Copyright © Diane Gainey -

"Seeing death as the end of life is like seeing the horizon as the end of the ocean."




References: 1,2 & 3

Using Fentanyl in the dying patient

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.

Appropriate doses are:

Fentanyl Patch
strength mcg/hr
mg/24 hrs s/c
Diamorphine mg/4 hrs s/c
for Breakthrough pain
25 15 5 - 10
50 30 5 - 10
75 40 10 - 20
100 60 20 - 30
200 100 25 - 50

The Diamorphine is given in addition to the Fentanyl patch.


1. British National Formulary 56 (September 2008). There is excellent additional information in the section at the front of the BNF - Prescribing in Palliative Care

2. Twycross R, Wilcock A, - Palliative Care Formulary Third Edition (2007) Palliative Ltd. (Also on with latest updates)

3. Changing Gear - Guidelines for managing the last days of life in adults. National Council for Hospice and Specialist Palliative Care Services. Northamptonshire, Land & Unwin (Data Sciences) Ltd 1997.

Last days of life pack 7 © North Cumbria Palliative Care Service Version 2004/1