Published: 1 March 2018

Publications

Transdermal Opioid Patches — Stick to the Correct Application

Prescriber Update 39(1): 11
March 2018

Key Messages

  • Risks of harm are associated with the incorrect use of transdermal opioid patches.
  • Continue to monitor patients for adverse reactions after a transdermal opioid patch is removed as opioid concentrations decline gradually after removal.


Medsafe was recently notified of a case where the administration of a buprenorphine transdermal patch may have contributed to the death of a patient.

There are two types of transdermal opioid patch currently available in New Zealand, the Norspan Transdermal Patch which contains buprenorphine and Fentanyl Sandoz which contains fentanyl1,2.

The risk of harm from transdermal opioid patches can be managed by:

  • starting with a low dose
  • discontinuing all other regular opioids when the patch is initiated
  • avoiding concomitant prescribing of benzodiazepines and other central nervous system depressants where possible because of the risks of profound sedation, respiratory depression, coma and death
  • not discontinuing patches abruptly, a gradual downward titration should be used
  • telling patients how to dispose of a patch safely and to keep them out of reach and sight of children
  • monitoring for adverse reactions and interactions after patch removal as removal of the patch does not instantly reduce opioid concentrations1.

The Health Quality and Safety Commission has published a medication alert to highlight the risks associated with the use of all transdermal patches3.

References
  1. Mundipharma New Zealand Limited. 2017. Norspan Transdermal Patch New Zealand Data Sheet June 2017. URL: www.medsafe.govt.nz/profs/Datasheet/n/Norspanpatch.pdf (accessed 25 January 2018).
  2. Novartis New Zealand Limited. 2017. Fentanyl Sandoz New Zealand Data Sheet 23 January 2017. URL: www.medsafe.govt.nz/profs/Datasheet/f/fentanylsandozpatch.pdf (accessed 25 January 2018).
  3. Health Quality and Safety Commission New Zealand. 2014. Medication Alert – Transdermal Patches September 2014. URL: www.hqsc.govt.nz/assets/Medication-Safety/Alerts-PR/Transdermal-patch-individual-clinician-Sep-2014.pdf (accessed 25 January 2018).
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