Fentanyl (Transdermal Route)

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Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of transdermal fentanyl in children 2 years of age and older. However, pediatric patients must be opioid-tolerant before using transdermal fentanyl. Safety and efficacy have not been established in children less than 2 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of transdermal fentanyl in the elderly. However, elderly patients are more likely to have age-related lung problems, which may require an adjustment in the dose for patients receiving transdermal fentanyl.

Pregnancy

Breastfeeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Naltrexone

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Adinazolam
• Alfentanil
• Alprazolam
• Amiodarone
• Amobarbital
• Amprenavir
• Anileridine
• Aprepitant
• Aprobarbital
• Bromazepam
• Brotizolam
• Buprenorphine
• Butabarbital
• Butalbital
• Butorphanol
• Carisoprodol
• Chloral Hydrate
• Chlordiazepoxide
• Chlorpromazine
• Chlorzoxazone
• Citalopram
• Clarithromycin
• Clobazam
• Clonazepam
• Clorazepate
• Clorgyline
• Codeine
• Crizotinib
• Dantrolene
• Dezocine
• Diazepam
• Diltiazem
• Erythromycin
• Estazolam
• Ethchlorvynol
• Fentanyl
• Fluconazole
• Flunitrazepam
• Fluphenazine
• Flurazepam
• Fosamprenavir
• Fospropofol
• Furazolidone
• Halazepam
• Hydrocodone
• Hydromorphone
• Imatinib
• Iproniazid
• Isocarboxazid
• Itraconazole
• Ketazolam
• Ketoconazole
• Levorphanol
• Linezolid
• Lopinavir
• Lorazepam
• Lormetazepam
• Medazepam
• Meperidine
• Mephenesin
• Mephobarbital
• Meprobamate
• Metaxalone
• Methocarbamol
• Methohexital
• Midazolam
• Moclobemide
• Morphine
• Morphine Sulfate Liposome
• Nalbuphine
• Nefazodone
• Nelfinavir
• Nialamide
• Nicardipine
• Nifedipine
• Nitrazepam
• Nordazepam
• Opium
• Oxazepam
• Oxycodone
• Oxymorphone
• Pargyline
• Paroxetine
• Pazopanib
• Pentazocine
• Pentobarbital
• Perphenazine
• Phenelzine
• Phenobarbital
• Prazepam
• Procarbazine
• Prochlorperazine
• Promazine
• Promethazine
• Propoxyphene
• Quazepam
• Ranolazine
• Rasagiline
• Remifentanil
• Ritonavir
• Secobarbital
• Selegiline
• Sertraline
• Sibutramine
• Sodium Oxybate
• Sufentanil
• Tapentadol
• Temazepam
• Thiethylperazine
• Thiopental
• Thioridazine
• Toloxatone
• Tranylcypromine
• Triazolam
• Trifluoperazine
• Troleandomycin
• Vemurafenib

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Atazanavir
• Azithromycin
• Carbamazepine
• Clotrimazole
• Dirithromycin
• Econazole
• Indinavir
• Josamycin
• Mepartricin
• Miconazole
• Miokamycin
• Nevirapine
• Phenytoin
• Rifampin
• Rokitamycin
• Roxithromycin
• Saquinavir
• Spiramycin
• Voriconazole

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse, or history of or
• Drug dependence, especially narcotic abuse or dependence, history of or
• Emotional problems or
• Mental illness (e.g., major depression) or
• Underactive thyroid—The chance of side effects may be increased.

• Brain tumor or
• Diarrhea caused by antibiotic treatment or poisoning or
• Enlarged prostate or problems with urination or
• Gallbladder disease or gallstones or
• Head injury, recent or
• Heart disease or
• Impaired consciousness (slow to respond) or
• Increased pressure in your head or
• Intestinal problems such as colitis or Crohn's disease or
• Pancreatitis, acute—Some of the side effects of fentanyl can cause serious problems in people who have these medical problems.

• Breathing problems (e.g., COPD or asthma) or
• Not opioid-tolerant (if you are not already taking a certain amount of morphine, oxycodone, hydromorphone or other opioid medicine) or
• Respiratory depression (hypoventilation or slow breathing)—Fentanyl patches should not be used in these patients. It could cause very serious breathing problems.

• Kidney disease or
• Liver disease—Effects may be increased because of slower removal from the body.

• Paralytic ileus (intestinal blockage)—Fentanyl patches should not be used in patients with this condition.

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