Transdermal fentanyl.
OBJECTIVE
To review the use of transdermal fentanyl for the treatment of moderate to severe chronic pain. The article provides background on the pharmacology and pharmacokinetics of the drug, as well as the properties of the transdermal system. In addition, clinical trials, adverse effects, and therapeutic considerations and recommendations are presented.


METHODS
Clinical trials, review articles, and reference texts.


METHODS
Comparative clinical trials involving the use of transdermal fentanyl on postoperative and chronic pain patients.


METHODS
Data from clinical human trials published in the English language were reviewed. Trials were assessed by sample size, opioid dosage regimen, and therapeutic outcome.


RESULTS
Transdermal fentanyl was found to be effective in the control of chronic and postoperative pain. In one trial the overall patient satisfaction with pain control was 79 percent for the transdermal fentanyl group and 44 percent for the placebo group. In another trial, the amount of additional parenteral morphine was significantly lower for the group receiving transdermal fentanyl than for the placebo group (49.9 +/- 4.9 vs. 77.0 +/- 6.3 mg, respectively, p < 0.01). The most common adverse effects recorded were nausea (45-85 percent), pruritus (14-60 percent), and sedation (40-59 percent). The cost of analgesic therapy with this delivery system is higher than that of parenteral opioid analgesia, but less than patient-controlled analgesia.


CONCLUSIONS
The transdermal fentanyl formulation offers some minor advantages over other forms of conventional pain management. Results of early clinical trials are promising, but more studies are needed to evaluate its long-term effectiveness and adverse effects. Specifically, comparisons with standard parenteral and patient-controlled opioid analgesia in chronic malignant and nonmalignant pain are necessary for adequate evaluation of transdermal fentanyl.
Yee
L Y
LY
Department of Veterans Affairs Martinez Medical Center, CA 94553.
Lopez
J R
JR
D000279:Administration, Cutaneous; D000368:Aged; D002626:Chemistry, Pharmaceutical; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D005283:Fentanyl / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D010146:Pain / Q000188:drug therapy*
D005283:Fentanyl