“Comfort” Kit:

Fentanyl Patch (Transdermal)

Commonly used Hospice drugs:

*Pain Management: Morphine (Roxanol), Hydrocodone, Dilaudid, Methadone, and Acetaminophen (suppository).

*Anxiety/Restlessness: Lorazepam (Ativan), Haloperidol (Haldol), Quetiapine, and Thorazine.

*Nausea/Vomiting: Haloperidol, Prochlorperazine (Compazine), Promethazine (Phenergan), and Reglan.

*Respiratory Distress/Excess Secretions: Atropine (drops), Hyoscyamine (Levsin), and Morphine.

*Constipation/Other: Bisacodyl (Dulcolax) and other stool softeners. Benadryl.

***RISKS***

Mixing benzodiazepines (Ativan) with opioids (Morphine) or antipsychotics (Haldol) causes falls, confusion, respiratory depression, coma/sedation, and death especially in older adults.

FENTANYL PATCH (TRANSDERMAL)

Fentanyl skin patch is used to treat severe pain. Fentanyl is a strong opioid analgesic (pain medicine). It acts on the central nervous system (CNS) to relieve pain.

Elderly patients are more likely to have drowsiness and age-related lung, kidney, liver, or heart problems, which may require caution and an adjustment in the dose for patients receiving fentanyl skin patch.

The presence of other medical problems may affect the use of this medicine, like:

• Addison's disease (adrenal problem) or

• Alcohol use disorder, or history of or

• Brain problems (including tumors, increased intracranial pressure) or

• Breathing problems (eg, asthma, apnea, low oxygen levels, sleep apnea) or

• Chronic obstructive pulmonary disease (COPD) or

• Cor pulmonale (serious heart condition) or

• Gallbladder disease (eg, gallstones) or

• Depression, history of or

• Drug dependence, including opioid or illicit drug use disorder or dependence, history of or

• Head injury, history of or

• Mental health problems, history of or

• Weakened physical condition—Use with caution. May increase risk for more serious side effects.

• Asthma, acute or severe or

• Respiratory depression (serious breathing problem) or

• Short-term pain or

• Stomach or bowel blockage (including paralytic ileus), known or suspected—Should not be used in patients with these conditions.

• Bradyarrhythmia (slow heart rhythm) or

• Hypotension (low blood pressure) or

• Pancreatitis (swelling of the pancreas), acute or

• Seizures, history of—Use with caution. May make these conditions worse.

• Kidney disease or

• Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

The fentanyl skin patch is only used for opioid-tolerant patients. A patient is opioid-tolerant if oral opioids have already been used for severe pain.

Taking 2 opioids together can increase the chance of serious side effects.

This medicine will add to the effects of alcohol and other CNS depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or opioids, benzodiazepines, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.

Using too much fentanyl skin patch, or taking too much of another opioid with fentanyl skin patch, may cause an overdose.

Symptoms of an overdose include: drowsiness, extreme dizziness or weakness, irregular, fast or slow, or shallow breathing, pale or blue lips, fingernails, or skin, pinpoint pupils, relaxed and calm, slow heartbeat or breathing, seizures, sleepiness, trouble breathing, or cold, clammy skin.

This medicine may cause sleep-related breathing problems (eg, sleep apnea, sleep-related hypoxemia).

SIDE EFFECTS:

• Anxiety

• bloating or swelling of the face, arms, hands, lower legs, or feet

• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

• confusion

• decrease in urine volume

• difficulty in breathing or swallowing

• difficulty in passing urine (dribbling)

• fast, irregular, pounding, or racing heartbeat or pulse

• painful urination

• rapid weight gain

• seeing, hearing, or feeling things that are not there

• skin itching, rash, or redness

• swelling of the face, throat, or tongue

• tremor

• unusual weight gain or loss

• upper stomach pain

• Bluish color of the fingernails, lips, skin, palms, or nail beds

• burning, itching, redness, skin rash, swelling, or soreness at the application site

• confusion about identity, place, and time

• false or unusual sense of well-being

• irregular, fast or slow, or shallow breathing

• Agitation

• blurred vision

• chest pain, discomfort, or tightness

• cough

• darkening of the skin

• diarrhea

• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

• fever

• headache

• hives

• lightheadedness, dizziness, or fainting

• loss of appetite

• mental depression

• nausea

• nervousness

• overactive reflexes

• poor coordination

• pounding in the ears

• restlessness

• severe constipation

• severe vomiting

• shivering

• sweating

• talking or acting with excitement you cannot control

• unusual tiredness or weakness

• vomiting

• Constipation

• feeling cold

• sleepiness or unusual drowsiness

• trouble sleeping

• Dry mouth

• feeling of constant movement of self or surroundings

• feeling of crawling, tingling, or burning of the skin

• lack or loss of strength

• memory loss

• sensation of spinning

• unusual dreams

• Abnormal ejaculation

• decreased interest in sexual intercourse

• decreased sexual performance or desire

• inability to have or keep an erection

• loss in sexual ability, desire, drive, or performance

• muscle twitching

• Belching

• heartburn

• indigestion

• stomach discomfort or upset

SOURCE:

Fentanyl (transdermal route) - Side effects & dosage - Mayo Clinic