Transdermal Fentanyl In Patients Research Articles

Transdermal Fentanyl in Patients with Cachexia-A Scoping Review.

Cachectic patients frequently require transdermal fentanyl (TDF) for pain management, but data on its efficacy and safety are scarce and inconsistent. This scoping review aims to analyze the evidence concerning TDF administration in patients with cachexia irrespective of the underlying pathology. The primary objective is to assess the analgesic efficacy and tolerability of TDF in cachectic patients. The secondary objective is to identify cachexia characteristics that may influence fentanyl pharmacokinetics (PK). A comprehensive search of PubMed, Embase, and Web of Science databases was conducted up to March 2024. The review included observational and clinical studies on cachectic patients with moderate to severe pain treated with TDF patches at any dosage or frequency. Phase 1 trials, animal studies, case reports, preclinical studies and conference abstracts were excluded. Nine studies were included: four studies reported that cachexia negatively impacted TDF efficacy, increasing required doses and lowering plasma concentrations; three studies found minimal or no impact of cachexia on TDF efficacy and PK; two studies suggested that cachexia might improve TDF outcomes. Study quality ranged from moderate to high, according to the National Institutes of Health (NIH) Quality Assessment Tool. The current evidence is insufficient to provide any definitive recommendations for TDF prescribing in cachectic patients.

A comparison between the administration of oral prolonged-release oxycodone-naloxone and transdermal fentanyl in patients with moderate-to-severe cancer pain: a propensity score analysis.

BackgroundOpioids are the most important pharmacological treatment for moderate-to-severe cancer pain, but side effects limit their use. Transdermal fentanyl (TDF) and oral prolonged-release oxycodone-naloxone (OXN-PR) are effective in controlling chronic pain, with less constipation compared to other opioids. However, TDF and OXN-PR have never been directly compared.Patients and methodsCancer patients with moderate-to-severe chronic pain were consecutively enrolled in two prospective 28-day trials, received either TDF or OXN-PR, and were assessed at baseline and after 7, 14, 21, and 28 days. The primary endpoint was 28-day analgesic response rate (average pain intensity decrease ≥30% from baseline). Other outcome measures included opioid daily dose changes over time; need for adjuvant analgesics; number of switches; premature discontinuation; presence and severity of constipation; and other adverse drug reactions. To compare the efficacy and the safety of TDF and OXN-PR, we used the propensity score analysis to adjust for heterogeneity between the two patient groups.ResultsThree hundred ten out of 336 patients originally treated (119 TDF and 191 OXN-PR) were included in the comparative analysis. The amount of responders was comparable after TDF (75.3%) and OXN-PR administration (82.9%, not significant [NS]). The final opioid daily dose expressed as morphine equivalent was 113.6 mg for TDF and 44.5 mg for OXN-PR (p<0.0001). A daily opioid dose escalation >5% was less common after OXN-PR (19.3%) than after TDS administration (37.9%, p<0.0001). Opioid switches and discontinuation were similar in both groups. Severe constipation in the two groups was comparable (32.6% after TDF vs 24.7% after OXN-PR, NS). Nausea, vomiting, and dry mouth were significantly less frequent in the OXN-PR group than in the TDF group.ConclusionDespite a similar analgesic activity in moderate-to-severe cancer pain, OXN-PR is characterized by lower daily dosages, less need for drug escalation, and fewer side effects compared to TDF.

経皮フェンタニル貼付剤からオキシコドン注射剤へのオピオイド・スイッチングにおける，鎮痛達成に向けたオキシコドン投与量の検討

経皮フェンタニル貼付剤からオキシコドン注射剤へのオピオイド・スイッチングにおける，鎮痛達成に向けたオキシコドン投与量の検討

(482) Daily application of transdermal fentanyl in patients receiving hyperbaric oxygen therapy

Therapy with hyperbaric oxygen (HBOT) can pose challenges in pain management when a patient’s drug regimen involves topical drug delivery. Safety protocols require that topically applied medications be removed from patients prior to entrance in the hyperbaric chamber, and many institutional policies state that removed patches are not to be re-applied. Ideally, a patient’s analgesic regimen would be changed to oral or parenteral analgesics while HBOT is underway. However, in certain instances this is not feasible, therefore, clinicians must seek safe methods of providing adequate analgesia to support patient adherence to HBOT. Transdermal fentanyl has a specialized drug delivery mechanism and provides an advantage in terms of selecting favorable routes of administration while considering patient ease of use. Coupled with the favorable route of administration is the risk of patient harm due to various factors: use of a narcotic analgesic with potent activity, equianalgesic dosing ranges, clinician unfamiliarity with pharmacokinetics specific to this formulation, or patient uncertainty about dosing schedule or factors which may alter drug absorption. While the recommended dosing interval is 72 hours, many references discuss the use of 48 hour intervals in select patients, and no published reference recommends dosing intervals shorter than 48 hours. This case series discusses the use of transdermal fentanyl, applied every 24 hours, in patients undergoing hyperbaric oxygen therapy for wound care. Patient 1 was a 47 year old female with diabetes mellitus, sepsis, and left foot wound with toe necrosis. Complicating her management was the presence of chronic pain syndrome secondary to fibromyalgia. Patient 2 was a 70 year old female with paralysis secondary to spinal fracture who presented with a stage IV sacral pressure ulcer, who was later diagnosed with osteomyelitis. Both patients were successfully managed with daily application of fentanyl transdermal patch. Therapy with hyperbaric oxygen (HBOT) can pose challenges in pain management when a patient’s drug regimen involves topical drug delivery. Safety protocols require that topically applied medications be removed from patients prior to entrance in the hyperbaric chamber, and many institutional policies state that removed patches are not to be re-applied. Ideally, a patient’s analgesic regimen would be changed to oral or parenteral analgesics while HBOT is underway. However, in certain instances this is not feasible, therefore, clinicians must seek safe methods of providing adequate analgesia to support patient adherence to HBOT. Transdermal fentanyl has a specialized drug delivery mechanism and provides an advantage in terms of selecting favorable routes of administration while considering patient ease of use. Coupled with the favorable route of administration is the risk of patient harm due to various factors: use of a narcotic analgesic with potent activity, equianalgesic dosing ranges, clinician unfamiliarity with pharmacokinetics specific to this formulation, or patient uncertainty about dosing schedule or factors which may alter drug absorption. While the recommended dosing interval is 72 hours, many references discuss the use of 48 hour intervals in select patients, and no published reference recommends dosing intervals shorter than 48 hours. This case series discusses the use of transdermal fentanyl, applied every 24 hours, in patients undergoing hyperbaric oxygen therapy for wound care. Patient 1 was a 47 year old female with diabetes mellitus, sepsis, and left foot wound with toe necrosis. Complicating her management was the presence of chronic pain syndrome secondary to fibromyalgia. Patient 2 was a 70 year old female with paralysis secondary to spinal fracture who presented with a stage IV sacral pressure ulcer, who was later diagnosed with osteomyelitis. Both patients were successfully managed with daily application of fentanyl transdermal patch.

Efficacy of transdermal fentanyl in patients with mechanic neck or back pain

Study population included 50 subjects who were consecutively recruited from Gaziantep University Department of Physical Medicine and Rehabilitation among patients referred for screening of mechanic low back or neck pain. They were diagnosed as cervical or lumbar disc herniation according to their clinical and radiological findings. The demographical features, medications, duration of each medications, concomitant diseases, routine test results were recorded. The severity of pain, health related quality of life was evaluated by Visual Analogue Scale (VAS), Short Form 36 (SF 36) in respectively. Transdermal fentanyl was applied as 12 μg/h patch after the first evaluation. Mean age of patients with low back pain and neck pain was measured as 43.6±10.5 and 48.7±10.6 years, respectively. There were no significant differences between two patients group in respect to age, gender, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) levels (p>0.05). There were significant healing in mean scores of role emotional, physical functioning, role physical, bodily pain subscales of SF 36 after treatment in cervical disc herniation group (p

Population Pharmacokinetics of Transdermal Fentanyl in Patients With Cancer-Related Pain

ABSTRACTDetermining the appropriate dose of transdermal fentanyl (TDF) for the alleviation of cancer pain requires determining the factors causing variations in serum fentanyl concentration after TDF treatment. The objective of this study was to identify these factors and incorporate them into a formula that can be used to predict serum fentanyl concentration after application of a TDF patch. Blood samples of cancer patients treated with a TDF patch for the alleviation of pain were collected at 24, 48, and 72 hours after application to evaluate population pharmacokinetics using the nonlinear mixed-effect model (NONMEM). Based upon this evaluation, Child-Pugh Score and use of a cytochrome P450 3A4 (CYP3A4) inducer were identified as the most significant factors in variations in serum fentanyl concentration and incorporated into the following Final Model formula: CLfenta (L/h) = 3.53 × (15 − Child-Pugh Score) × (1 + 1.38 × use or no use of CYP3A4 inducer). Bootstrap evaluation of the Final Model revealed a high convergence rate, suggesting that the model formula is a reliable and useful tool for determining TDF dose for the alleviation of cancer pain.

Factors Predicting Requirement of High-dose Transdermal Fentanyl in Opioid Switching From Oral Morphine or Oxycodone in Patients With Cancer Pain

To identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain. The participants were 76 hospitalized terminal cancer patients who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl at our hospital between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 μg/h)/oral morphine (60 mg) or oxycodone (40 mg)=1. The response evaluated was the dose conversion ratio [transdermal fentanyl/oral morphine or oxycodone (conversion dose to fentanyl)]=Y and was taken to be 0 for Y≤1, 1 for 1<Y≤2, 2 for 2<Y≤3, and 3 for 3<Y. Predictors evaluated were factors potentially impacting pain. Ordered logistic regression analysis was carried out to identify the predictive factors requiring high-dose transdermal fentanyl in opioid switching. Breast cancer [odds ratio (OR)=8.218; 95% confidence interval (CI), 1.219-55.407; P=0.0305], total protein level (OR=0.630; 95% CI, 0.408-0.974; P=0.0377), alanine aminotransferase level (OR=1.017; 95% CI, 1.001-1.033; P=0.0390), advanced age (OR=3.700; 95% CI, 1.360-10.063; P=0.0104), and male sex (OR=3.702; 95% CI, 1.355-10.115; P=0.0107) were found to be significant predictive factors requiring high-dose transdermal fentanyl in opioid switching. Our study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male sex are significant predictors of a need for higher dose transdermal fentanyl in opioid switching. Our results are considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.

The dosing frequency of sustained-release opioids and the prevalence of end-of-dose failure in cancer pain control: a Korean multicenter study

End-of-dose failure is commonly observed as therapeutic levels of sustained-release opioids fall. However, little is known about using these medications for cancer pain control. To determine the dosing frequency of sustained-release opioids (morphine, oxycodone, and transdermal fentanyl) and the prevalence of end-of-dose failure in clinical practice, a patient-reported survey was performed. A multicenter survey was conducted in 56 hospitals in Korea between June and November 2008. The study enrolled 1,097 cancer outpatients who were prescribed oral sustained-release opioids (morphine or oxycodone) or transdermal fentanyl. Of the oral sustained-release opioid patients, 67.0% took oral sustained-release oral opioids twice daily, while 26.2% took them more than twice daily. Of the transdermal fentanyl patients, 88.8% wore the patch for 72 h. Of the enrolled patients, 48.3% experienced worsening pain just before the next sustained-release opioid dose, and 36.8% of these patients took medication earlier than the prescribed dosing schedule. Patients felt that oral sustained-release opioids gave adequate pain control lasting an average of 9.6 h, versus an average of 62.9 h for transdermal fentanyl. This survey demonstrated that sustained-release opioids are used by patients in a manner that is inconsistent with standard recommendations. End-of-dose failure is suggested to explain increased dosing frequency, and patients reported that adequate pain relief lasted for less time than was stated in the manufacturers' prescription recommendation.

Transdermal fentanyl improves pain control and functionality in patients with osteoarthritis: an open-label Canadian trial

Current treatment guidelines advocate opioids for arthritis when standard analgesics produce inadequate relief. Efficacy, adverse effects (AEs), dosing regimens, physician expertise and patient preference influence treatment selection. This study assessed transdermal fentanyl (TDF) as a treatment option for osteoarthritis (OA) patients. This prospective, Canadian open-label, 8-week trial assessed the efficacy and safety of TDF in patients with OA of hip or knee with moderate-to-severe target joint pain inadequately controlled using weak opioids. TDF was initiated at 25 mcg/h and titrated to optimal pain control. Rescue acetaminophen 500 mg was allowed (maximum 4 g/day). The main endpoint was improvement in pain control assessment rating (five rating categories); pain intensity (0-10 numerical scale), functionality (WOMAC-OA Index), health-related quality of life (SF-36 Health Survey) and global impression were also evaluated. Eighty-one patients (61% female, mean age 60 years) were enrolled; 62 were evaluable. All had failed on previous weak opioid therapy, primarily codeine or codeine combinations. At treatment end, 65% rated pain control as improved (Pain Control Assessment rating change >or=1 category; p<0.0001); mean change in pain intensity was a reduction of greater than 2 (p<0.0001); almost 50% were maintained on TDF 25 mcg/h with less than 1.3 g/day of rescue acetaminophen. At 1 month and end of treatment, changes in the SF-36 physical global scale and individual sub-scores for the pain index and role-physical scales were highly significant (p<0.0001). Improvement in functionality was noted at 1 month and at end of treatment with significant reductions in total WOMAC score, individual pain, stiffness and physical function sub-scores (p<0.0001). AEs causing discontinuation (n=32) included nausea, dizziness and vomiting. Most treatment-related AEs were mild to moderate in intensity. TDF improved pain control, functionality and health-related quality of life in these patients. The findings support current recommendations for use of opioids such as TDF as a treatment option for a sub-population of patients with OA pain.

Transdermal fentanyl in patients with osteoarthritis: Comment on the article by Langford et al

Transdermal fentanyl in patients with osteoarthritis: Comment on the article by Langford et al

Economic evaluation of Durogesic in moderate to severe, nonmalignant, chronic pain in Germany

We carried out a cost-effectiveness evaluation of transdermal fentanyl compared to three other widely used opioids: transdermal buprenorphine, sustained-release morphine, and controlled-release oxycodone from a third-party-payers perspective. A decision analytic model with data from a structured database search and from panel data and assumptions was used to derive both cost and utility results. Probabilistic sensitivity analysis was performed to ensure the findings. Transdermal fentanyl patients gain more quality adjusted life-days or quality-adjusted life-years per euro. The incremental cost per quality-adjusted life-year is 1,625.65 euro for transdermal fentanyl compared to sustained-release morphine and 1,003.03 euro compared to CO, and it is cost-saving compared to transdermal buprenorphine (-203.38 euro per patient). Transdermal fentanyl is thus cost-effective compared to both sustained-release morphine and CO and dominant compared to transdermal buprenorphine in the treatment of adults with nonmalignant moderate to severe chronic pain.

Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial

We have performed a prospective evaluation of the efficacy, safety and convenience of the transdermal therapeutic system - fentanyl (TTS-F) in Turkish cancer patients when it was newly available in Turkey. Ninety-nine patients with historically confirmed malignancy and pain entered the study; the mean age was 55.1 (16-58) years. The study duration was 28 days. Transdermal therapeutic system - fentanyl was used in opioid-naïve or pre-treated patients. Most patients reported a decrease in pain severity. Use of rescue medication decreased from day 4 to day 28. The majority of patients rated patch convenience of use as excellent. A total of 22.2% of patients experienced adverse events that were either probably related or very likely to be related to the study drug. The majority of the adverse events mentioned were related to the digestive system. Eighteen serious adverse events were reported by 13 patients. Six events were doubtfully related, and 12 events were not related to the study drug. Four patients died during the trial. None of these deaths was attributed to the study drug. In conclusion, the trial showed that TTS-F is easily managed, effective and will help to enable the appropriate opioid administration to patients who are suffering from cancer pain in Turkey.

Benefits of transdermal fentanyl in patients with rheumatoid arthritis or with osteoarthritis of the knee or hip: an open-label study to assess pain control

SUMMARYObjectives: To evaluate the effectiveness and safety of transdermal fentanyl (TDF) for the treatment of pain associated with rheumatoid arthritis (RA) or osteoarthritis of the knee or hip (OA), which was not adequately controlled by non-opioid analgesics and/or weak opioids.Methods: The study design incorporated a 1-week run-in period when current analgesic medications were optimised, a 28-day treatment period and a 1-week taper-off period. Patients with RA (n = 104) and OA (n = 159) started treatment with TDF 25 µg/h. Patches were replaced every 72 h, with the option to up-titrate until adequate pain control was achieved. Metoclopramide was taken during the first treatment week and as needed thereafter.Results: 203 patients completed the treatment phase, 90 entered the taper-off phase. 25 µg/h was the most frequently used maximum dose (51%). Pain control was increased from 4% to 29% of patients during run-in. The number of patients reaching adequate pain control in the first treatment week was increased to 75%, and increased further to 88% on day 28 and to 80% at endpoint. From baseline (screening) to endpoint, there were significant reductions in pain ( p < 0.001) on the Wisconsin Brief Pain Inventory, and significant improvements in quality of life (Short-Form-36: physical p < 0.001; mental health p < 0.05). Eighty per cent of the patients (n = 134) assessed the treatment favourably; nausea and vomiting were the most common adverse events, mainly occurring at treatment initiation. Efficacy of metoclopramide appeared limited. TDF could be initiated in patients pre-treated with non-opioid analgesics or weak opioids and tapered off without major complications.Conclusions: TDF significantly improved pain control and quality of life, and was well tolerated in patients with RA or knee/hip OA who continued to experience pain on their current analgesic treatment. Treatment could be discontinued without issues. Nausea and vomiting was usually mild during treatment initiation. Patients’ well being could be further accommodated by optimising prophylactic treatment.

Efficacy and safety of transdermal fentanyl and sustained-release oral morphine in patients with cancer and chronic non-cancer pain

SUMMARYPurpose: To evaluate effectiveness and safety information of transdermal fentanyl (TDF) (Duragesic/Durogesic*) and sustained-release oral morphine (SRM) in cancer pain (CP) and chronic non-cancer pain (NCP), a pooled analysis was conducted on datasets of published, open label, uncontrolled (no comparator group) and randomised controlled (with SRM as comparator) studies of TDF.Patients and methods: Eight trials with treatment durations of at least 28 days met the inclusion criteria. The effectiveness analysis assessed changes in average pain and pain ‘right now’ scores between baseline and Day 28. The safety analysis evaluated the incidence of adverse events (AEs) reported within the first 28 days of treatment with TDF or SRM. Subgroup analyses included pain type, gender, age, weight, and body mass index.Results: Pooled efficacy data were available from 1220 patients; these showed that both TDF and SRM were effective in improving pain ‘right now’ scores (0–100 scale) from baseline to Day 28. The improvement was significantly more pronounced in the TDF treatment group (–26.7 ± 31.3 for TDF, –18.7 ± 30.9 for SRM, p = 0.002). This favourable effect of TDF was most apparent amongst patients with NCP. Data concerning AEs were available from over 2500 patients with CP (3 out of 10 patients) or chronic NCP (7 out of 10 patients). Significantly fewer patients in the TDF than in the SRM group reported any AE (72% vs. 87% respectively; p < 0.001), or an AE leading to the study drug being permanently discontinued (16% vs. 23% respectively; p < 0.001). Constipation and somnolence occurred considerably less frequently in the TDF than in the SRM treatment group. This difference was statistically significant in both the CP and NCP subgroups.Conclusion: This pooled data analysis provides expanded insight into the safety and effectiveness profile of transdermal fentanyl in patients with chronic pain. It shows significantly improved pain relief with transdermal fentanyl compared with sustained-release oral morphine, and supports current evidence of favourable tolerability of transdermal fentanyl, particularly with regard to reduced constipation and somnolence.

Risk of Constipation in Patients Prescribed Fentanyl Transdermal System or Oxycodone Hydrochloride Controlled-Release in a California Medicaid Population

To compare the risk of developing constipation between patients prescribed fentanyl transdermal system or oxycodone hydrochloride (HCl) controlled-release. California Medicaid (Medi-Cal) claims data. Medicaid beneficiaries in California. Chronic pain patients who received a prescription for transdermal fentanyl or oxycodone controlled-release between October 1, 1997, and February 28, 2000, for at least three consecutive months. Constipation was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification code (ICD-9-CM 564.0). The association between long-acting opioid use and constipation was determined by multivariate logistic regression after controlling for drug strength, short-acting opioid usage, and comorbidities. Odds ratios (ORs), 95% confidence intervals (CIs), and P values were reported. A total of 2,095 patients were included in the regression analysis (transdermal fentanyl = 877; oxycodone controlled-release = 1,218). Seventy-five patients received a constipation diagnosis (transdermal fentanyl = 28; oxycodone controlled-release = 47). Approximately 40% of patients were at least 65 years of age. Overall, oxycodone controlled-release patients had a significantly greater risk of developing constipation compared with transdermal fentanyl patients (transdermal fentanyl: n = 877; oxycodone controlled-release: n=1,218; OR = 2.55; 95% CI = 1.33-4.89; P = 0.005). Among patients who were 65 years or older, oxycodone controlled-release patients were 7.33 times more likely to be constipated than transdermal fentanyl patients (transdermal fentanyl: n = 518; oxycodone controlled-release: n = 317; OR = 7.33; 95% CI = 1.98-27.13; P = 0.003). These findings suggest that patients prescribed transdermal fentanyl may have a significantly lower risk of developing constipation compared with oxycodone controlled-release, particularly in the elderly.

Comparison of resource utilization by patients treated with transdermal fentanyl and long-acting oral opioids for nonmalignant pain.

To quantify resource utilization and costs incurred for patients who received transdermal fentanyl as their first long-acting analgesic for non-malignant pain, and to compare these with utilization and costs for similar patients dispensed other long-acting oral opioids. A retrospective matched cohort study using medical claims data from a large New England Insurer. We identified 478 patients without cancer who received transdermal fentanyl during 1995-1998. We selected patients who had no previous long-acting opioid dispensings and were enrolled during the 180 days before and 30 days following the initial dispensing. We used propensity scores to identify a matched comparison group of 478 long-acting oral opioid users. Transdermal fentanyl and matched long-acting oral opioid users incurred identical median costs for outpatient medical services and prescriptions during 2 years of follow-up. A larger proportion of transdermal fentanyl patients were still taking their initial opioid analgesic at the end of the 2-year follow-up than were patients initially taking other long-acting opioids. Use of short-acting opioids tapered off more slowly among transdermal fentanyl patients than among long-acting opioid patients. In the first 6 months, the transdermal fentanyl patients had more hospital discharges than the long-acting oral opioid patients, but this difference appeared to reflect preexisting conditions. Users of fentanyl transdermal system and other long-acting opioids experienced essentially identical evolution of health services utilization and costs over a 2-year period. The choice of long-acting opioid analgesia does not appear to be a determinant of future medical costs.

Use of Transdermal Fentanyl in Patients with Continuous Non-Malignant Pain

Objective: The aim of this case report series is to detail the use in a clinical setting of transdermal fentanyl patches for the treatment of patients with continuous non-malignant pain. Case reports: These cases, collected in Ireland, describe patients with back pain, leg pain, arthritic pain and pain from other non-malignant pathologies. Opioids differ in terms of potency and adverse effects, and also in their methods of administration. In these case reports fentanyl used transdermally was effective in alleviating pain where other analgesics had provided only limited relief. Patients show a range of individual benefits from treatment with transdermal fentanyl, including increased independence. Conclusion: Transdermal fentanyl is a well tolerated and highly acceptable treatment for patients requiring strong opioids for continuous pain secondary to non-malignant conditions.

(218) Outcomes Associated with Fentanyl Transdermal System and Oxycodone Controlled-Release in a California Medicaid Population

Introduction: In addition to chronic pain interfering with physical and mental functioning, certain medications used to treat chronic pain may have undesirable effects. A health insurance claims database study was conducted to identify the incidence of two side effects that may be associated with chronic opioid use-constipation and drowsiness-and to compare the risk of developing these conditions. Methods: The California Medicaid (Medi-Cal) database was used to identify the number of chronic pain patients who received a prescription for Duragesic® (fentanyl transdermal system), OxyContin® (oxycodone HCL controlled-release), or codeine between July 1, 1994 and November 30, 1999. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to define constipation (564.0) and drowsiness (780.09). Amphetamine use (defined using NDC codes) was also examined as a marker of drowsiness, since these drugs are likely to be used as a stimulant in drowsy patients. Results: A total of 1,422,427 patients met these criteria, the majority of whom were codeine patients (codeine only = 1,411,251; transdermal fentanyl only = 8,198; oxycodone controlled-release only = 2,978). Oxycodone controlled-release patients had a 58% greater risk of developing constipation compared with transdermal fentanyl (RR = 1.58, p < 0.001); codeine patients had a 26% greater risk of this outcome compared with transdermal fentanyl (RR = 1.26, p = 0.001). Oxycodone controlled-release patients were 34% more likely to be drowsy than transdermal fentanyl patients (RR = 1.34, p = 0.040). Amphetamine use was significantly higher in oxycodone controlled-release patients compared with transdermal fentanyl patients (RR = 2.79, p < 0.001). Amphetamine use in the codeine group was not significantly different from the transdermal fentanyl group. Conclusions: These preliminary findings suggest that patients prescribed Duragesic® (fentanyl transdermal system) have a significantly lower risk of developing constipation or drowsiness compared with OxyContin® (oxycodone HCL controlled-release). Future research will consider the impact of confounding factors-such as age, drug strength, and short-acting opioid usage-on these outcomes.

Transdermal Fentanyl in Opioid-Naive Cancer Pain Patients: An Open Trial Using Transdermal Fentanyl for the Treatment of Chronic Cancer Pain in Opioid-Naive Patients and a Group Using Codeine

To treat cancer pain, physicians often decide to jump directly from step 1 of the World Health Organization (WHO) analgesic ladder to step 3. The use of transdermal fentanyl in patients with cancer pain who had either used no opioid before, or only codeine, is evaluated in the present trial. Both opioid-naive ( N = 14) and codeine-using ( N = 14) patients started with transdermal fentanyl in the lowest available delivery rate (25 μg/hr). Immediate-release oral morphine was present as “rescue” medication. Transdermal fentanyl provided good to excellent pain relief in the majority (68 %) of these patients. During the study, 5 patients continued with 25 μg/hr, and the others used a higher dose. Clinically relevant respiratory depression was not observed. The common side effects of opioids were found; constipation was mentioned by 3 patients (11 %). Transdermal fentanyl appeared a safe analgesic in these opioid-naive cancer pain patients. In this study, WHO step 2 could be skipped without untoward complications.

Successful Use of Transdermal Fentanyl in Patients with Cancers of the Prostate, Ovary and Stomach

Successful Use of Transdermal Fentanyl in Patients with Cancers of the Prostate, Ovary and Stomach