Can fentanyl transdermal patch be cut into half ?

Can fentanyl transdermal patch be cut into half ?

 ·         Sometimes due to restriction in availability, there may be intention to cut a fentanyl patch by half to get half of the dose prescribed.

·         However, it is generally NOT advisable to cut it into half as there is no established data on its effectiveness.

·         However, as off-label use, there are some studies that cut the patch into half PROVIDED it is MATRIX FORMULATION. For ACCURACY purpose, it is advised to be CUT DIAGONALLY.

·         The second half of the patch cannot be kept for future use. It must be disposed of immediately. ^2,3

·         Prescriber needs to be aware that this is OFF LABEL USE.

·         Strictly NOT to be cut if it is a reservoir formulation as this may result in unintentional overdose.

 

P/S:

§  Fentanyl-HEXAL 25 mcg/h transdermal patch is a matrix formulation.¹

§  Matrix systems: ⁵

o   The drug is evenly distributed throughout an adhesive matrix in these patches, similar to a drug in adhesive layer system.

o   Again, the amount of available drug is directly proportional to the surface area of the patch.

o   Cutting the patch may be possible, but it may also reduce the efficacy of the adhesive.⁵

 

 

Extra Note: Fentanyl patch care ³

 ·         Apply to intact, non-hairy skin on the upper trunk or upper arm; avoid areas treated with radiotherapy, scar tissue or oedematous areas.

·         Apply each new patch to a different skin site; clean the skin with water only as soap products can alter absorption. Make sure skin is dry. Following removal of both parts of the protective liner, the patch should be pressed firmly in place with the palm of the hand for approximately 30 seconds, making sure the contact is complete, especially around the edges.

·         Record the date, time and site if the patch is changed by different people.

·         Change the patch every 72 hours at about the same time of day.

·         Check the patch daily (or as per local guidance) to ensure it is still in place.

·         If patch adherence is poor, check local guidance for advice – micropore tape may be recommended; fentanyl is unsuitable for patients with marked sweating.

·         Used patches still contain active drug. When removed, fold the patch in half with the adhesive side inwards. Dispose of it safely (sharps bin for in-patients, domestic waste in the community). Wash your hands after patch changes.

·         Once fentanyl patches are discontinued, residual medicine in the dermis will continue to have an effect for up to 24 hrs, and the patient should be monitored for up to 48 hrs for residual effects. ⁴

 

References:

1.    Product Leaflet: Fentanyl HEXAL   

2.    Derbyshire Joint Area Prescribing Committee (JAPC). Choice of strong oral / topical opioid for cancer pain. Updated on October 2018. http://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_4/Strong_opioids_in_cancer_pain.pdf

3.    Siún Tobin, Palliative Meds Info., Our Lady’s Hospice & Care Services. Transdermal Opioid Patches: Quick Reference Guide. Reviewed on August 2018. https://olh.ie/wp-content/uploads/2019/01/Opioid-Transdermal-Patches-2018.pdf

4.    Scottish Palliative Care Guidelines: Fentanyl patches. NHS Scotland, 26 August 2020. https://www.palliativecareguidelines.scot.nhs.uk/guidelines/medicine-information-sheets/fentanyl-patches.aspx

5.    Strong opioids for pain management in adults in palliative care. BPJ Issue 49. Pg 13. https://bpac.org.nz/BPJ/2012/december/docs/bpj_49_opioids_pages_8-17.pdf

6.    American Pharmacists Association (APhA). The danger with cutting medication patches. March 1, 2013. https://www.pharmacist.com/danger-cutting-medication-patches