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Transdermal fentanyl ,,,the good and bad

The transdermal formulation offers the following advantages:

  • Does not require oral intake (especially useful in patients with dysphagia and NPO status)
  • Does not depend on GI absorption
  • Improved patient compliance
  • Less frequent dosing
  • Long steady state with less peaks and troughs
  • Intravenous access is not required
  • Transdermal administration is not associated with patient discomfort

The disadvantages of the transdermal route include:

  • Lack of efficacy for breakthrough pain given long steady state
  • Difficulty delivering high doses
  • Requires subcutaneous fat making it ineffective in cachectic patients
  • Pharmacokinetics and pharmacodynamics are affected by body temperature (and blood flow to the skin) - Higher levels than expected may be absorbed during a febrile episode.

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