Individualized dosage. Assess at regular intervals after application. Initiate dose based on patient’s current opioid use. Replace patch 72 hrly. Increase dose after 3 days if analgesia is insufficient after initial application; or replace patch 48 hrly. Dose titration range: 12-25 mcg/hr. Adult: Opioid-tolerant patient
May titrate dose upward or downward subsequently, in increments of 12 or 25 mcg/hr, depending on response & supplementary analgesic requirements. Opioid-naive patient
Titrate w/ low doses of immediate release opioids (eg, morphine, hydromorphone, oxycodone, tramadol, & codeine) to attain equinalgesic dosage to fentanyl release rate 25 mcg/hr. May titrate dose upward or downward subsequently, in 12 or 25 mcg/hr increments to achieve lowest appropriate dose depending on response & supplementary analgesic requirements. Ped: Opioid-tolerant patient (2-16 yr)
Recommended dosage based upon daily PO morphine dose: 30-44 mg/day 24-hr PO morphine: 12 mcg/hr fentanyl; 45-134 mg/day 24-hr PO morphine: 25 mcg/hr.