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:
| 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/hr | Diamorphine mg/24 hrs s/c | Diamorphine 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:
- Hospital Pharmacy
- Palliative medicine consultant/staff grade doctors
- Any member of the hospital or Community Macmillan team
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