Page 36 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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Fentanyl is an alternative opioid that can be used in cancer pain. In
Malaysia, it is available as transdermal patch, sublingual and parenteral
preparations.
Transdermal (TD) fentanyl should only be considered in patients with
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nausea and vomiting. In a Cochrane systematic review comparing
TD fentanyl with oral morphine for relief of cancer pain, there was
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for the analgesic effect. However, transdermal fentanyl showed a
reduction in constipation (RR=0.61, 95% CI 0.47 to 0.78; NNT=5.5). No
meaningful analysis was possible for other AEs. 37, level I
When switching from other opioids to transdermal fentanyl, there is a
lag time between application of the patch and onset of analgesia due to
its pharmacokinetics whereby on average, minimally effective plasma
concentrations of fentanyl are seen in 12 hours. Regular 4-hourly
oral opioids should therefore, be discontinued 12 hours after patch
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However, an RCT on the conversion of IV to transdermal fentanyl in
chronic cancer pain revealed that the effectiveness of continuing the IV
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12-h method in terms of number of rescue doses for breakthrough pain
required (p>0.05) and thus may be considered for a simpler method of
conversion. 38, level I

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action is 72 hours. The plasma half-life of transdermal fentanyl ranges
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used for maintenance therapy. 34
Fentanyl is generally considered a safer opioid in renal impairment as
its metabolites have minimal effect. 39, level I
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and fentanyl are shown in Table 3.

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