This will be a slower taper, the dose delivered starts to decrease a little after two days of wear on the patch.

 

[deleted875186]

 

[Orin]

The patient already showed you they can drop 75 mcg/h in a hurry, so why the stress about the last 25?

I hate to hesitate with a willing patient. They're generally very forgiving of you listening to what they want to do. If you must, I would agree with BID to TID to even QID on the 12.5 to taper the steady state slowly but I would generally just go off at 12.5 after 1-2 patches and not look back.

Make sure you've got a way for them to get in touch with your clinic at 24-72h from the last patch coming off if things turn south.

 

[kstarm]

Make sure you've got a way for them to get in touch with your clinic at 24-72h from the last patch coming off if things turn south.

As above: Being available is probably the most important thing you do to impact the success of the taper

 

[Ducttape]

i would not do the every 2 day patching dosage - are presupposing that it makes the total fentanyl slightly higher than the every 3 days, but it will most likely serve to confuse the patient, as it is completely different dosing than what they have been doing for years, so increases likelihood of patient error.

make it simple. go to 12.5, stay at that dose for 1 month, then stop, with follow up appointment scheduled for 2-3 days after the last patch is taken off (which i usually tell patients to leave on an extra day).