• Oral morphine is preferred when an opioid is required for severe chronic pain, because of its familiarity, availability and the ease of dose adjustment.
• Reserve fentanyl patches for use in opioid-tolerant patients with chronic pain and established opioid needs who cannot take oral morphine, for example, in severe renal impairment. Fentanyl patches might also be useful when oral opioids cannot be used because of vomiting or difficulty swallowing.
• Do not use fentanyl patches in opioid-naïve patients with non-cancer pain because of the potential for serious adverse effects. Fentanyl patches have a delayed onset and prolonged duration of action; adverse opioid effects may be difficult to control.
• Monitor serious adverse effects carefully for 24 hours after removal of the patch, as serum concentrations decline slowly.
• Advise patients to replace patches every 72 hours and no earlier.
• Ensure that patients and carers know about the safe use and disposal of fentanyl patches.

Restricted benefit

Chronic severe disabling pain not responding to non-narcotic analgesics.

Restrictions apply for prescribing increased maximum quantities or repeats for opioid analgesics; review by a second medical practitioner is required if opioid therapy extends beyond 1 year.¹