How do you take Fentanyl patch?

Answer 1

As most Duragesic/Fentanyl patch patients know, the recommended procedure is to clean the area with water and then apply the patch. However, for anyone who has used Fentanyl Generics or Duragesic, we know that's ridiculous. Skin oil, patch location and hair are the 3 biggest adhesion factors for the patch adhesive to contend with.

Having used Duragesic 100mcg patches (x2 on occasion) for 13 years, I know of 4 good ways to keep the patch stuck:

1. If you're using Duragesic, Janssen Pharmaceuticals has long had a program for its Duragesic users who have this problem. They will send out free of charge 300 Bioclusive bandages (clear adhesive bandages) that will fit over the 100mcg patch. I've used them many times and they work well. You need to call them at the 800 number on the box. Only Duragesic users are eligible; you can get them online or order them at a pharmacy, but they're not cheap, around $100 a box.

Note: It's unclear as of 2013 whether or not Janssen still runs the Bioclusive program, but it's an automatic NO if you don't ask. You can of course just by them outright, but as I said, they're not cheap.

Worst case, you can always use medical tape to tape the edges of the patch.

2. Skin Prep - Skin Prep is a product made for Colostomy patients. It applies a thin film to the skin that helps the adhesive bond strongly to the skin. The tricky part is to only apply it to the skin area where the edges of the patch are going to be, since applying it to the transdermal area will block release of the drug. It works fantastic though, and most pharmacies carry it. They make 2 types, a lower cost one that stings, and a non-stinging one for double the cost. It doesn't sting that bad compared to the pain you're already dealing with.

2013 Note: Skin Prep works well with the older style patch type that used an adhesive edge and gel pocket, but it's impractical if you're using a patch such as the new Duragesic patches that are essentially a one-piece adhesive patch. Using SP will block the release of the Fentanyl.

3. Isopropyl Alcohol - all patch literature will tell you not to use Iso to clean the skin and then put the patch on. The reason for this is that Isopropyl leaves a residue on the skin that can interfere with the drug release. However, to get around that issue, clean the area with Iso, then rinse it with water to remove any residue and then dry well before applying. Iso is the only real way to get skin oil off of the skin, which is the primary reason the patch adhesive comes unbonded from the skin.

Of course if you use Grain alcohol (purchased from a liquor store), it leaves no residue.

The other reason is that Iso can cause skin irritation if not rinsed prior to the patch being applied.

4. Location, Location, Location - SRE (Skin real estate) is a major factor in how well your patch stays applied. The instructions tell you not to use the patch in the same spot over and over - this is to let the skin breathe between applications. It must be applied on the upper torso in order for the heart to properly distribute the drug throughout the body. I've always applied mine to my upper biceps, as the area is flat, relatively hairless, and the skin there doesn't flex like it does on the chest or elsewhere. Normally my regular dose is 1 100mcg patch, so I just switch arms every 2 days when I change it out for a new one. However, there have been times where I've needed 2 100mcg patches, and I have used them on both arms simultaneously. In those cases, I've overlapped the application by several hours so that the skin has time to breathe before reapplying. I also will apply it vertically or horizontally so that the same area isn't always completely covered. Edge scarring on the skin from the patch will occur, but it will go away in time if you stop using them.

If you're having difficulty with the patch staying applied and the area doesn't appear to have any hair, keep in mind that the small micro-hairs that we all have can interfere with the patch adhesive. In those cases, shave the area or use a hair remover / wax to ensure there's nothing to get in the way between the patch and your skin. Make sure you rinse it well with warm water and dry it well before you apply the patch though.

I know of terminal cancer patients who have required up to 6 100mcg patches, and in those cases they were applied on the back. The problem with that is you need someone to apply it, and if you're like me, you probably like doing it in private by yourself.

In a pinch, if your patch comes off, don't toss it. It's a misconception that it cannot be reapplied and used; as long as it doesn't stick to itself, you can re-use it, but if it does, of course you're out of luck. If you're using generics, you can buy Bioclusives yourself. Alternatively, simple transparent medical tape on the patch edges will keep the patch in place or help you to re-attach it. Make sure you clean the skin before reapplying, and put it in the same place. It takes about an hour, but if there's enough adhesive and medicine left, the body heat will start the drug release again.

When applying your patch after you've prepped the area, make sure you hold it between your hands for about a minute (BEFORE you remove the backing...) to warm and soften the adhesive. After you put it on, hold your hand over it for a minute to help the adhesive stick better

One other bit of advice - all doctors are required by Federal Law to only give a month's worth of Schedule 2 opiates to any patient, making us slaves to the system, and making it a real pain if a patch comes off and cannot be reused, especially if it was just applied recently. I learned early on to build up an emergency month supply of meds that will help me in such situations, or in those rare times where you have problems with medical insurance companies or prescription supply interruptions. It takes time, but most Fentanyl patients have breakthrough meds like Percocet. Use that to help you get by and try stretching your dosage in order to bank up extras so you don't fall short if a patch does get screwed up. If you're seeing a doctor that tells you to turn in any extras, get another one. Federal Law prohibits transfer of any narcotic to anyone other than whom it was prescribed for, and I know of no such exception for doctors, even prescribing ones. I have always been up front with my doctor about my emergency supply, and over the years he's been willing to give me a bit more when it's run low.

Answer 2

All patches come with documentation on how to apply them.

The skin needs to be clean and free of adhesive. This can be real pain to remove.

You can use baby oil, or Mentor Adhesive Remover wipes. You can get them at a local pharmacy.

Make sure you get the oil off - use isopropyl or an alcohol patch to clean the area. Make sure you then wipe it with a clean dampened rag to wipe away any residue from the isopropyl. Dry it real good.

After the skin is clean and dry, remove the backing from the patch, then apply evenly across the skin. Hold your hand over it for about 30 seconds - the heat from your hand helps bond the adhesive better, and starts the flow of the drug a little faster.

I tend to use my arms (biceps) for my patch areas. I alternate one arm, then the other, unless I'm using two patches in which case I'll alternate taking the patches off and putting new ones on. I've been doing it that way for 9 years now.

Answer 3

Fentanyl patches are transdermal in nature (i.e., they deliver the drug through the skin) and as such are applied to an area of skin on the upper torso. The patches last from 48 - 72 hours, at which time they must be replaced.