Transdermal fentanyl comes as a patch to apply to the skin. The patch is usually applied to the skin once every 72 hours. Change your patch at about the same time of day every time you change it. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply fentanyl patches exactly as directed.

Your doctor may start you on a low dose fentanyl patch and gradually increase your dose, not more often than once every 3 days at first, and then not more often than once every 6 days. Your doctor may adjust your dose during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with fentanyl patches. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with fentanyl patches.

Fentanyl patches are only for use on the skin. Do not place patches in your mouth or chew or swallow the patches.

Do not stop using fentanyl patches without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop using fentanyl patches you may have symptoms of withdrawal. Call your doctor if you experience any of these symptoms of withdrawal: restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, large pupils (black circles in the center of the eyes), irritability, anxiety, backache, pain in the joints, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast heartbeat, or rapid breathing.

Do not use a fentanyl patch that is cut, damaged, or changed in any way. If you use cut or damaged patches, you may receive most or all of the medication at once, instead of slowly over 3 days. This may cause serious problems, including overdose and death.

You may bathe, swim, or shower while you are wearing a fentanyl patch. If the patch falls off during these activities, dispose of it properly. Then dry your skin completely and apply a new patch to a different skin area. Leave the new patch in place for 72 hours after you apply it.

You can apply a fentanyl patch to your chest, back, upper arms, or the sides of your waist. If you are applying the patch to a child or to a person who is unable to think clearly, choose an area on the upper back to make it more difficult for the person to remove the patch and place it in his or her mouth. Choose an area of skin that is flat and hairless. Do not apply the patch to parts of the body that move a lot or to skin that has been exposed to radiation or that is sensitive, very oily, broken out, irritated, broken, cut or damaged. If there is hair on the skin, use scissors to clip the hair as close to the skin as possible. Do not shave the area.

To apply the patch, follow these steps:

1. Clean the area where you plan to apply the patch with clear water and pat completely dry. Do not use any soaps, lotions, alcohols, or oils.
2. Tear open the pouch containing the fentanyl patch, starting at the slit. Remove the patch from the pouch and peel off both parts of the protective liner from the back of the patch. Try not to touch the sticky side of the patch.
3. Immediately press the sticky side of the patch onto the chosen area of skin with the palm of your hand.
4. Press the patch firmly for at least 30 seconds. Be sure that the patch sticks well to your skin, especially around the edges.
5. If the patch does not stick well or comes loose after it is applied, tape the edges to your skin with first aid tape. If the patch still does not stick well, you may cover it with Bioclusive^® orAskina^® Derm brand see-through dressings. Do not cover the patch with any other type of bandage or tape.
6. If a patch falls off before it is time to remove it, dispose of the patch properly. Apply a new patch to a different skin area and tell your doctor that this happened. Leave the new patch in place for 72 hours.
7. When you are finished applying the patch, wash your hands with water right away.
8. When it is time to change your patch, peel off the old patch and apply a new patch to a different skin area.
9. After you remove your patch, fold it in half with the sticky sides together and flush it down a toilet.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Before using fentanyl patches,

• tell your doctor and pharmacist if you are allergic to fentanyl, or any other medications, or any of the ingredients in fentanyl patches. Ask your doctor or pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Emsam, Zelapar), or tranylcypromine (Parnate).
• The following nonprescription or herbal products may interact with fentanyl: St. John’s wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using fentanyl patches. Do not start these medications while using fentanyl patches without discussing it with your healthcare provider.
• tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to use fentanyl patches.
• tell your doctor if you have or have ever had seizures; slowed heartbeat; difficulty urinating; low blood pressure; adrenal insufficiency (condition in which the adrenal glands do not produce enough of certain hormones needed for important body functions); diabetes; or thyroid, heart, liver, pancreas, gallbladder, or kidney disease.
• tell your doctor if you are breastfeeding. You should not breastfeed while you are using fentanyl patches. Fentanyl can cause shallow breathing, difficulty or noisy breathing, confusion, more than usual sleepiness, trouble breastfeeding, or limpness in breastfed infants.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using fentanyl transdermal patch.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using fentanyl patches.
• you should know that this medication may make you drowsy. Do not drive a car, operate machinery, or do other possibly dangerous activities until you know how this medication affects you.
• you should know that fentanyl patches may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start using fentanyl patches. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• you should know that fentanyl patches may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using fentanyl patches.