Monitor patients who have experienced serious adverse events for at least 24 hr. Do not cut patches. Use only in patients who have demonstrated opioid tolerance. Observe patients for significant resp depression. Patients w/ COPD or other pulmonary disease; susceptible to the intracranial effects of CO2
eg, those w/ evidence of increased intracranial pressure, impaired consciousness or coma; brain tumors; cardiac disease. Drug dependence may develop upon repeated use. Monitor for signs of misuse, abuse or addiction in patients at increased risk of opioid abuse. Patients w/ fever should be monitored for opioid side effects. Avoid exposing Durogesic to direct external heat sources. Co-administration w/ drugs that affect the serotonergic neurotransmitter systems. May impair ability to drive & use machines. Renal & hepatic impairment. Do not use during pregnancy unless clearly necessary. Not recommended for use in breastfeeding women. Childn <2 yr. Elderly.