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Overview: Transdermal fentanyl is an opioid pain medicine used to treat severe and persistent pain when other medicines are not enough. It works on receptors in the body to help keep you from feeling pain. Common side effects include nausea, vomiting, sleepiness, dizziness, and constipation. Talk to your health care provider right away if you develop confusion or shortness of breath, have trouble staying awake, or feel like your pain is getting worse instead of better. Before using transdermal fentanyl, make sure to tell your health care provider about any health conditions you have or medicines you are taking. 

Uses

What is transdermal fentanyl used for?

Transdermal fentanyl is commonly used to treat severe and persistent pain when other medicines are not enough.

Transdermal fentanyl may also be used for other conditions as determined by your health care provider.

How does transdermal fentanyl work (mechanism of action)?

Transdermal fentanyl works on receptors in the body to help keep you from feeling pain by altering how your body feels and responds to pain.

How is transdermal fentanyl supplied (dosage forms)?

Brands and other names

  • Duragesic

Dosage forms and strengths

  • 12 mcg/hr, 25 mcg/hr, 37.5 mcg/hr, 50 mcg/hr, 62.5 mcg/hr, 75 mcg/hr, 87.5 mcg/hr, 100 mcg/hr transdermal system (patch)

How should I store transdermal fentanyl?

Transdermal fentanyl should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. Keep transdermal fentanyl in the original unopened pouch until you are ready to apply the patch. 

Side Effects

What are the most common side effects of transdermal fentanyl?

The most common side effects of transdermal fentanyl are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Nausea or vomiting
  • Sleepiness or tiredness
  • Dizziness
  • Trouble sleeping
  • Constipation (see below)
  • Excessive sweating
  • Feeling cold
  • Loss of appetite
  • Headache
  • Stomach pain or diarrhea
  • Itching, redness, or rash where the patch is applied

There may be other side effects of transdermal fentanyl that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of transdermal fentanyl?

While less common, the most serious side effects of transdermal fentanyl are described below, along with what to do if they happen.

Severe Allergic Reactions. Transdermal fentanyl may cause allergic reactions, which can be serious. Get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Risk of Misuse and Addiction. Misusing transdermal fentanyl can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Use transdermal fentanyl exactly as prescribed. Tell your health care provider if you feel that transdermal fentanyl is not working. Call your health care provider right away or go to the nearest emergency room if you have any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures

Breathing Problems. Transdermal fentanyl may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your health care provider if you develop severe sleepiness or trouble breathing, especially when you start transdermal fentanyl or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including a bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake

Increased Pain and Pain Sensitivity. Transdermal fentanyl may cause allodynia, which is when you have pain from something that normally does not cause pain, such as brushing your hair. Transdermal fentanyl may also cause hyperalgesia, which is when you are very sensitive to pain. Contact your health care provider right away if you have pain from things that did not cause pain before, worsening pain, or more pain sensitivity. Do not use more transdermal fentanyl if your pain feels worse as this may cause serious side effects. 

Reduced Adrenal Function. Long-term use of transdermal fentanyl can cause your body’s adrenal glands to stop making as much cortisol (the stress hormone). This is known as adrenal insufficiency. Adrenal insufficiency can get worse if your body is under stress because of fever, surgery, or trauma. Tell your health care provider if you have any of the following symptoms of adrenal insufficiency.

  • Nausea and vomiting
  • Weakness, tiredness, or lack of energy
  • Low blood pressure

Low Blood Pressure (Hypotension). Transdermal fentanyl may cause low blood pressure. If you feel faint or dizzy, lie down. Tell your health care provider right away if you have any of the following symptoms of low blood pressure.

  • Dizziness, feeling lightheaded, or fainting
  • Confusion
  • Feeling weak or tired

Heart Rate Changes. Transdermal fentanyl can make your heart beat slower than normal (bradycardia). Call your health care provider right away if you have any of the following symptoms of bradycardia. 

  • Feeling lightheaded, dizziness, or fainting
  • Confusion
  • Feeling weak or easily tired 
  • Slow heartbeat or feeling of skipped heartbeats 
  • Chest pain
  • Shortness of breath

Sphincter of Oddi Spasm. The sphincter of Oddi is a muscular valve in your body that controls the flow of bile and digestive juices from the pancreas into the small intestine. When this valve spasms, it may feel like getting a tight muscle cramp, causing pain and blocking the flow of these juices, which can lead to discomfort and digestive problems. This is more likely to happen if you do not have a gallbladder. Get emergency help if you have new or worse stomach pain or pain in the upper right side of your stomach area that travels to your back or shoulder, with or without nausea and vomiting. 

Constipation. Some people using transdermal fentanyl have had severe constipation. Some needed to go to the hospital. Get help right away if you have severe constipation. 

Warnings & Precautions

Who should not use transdermal fentanyl?

Allergies to Ingredients. People who are allergic to any of the following should not use transdermal fentanyl.

  • Duragesic
  • Fentanyl
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific transdermal fentanyl products they stock.

Opioid Intolerant. Transdermal fentanyl should not be used if you are not already using an opioid pain medicine regularly. That is because your body will not be used to handling opioids (opioid intolerant), and using transdermal fentanyl could lead to serious risks like dangerous breathing problems or overdose.

Pain. Transdermal fentanyl should not be used for treating acute, intermittent, or mild pain. It should also not be used to manage pain after surgery, especially outpatient procedures. Using transdermal fentanyl could lead to serious risks like dangerous breathing problems or overdose.

Lung problems. Transdermal fentanyl should not be used if you have severe asthma, trouble breathing, or other lung problems. Transdermal fentanyl can make these conditions worse.

Gut Blockage. Transdermal fentanyl should not be used if you have a blockage of your gut (bowel obstruction) or a narrowing of the stomach or intestines. Transdermal fentanyl can make these conditions worse. 

Slowed Gut Movement. Paralytic ileus is a type of ileus where your intestines are unable to move food through them. Transdermal fentanyl can make this condition worse.

What should I know about transdermal fentanyl before using it?

Do not use transdermal fentanyl unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share transdermal fentanyl with other people, even if they have the same condition as you. It may harm them.

Keep transdermal fentanyl out of the reach of children. Transdermal fentanyl is a controlled substance because it can be misused or lead to dependence. Store transdermal fentanyl in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

Make sure that you or a caregiver understands how to properly apply and remove transdermal fentanyl. If you have any questions, talk to your health care provider.

Apply transdermal fentanyl to a flat surface on your chest, back, flank (sides of the waist), or upper arm. Do not apply the patch to skin that is oily, burned, broken out, cut, irritated, or damaged in any way. Avoid sensitive areas or those that move a lot. 

If the area where you are applying transdermal fentanyl is hairy, clip the hair as close to the skin as possible. Do not shave the area as shaving can irritate the skin. 

If you need to clean the site where you are applying transdermal fentanyl, use water. Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin. Allow the skin to dry completely before applying the patch.

After applying transdermal fentanyl, always wash your hands with soap and water. 

It is okay to bathe, swim, or shower while wearing transdermal fentanyl. But do not take hot baths or sunbathe; use hot tubs, saunas, heating pads, electric blankets, heated waterbeds, or tanning lamps; or engage in exercise that increases your body temperature. These can cause too much medicine to be released into your body that can lead to an overdose or death. 

If your patch is not sticking well to your skin, talk to your health care provider or pharmacist. Certain types of tapes or adhesive films can be applied on top of transdermal fentanyl if your patch does not stay on your skin properly. Do not apply anything on top of transdermal fentanyl without talking to your health care provider first.

If your patch falls off, do not reapply the same patch. Apply a new fentanyl patch at a different application site. 

Dispose of expired, unwanted, or unused transdermal fentanyl right away by taking your medicine to an authorized DEA-registered collector or a drug take-back program. If one is not available, you can remove the patch from its pouch and liner, fold the sticky sides of the patch together, then flush it down the toilet.

Do not stop using transdermal fentanyl without talking to your health care provider. Stopping transdermal fentanyl too quickly can cause serious withdrawal effects. Call your health care provider right away if you have any of the following symptoms.

  • Feeling restless
  • Watery eyes or runny nose
  • Yawning
  • Sweating or chills
  • Muscle, joint, or back pain
  • Dilated pupils 
  • Irritability, anxiety, or trouble sleeping
  • Nausea, vomiting, diarrhea, stomach cramps, or loss of appetite
  • Increase in blood pressure, breathing rate, or heart rate

Do not cut, break, chew, crush, dissolve, snort, or inject transdermal fentanyl. This can increase your risk of overdose and death.

Your health care provider may ask you to have naloxone, a medicine used to reverse the effects of transdermal fentanyl, on hand in case of an emergency. Make sure that you and a caregiver know how to use naloxone. If you have any questions, talk to your health care provider or pharmacist. 

People who are 65 or older can be at greater risk for some side effects from transdermal fentanyl. Talk to your health care provider about your risks if you are in this age group.

Transdermal fentanyl can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how transdermal fentanyl affects you.

Long-term use of transdermal fentanyl may affect your ability to become pregnant or get a partner pregnant. Talk to your health care provider if you have any concerns.

What should I tell my health care provider before using transdermal fentanyl?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if transdermal fentanyl is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following. 

  • Head injury or brain problems, such as brain tumors or increased pressure around the brain
  • Seizures
  • Liver, kidney, or thyroid problems
  • Pancreas or gallbladder problems
  • Breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD)
  • Sleep apnea
  • Heart problems
  • Problems peeing 
  • Substance use disorder or living with someone who has this problem
  • Alcohol use disorder
  • History of opioid overdose
  • Mental health problems

Other Medicines and Supplements. Transdermal fentanyl may interact with other medicines and supplements. Before using transdermal fentanyl, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Transdermal fentanyl may cause harm to a fetus. Tell your health care provider if you are pregnant or plan to become pregnant. Your health care provider will let you know if you should use transdermal fentanyl while you are pregnant or trying to get pregnant. If you use transdermal fentanyl on a regular basis during pregnancy, your baby may have withdrawal symptoms that can be life-threatening. Tell your health care provider if you used transdermal fentanyl during your pregnancy, especially near the end of your pregnancy.

Breastfeeding. Do not use transdermal fentanyl while you are breastfeeding. Transdermal fentanyl can pass into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Tell your health care provider right away if your baby is sleepier than usual and get emergency help if your baby is having trouble breathing or is limp.

Interactions

Does transdermal fentanyl interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice can increase the drug levels of fentanyl in your body and increase the risk of side effects. Talk to your health care provider if you eat grapefruit or drink grapefruit juice. 

Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol. Using alcohol while using transdermal fentanyl can increase your risk of overdose and death.

Does transdermal fentanyl interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using transdermal fentanyl.

  • A benzodiazepine, such as clonazepam (Klonopin), diazepam (Valium and others), or lorazepam (Ativan and others), which is a medicine used for anxiety, muscle spasms, or seizures
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, muscle relaxants, and medicines for anxiety
  • Any medicine that affects serotonin in your body, such as medicines for depression, anxiety, or certain mental health conditions; some migraine medicines; and some medicines for nausea and vomiting
  • A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
  • A macrolide antibiotic, such as clarithromycin or erythromycin (Ery-Tab and others), which is a medicine used for bacterial infections
  • Fluconazole (Diflucan), itraconazole (Sporanox, Tolsura), ketoconazole, posaconazole (Noxafil), or voriconazole (Vfend), which are medicines used for fungal infections
  • A protease inhibitor, such as nelfinavir (Viracept) or ritonavir (Norvir), which is a medicine commonly used to treat HIV
  • Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
  • Carbamazepine or phenytoin, which are medicines used for seizures
  • A mixed agonist/antagonist or partial agonist opioid analgesic, such as buprenorphine (Butrans, Sublocade), butorphanol, and others, which are medicines used to treat certain types of pain or opioid use disorder
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems

Some other medicines may alter the blood levels of transdermal fentanyl. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with transdermal fentanyl. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much transdermal fentanyl?

If you or someone else has used too much transdermal fentanyl, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of transdermal fentanyl?

Each transdermal fentanyl patch is usually worn for 72 hours (three days). If you forget to apply a new patch after removing transdermal fentanyl, apply one as soon as you remember. Do not use double or extra patches.