Copyright © Diane Gainey - http://www.diane-gainey.co.uk

"If you want others to be happy, practice compassion. If you want to be happy, practice compassion."

THE 14th DALAI LAMA

Using fentanyl in dying patients

Sometimes there is confusion about how best to manage a patient who has been using Fentanyl patches for pain control but who is dying and can no longer take oral medication for breakthrough pain.

These guidelines are intended to clarify and simplify good practice.

1. Continue to change the Fentanyl patch every three days

2. If additional analgesia is necessary, S/C diamorphine or S/C morphine should be given. This can be given in a syringe driver with additional 4 hourly S/C injections available for immediate relief of breakthrough pain

Appropriate doses are:

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Fentanyl patch strength mcg/hr Morphine mg/24 hrs S/C Morphine mg/4 hrs S/C for breakthrough pain
25 10 - 20 5 - 10
50 30 - 40 10 - 15
75 40 - 60 10 - 20
100 60 - 90 15 - 30
200 90 - 180 30 - 60

The Morphine is given in addition to the Fentanyl patch.

For diamorphine, approximate doses are:

Fentanyl patch strength mcg/hrDiamorphine mg/24 hrs s/cDiamorphine mg/4 hrs s/c for breakthrough pain
25 10 - 15 5 - 10
50 20 - 30 5 - 10
75 30 - 40 10 - 20
100 50 20 - 30
200 100 25 - 50

3. The Fentanyl patch should only be discontinued in exceptional circumstances by practitioners with a good working knowledge of the pharmacodynamics of Fentanyl. Many practitioners may prefer to seek expert advice first from:

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Useful Links

North of England cancer network guidelines - PDF file

© Dr. Eileen Palmer, Dr John Howarth Palliative Care for the Primary Health Care Team Quay Books 2005 ISBN 1856422291
© Palliative care pain pack 10 Dr Eileen Palmer 2008
Updated February 2011

Important News

Important Changes in Cumbria Palliative Care Prescribing Practice

Cumbria is changing practice, from 1st April 2011.

The Area Prescribing Committee has recommended the following changes:

  • All strong opioids are to be prescribed by brand name
  • "Just in Case" prescribing is to be encouraged and promoted
  • Morphine is to replace diamorphine as the subcutaneous injectable strong opioid of choice for palliative care patients in Cumbria

21/03/2011

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North Cumbria Pallative Care website

The award winning North Cumbria Palliative Care website continues to receive around 30,000 page views a year. This is 82 page views every single day of the year, 2,500 hits every month, without any publicity or advertising program.

1/3/2011

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