Download Transdermal Buprenorphine and Fentanyl for pain relief (Ref 1502)

Not to be photocopied
Patient Information
Author: Pharmaceutical Services
Produced and designed by the Communications Team
Issue date April 2013 Review date April 2016 Expiry date April 2017
This information can be
provided in a different
language or format
Version 2
Ref no. PILCOM1502
Transdermal Buprenorphine and
Fentanyl for pain relief
(e.g. large print or audio
cassette) on request.
This is a smokefree Trust.
Smoking is not allowed
Your pain management specialist has prescribed you transdermal
buprenorphine (Transtec or Butrans) or fentanyl (Durogesic). These medications
come as patches.
Giving medication through the skin has become possible for a variety of drugs.
You may already know of some like hormone replacement and nicotine patches.
It is particularly useful for pain relief medication as you are less likely to forget
to use your patch than taking tablets and they fit around your lifestyle more
easily. You do not need to put the patch where your pain is felt. The patch is
just used to get the medicine into the blood which can then carry it to where it
works.
in any of our hospital
buildings or grounds.
l The Butrans patch (buprenorphine) comes in 3 strengths (5ug/hour,
10ug/hour and 20ug/hour) and will deliver the same dose each hour for
7 days
l The Transtec patch (buprenorphine) comes in 3 strengths (35ug/hour,
52.5ug/hour and 70ug/hour) and will deliver the same dose each hour for
4 days
The Trust will not tolerate
aggression, intimidation or
violence directed towards
its staff.
l The Durogesic (Dtrans) patch (fentanyl) comes in 4 listed strengths
(25ug/hour, 50ug/hour, 75ug/hour and 100ug/hour) and will deliver the same
dose each hour for 3 days
There are two stages to this treatment. The first is called the Titration phase
and the second is called the Maintenance phase.
Titration phase
Your pain management specialist believes that your pain may be helped by
using this patch. You have been taking other medicines and these have either
not helped or their effect has not lasted long enough. You might feel that you
are taking too many tablets at present.
Basildon University Hospital
Nethermayne
Basildon
Essex SS16 5NL
( 01268 524900 / 0845 155 3111
Minicom
( 01268 593190
Patient Advice and
Liaison Service (PALS)
( 01268 394440
E [email protected]
W www.basildonandthurrock.nhs.uk
We do not know how much you need of these medicines to get the best pain
control with the fewest side effects. This is why we are going to start you off on
a low dose and ask you to monitor your pain and side effects after six or seven
days. You will then have a chance to try an increase in the dose and monitor
your pain again a week later and so on.
You will have an appointment to see your pain management specialist some
weeks later. The pain specialist will want to know if you feel that your pain is
reduced, that you are managing any side effects well, and that you have
become more active as a result of better pain control.
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It is helpful if you bring in your patches at that appointment so that we can be clear about the doses that you are
actually taking.
7 day patch
Name of drug
Week 1
Week 2
Week 3
Week 4
Buprenorphine ‘Butrans’
Exchanged each week
ug/hour
ug/hour
ug/hour
ug/hour
Name of drug
Week 1
Week 2
Week 3
Week 4
Fentanyl ‘Durogesic DTrans’
Exchanged after 72 hours
ug/hour
ug/hour
ug/hour
ug/hour
Name of drug
Week 1
Week 2
Week 3
Week 4
Buprenorphine ‘Transtec’
Exchanged after 96 hours
ug/hour
ug/hour
ug/hour
ug/hour
3 day patch
4 day patch
You will have talked to your pain management specialist about this type of medicine but it is important to
understand the following:
l You must not suddenly stop taking these medicines as you might feel ill for a few days afterwards. This is
called a withdrawal reaction. For a few people it is quite a severe reaction but for most people it is not. If you
decide to stop the medication it is better to reduce the dose slowly just as you built it up slowly.
This is NOT the same thing as addiction. Addiction is where someone, who is not taking the medicine for pain
relief, has a continual craving for more of the drug. The individual becomes less active and less happy with the
outcome as time goes by.
Management of side effects
All drugs will have a desired effect (in this case pain relief) and side effects (less desirable effects). Most side
effects can be managed and most will reduce as your body becomes more familiar with them.
l Constipation
All opioid drugs cause constipation so it is important to try and manage this symptom. We recommend that you
drink plenty of water and eat a diet rich in fruit and vegetables. Each night you can take a natural laxative such
as senna which you can buy from the chemist. If this doesn’t work for you then we would suggest that you
speak to your GP or pain management specialist.
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l Feeling sick
Some people can feel sick when they first start taking buprenorphine or fentanyl but this is less likely if you
have already been taking medicines such as codeine or dihydrocodeine. This feeling usually stops after the
first week or two. In the meantime it can help to take regular anti sickness medicines such as cyclizine,
metoclopramide, prochlorperazine or odansetron which your GP can prescribe for you.
l Drowsiness
We do not want to make you feel drowsy. If you feel drowsy it is usually because you are taking a little too
much. Not all pain is helped by these medicines so sometimes patients take too much hoping that it will
help. Try reducing the dose and then see whether any of your pain is still helped. If not then you will have to
reduce and stop it altogether.
Maintenance phase
Once you have carefully increased the dose of tansdermal buprenorphine or fentanyl your pain should be at a
manageable level. You should also have any side effects under control and be more active. This has been a
successful titration phase but what about the long term?
l Medicine supply
The pain management specialist will have sent a letter to your GP about the reasons for prescribing
buprenorphine or fentanyl patches. Usually the GP is satisfied with this treatment and will be happy to
continue the prescription in the long term. If your GP is not happy to prescribe the medicine then please ask
them to speak with your pain management specialist or the pain management nurses directly.
Always make sure that you have a sufficient supply so that you do not run out such as over a long weekend or
on holiday.
l Constipation
This may continue to be a problem unless you take regular laxatives. They are not harmful as we know the
cause of your constipation and the laxatives counteract this.
l Routine assessment
The pain management specialist will keep you under long-term review for at least the first year after starting
these medicines. If you continue to benefit and the dose remains stable then there is no reason why this
review cannot be managed by your GP.
CAUTION: NEVER APPLY HEAT OVER A PATCH.
This includes hotwater bottles, commercial hot packs, leaning against hot surfaces etc.
Contact details
If you need further advice then contact your GP or pain management specialists secretary and leave a
message with name and contact number and we will call you back.
Dr Thomson’s secretary
- 01268 592268
Dr Jayasekera’s secretary - 01268 592389
Dr May’s secretary
- 01268 598532
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