Treatment of moderate to severe cancer pain and severe pain which does not respond to non-opioid analgesics. Apply a new patch after up to 96 hours 4 days. SPC suggests bi-weekly dosing, for example Tuesday and Friday. It is recommended that patients should ideally stay on the same formulation and should not switch between patches. Consult local guidance for preferred brand.
Note that for small dose titrations matrix patches may be cut diagonally unlicensed practice. Seek specialist advice. Patients who require the topical route of administration and where opioid requirements are lower than the lowest initiating strength of fentanyl patch refer to Choosing and Changing Opioids guideline.
In addition, advise patients not to apply the patch to irritated or broken skin. The buprenorphine transdermal patch should not be cut.
Patients should press the patch down firmly at the application site with the palm of the hand and hold for 15 seconds without rubbing the patch to ensure the patch sticks to the skin. Advise patients to wash their hands after touching or applying the buprenorphine transdermal patch. Inform patients to avoid exposing the patch to heat e. In order to help keep the patch in place, patients may use first-aid tape on the edges of the patch. If this fails, a see-through dressing may be used to cover the patch, such as Tegaderm, to allow the buprenorphine patch to be seen underneath the tape while keeping it in place on the skin.
Patients should be instructed to remove the old patch prior to applying the new one. The old patch may be disposed of using one of two methods: fold the adhesive sides of the buprenorphine patch together and dispose of it by flushing, or use the Patch-Disposal Unit that is packaged with the patches. There were two pivotal phase III trials that led to the approval of the buprenorphine patch for use in pain. The goal of the REMS is to decrease serious adverse events due to inappropriate prescribing, misuse, and abuse of long-acting opioids.
The REMS for these products requires that a medication guide be dispensed to patients. Additionally, it includes Elements to Assure Safe Use, which requires healthcare-provider training on these medications.
Potential advantages for use of the buprenorphine patch include the convenience of the dosing interval, which allows for once-weekly patch application versus oral opioids that may need to be taken multiple times per day or the fentanyl patch, which is dosed every 72 hours.
Additionally, the use of a transdermal patch may be beneficial in patients who are unable to swallow or in patients with nausea or vomiting. The buprenorphine transdermal patch may be a potential alternative for patients requiring around-the-clock opioid therapy. Providers and patients should be aware that potential adverse effects and precautions are similar to those of other opioid medications.
Patients should be educated on the proper application, use, and disposal of this product. Butrans buprenorphine transdermal system package insert. Kress HG. Clinical update on the pharmacology, efficacy and safety of transdermal buprenorphine. Eur J Pain. Morphine sulfate package insert. Opioid pharmacology. Pain Physician. Endogenous opioids: their physiological role and receptors.
Global J Pharmacol. A trend towards a longer survival with TD opioids, compared to peroral ones, was observed but was not statistically significant. Surprisingly, however, the patients who used NSAIDs concomitantly did not have a lower initial or final dose.
This might support the thesis that the only essential analgesics in the hospice are the opioids 2. Several weaknesses of the study need to be mentioned. First of all, we did not analyze the quality of life or pain ratings in this study, which is paramount for the choice of opioid and the dose elevation.
However, our goal here was only to access the relationship of different TD opioids and their combinations to survival, regardless of the effect on the quality of life or symptoms such as constipation or delirium. We also recognize that there may be unknown confounders between the groups that receive opioids versus opioids plus NSAIDs which may account for the lack of opioid sparing effects.
Additionally, this was a retrospective investigation, enrolling only Caucasian patients and performed in only one center. For future studies, to eliminate potential bias, we recommend performing a multicentric randomized prospective investigation with a parallel analysis of the quality of life and the doses and formulation of opioids. This research supports the safety of both TD fentanyl and buprenorphine in the hospice population.
The choice of the drug should depend on patient preferences, dosing schedule, and the type of pain. Although adjuvant NSAIDs could be useful in the treatment of pain in terminal cancer, they do not affect survival or the reduce the opioid doses.
Finally, our data suggest that for elderly hospice patients, with cancer as a dominant diagnosis, the equianalgesic ratio of buprenorphine might be more appropriate for conversion purposes. The data is in control of the authors and is available after contacting the corresponding author. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Special Issues. Academic Editor: Ke Ren. Received 27 May Accepted 25 Jul Published 15 Oct Abstract Introduction. Introduction Opioids are the essential drugs in treating pain in palliative care patients [ 1 ]. Methods The study was a retrospective analysis of the patients enrolled in the only Croatian hospice Marija K.
Statistics We initially performed the Kolmogorov-Smirnov test, which pointed us to use nonparametric tests. Results Initially, we assessed patients enrolled in the hospice over the examined period of 4 years.
Parameter Fentanyl Buprenorphine Buprenorphine Peroral opioids Number of patients 93 88 Average age yr The performance score is rated from 0 to 4, with 0 being fully mobile patients and 4 being bedridden patients.
Table 1. Differences between patients on transdermal fentanyl and buprenorphine. Combination Number of patients Initial dose Final dose Diff. Table 2. Differences in dosages and survival in patients with transdermal opioids with additional peroral analgesics with an equianalgesic ratio of for buprenorphine. References J. However, a higher equipotent dose of fentanyl was required for comparable pain relief.
However, a greater number of buprenorphine users suffered from local skin reactions. Buprenorphine users had significant improvement in mood. Both had more doctor visits in the latter half of the study. Conclusion: Thirty percent of the total number of patients discontinued treatment because of side effects or unsatisfactory pain relief.
For those continuing treatment, clinical improvements were seen in the initial 6 months in both groups.
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