Fentanyl transdermal patch dosage: A detailed guide

This article describes fentanyl transdermal* patch’s dosages and strengths and gives details on how to apply it. You’ll also find information on cost savings and coupon options for fentanyl. If you want to know more about fentanyl transdermal patch, see this overview article. It covers details about the drug’s uses, side effects, and more.

Fentanyl transdermal patch is a generic medication. It’s not available in a brand-name version. Fentanyl comes in other dosage forms, such as a solution for injection that’s given by a healthcare professional. It’s also available as an oral lozenge and a buccal tablet that’s dissolved between the cheek and gum. But none of those other dosage forms are described in this article. To learn more about those forms, talk with your doctor.

* “Transdermal” means the medication is absorbed through the skin into the bloodstream.

Boxed warnings

Fentanyl transdermal patch has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). The warnings are for:

• risk of misuse and addiction*
• risk of serious breathing difficulty called respiratory depression
• risk of accidental exposure
• risk of neonatal opioid withdrawal syndrome
• risk of drug interactions
• risk of increased absorption with heat
• opioid Risk Evaluation and Mitigation Strategy (REMS)

* Misuse is taking a drug in a way other than how a doctor prescribes it. Addiction is feeling unable to stop using a drug even though it may be causing harm.

Due to its serious risks, fentanyl transdermal patch is a Schedule II controlled substance. This means the federal government regulates the drug due to the risk of dependence or misuse. (With dependence, your body needs the drug to function as usual.)

For details about these warnings, see the “Dosage of fentanyl” section below. Also see the end of this article for more information.

Form and strengths of fentanyl

Fentanyl transdermal patch comes as follows:

• Form: patch that you apply to the skin
• Strengths: 12 micrograms per hour (mcg/hour),* 25 mcg/hour, 37.5 mcg/hour, 50 mcg/hour, 62.5 mcg/hour, 75 mcg/hour, 87.5 mcg/hour, 100 mcg/hour

* The 12-mcg strength of fentanyl transdermal patch delivers 12.5 mcg of the drug per hour.

“Transdermal” means the medication is absorbed through the skin into the bloodstream.

Dosage of fentanyl

This article describes the recommended dosages for fentanyl transdermal patch. The drugmaker provides these dosages.

If your doctor prescribes this medication, you should follow the dosage they prescribe. Your doctor will determine the dosage that best meets your needs. Do not change your dosage of fentanyl transdermal patch without your doctor’s recommendation.

Usual recommended dosage of fentanyl in adults

Fentanyl transdermal patch is prescribed to treat severe chronic (long-term) pain in adults needing around-the-clock pain management. It’s prescribed only when other pain medication options don’t work to manage pain. And it’s prescribed only for people who are tolerant to opioid medications. With opioid tolerance, you need a higher opioid dose to feel the effect you had before with a lower dose.

You’re considered opioid tolerant if you’ve been taking a certain dosage of an opioid medication for at least 1 week. Examples include:

• 60 milligrams (mg) of morphine per day
• 25 micrograms (mcg) of transdermal fentanyl per hour
• 30 mg of oral oxycodone per day
• 8 mg of oral hydromorphone per day
• 25 mg of oral oxymorphone per day
• 60 mg of oral hydrocodone per day

Doctors start by prescribing a low dosage of fentanyl transdermal patch. Then, they’ll adjust it over time until the right dosage is reached. Ultimately, your doctor will prescribe the smallest dosage of fentanyl transdermal patch that gives the desired outcome.

Note: Fentanyl has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). See the end of this article for more information about all of fentanyl’s boxed warnings.

Starting dosage: Your doctor will calculate your starting dosage based on several factors. These include your level of pain, dosage of previous opioid medications, and risk of misuse or addiction.* Before you start fentanyl transdermal patch, your doctor will stop or taper you off other extended-release opioid medications. This helps lower your risk of overdose.

Your doctor will start you on the lowest appropriate dosage of fentanyl transdermal patch. They’ll base this on the factors described above. As an example, assume someone was previously taking a total of 60–134 mg of oral morphine per day. In this example, the doctor would likely prescribe a starting dosage of 25 mcg/hour of fentanyl transdermal patch.

Frequency: You’ll apply one patch and leave it in place for 72 hours (3 days) as prescribed.

Once you start fentanyl transdermal patch, your dose won’t increase for at least 3 days. Your doctor will monitor you closely when you begin treatment and whenever your dosage changes.

Maintenance dosage: You’ll take a maintenance dosage for the remainder of treatment after the starting dosage. If needed, your doctor will increase your dose slowly until you reach the dose that manages your pain best.

Some people have a delay before a new dosage of fentanyl reaches its full effect in the body. Because of this, your doctor will wait at least 6 days before increasing the dosage again. (This means after two 3-day applications: one patch worn for 3 days and then another patch worn for 3 days.) This is to avoid serious side effect risks such as breathing difficulty (respiratory depression) or overdose.

Some people have pain despite taking fentanyl transdermal patch, which is called breakthrough pain. In this case, your doctor may adjust your fentanyl transdermal patch dosage. Or they may prescribe an immediate-release (IR) opioid pain medication to be taken with it. An IR medication starts to work in the body right away and typically works for a short period of time.

Frequency: You’ll apply one patch every 72 hours (3 days) as prescribed. You’ll remove the old patch when you apply the new one.

 * Misuse is taking a drug in a way other than how a doctor prescribes it. Addiction is feeling unable to stop using a drug, even though it may be causing harm.

Dosage of fentanyl in children

Fentanyl transdermal patch is prescribed to treat severe chronic (long-term) pain in certain children. They must be age 2 years or older and need around-the-clock pain management.  It’s prescribed only when other pain medication options don’t work to manage pain. And it’s prescribed only to children who are tolerant to opioid medications. With opioid tolerance, you need a higher opioid dose to feel the effect you had before with a lower dose. Children prescribed fentanyl transdermal patch must have previously taken at least 45 mg of oral morphine per day. Or they must have taken a comparable dosage of another opioid medication.

Your child’s doctor will calculate your child’s dosage based on several factors. These include the child’s level of pain and dosage of previous opioid medication. Your child’s doctor will monitor how your child responds to treatment with fentanyl transdermal patch.

To learn more about your child’s dosage of fentanyl transdermal patch, talk with their doctor.

Dosage adjustments for fentanyl

Your doctor will prescribe a dosage of fentanyl transdermal patch based on several factors. These include:

• the severity of your pain
• your age
• other health conditions you may have
• other medications you’re taking
• your tolerance to opioid medications
• how your body responds to fentanyl transdermal patch

Missed dose of fentanyl

Talk with your doctor or pharmacist right away if you realize you forgot to apply a dose of fentanyl transdermal patch. They may advise you to apply the missed dose. Or they may advise you to skip it and apply your next dose as scheduled.

For tips on how to plan your doses of fentanyl transdermal patch and avoid missing a dose, read this article. You could also try:

• downloading a reminder app on your phone
• setting an alarm
• putting a note where you’ll see it, such as on your calendar, bathroom mirror, or bedside table

Frequently asked questions

Below are answers to some commonly asked questions about fentanyl transdermal patch and its dosage.

Do older adults require a dosage adjustment when using fentanyl?

Yes, some older adults (age 65 years or older) may need dosage adjustments of fentanyl transdermal patch. In some older adults, it may take longer for the drug to clear from the body. This can increase the risk of serious side effects, including serious breathing difficulty or overdose.

Older adults with liver or kidney problems typically need lower doses of fentanyl transdermal patch.

If you have questions about your dosage of fentanyl transdermal patch, talk with your doctor. They’ll discuss the best dosage for you based on your individual situation.

Is fentanyl applied long term?

In some cases, fentanyl transdermal patch may be prescribed as a long-term treatment. Fentanyl transdermal patch doesn’t have a specified length of treatment for severe chronic (long-term) pain. Your doctor will prescribe the drug for the appropriate amount of time to manage your pain.

Each fentanyl transdermal patch should be applied to the skin for up to 3 days. You’ll leave the patch in place for 72 hours (3 days) as directed by your doctor. Then you’ll remove the old patch when you apply a new one. You should not leave a patch on your skin for longer than 3 days.

Note: Using fentanyl transdermal patch long term can cause dependence. This is when your body needs the drug to function as usual. Long-term treatment with fentanyl transdermal patch can increase the risk of misuse and addiction. (Misuse is taking a drug in a way other than how a doctor prescribes it. Addiction is feeling unable to stop using a drug even though it may be causing harm.)

Fentanyl treats severe chronic (long-term) pain in certain people needing around-the-clock pain management. It’s generally prescribed when other treatments don’t work. Your doctor will discuss how long you’re likely to be treated with fentanyl transdermal patch.

Does fentanyl have a risk of withdrawal?

Yes, it’s possible. If you suddenly stop treatment with fentanyl transdermal patch, you may develop withdrawal symptoms. This is true especially after you’ve been using the patches for several weeks or longer.

Your body may become physically dependent on fentanyl transdermal patch. With dependence, your body needs the drug to function as usual. Suddenly stopping it can cause withdrawal.

Symptoms of withdrawal include:

• stomach cramps or pain
• excessive sweating
• fast heart rate
• high blood pressure
• muscle aches
• nausea and vomiting
• diarrhea
• restlessness
• runny nose

Do not stop using fentanyl transdermal patch on your own. If you’re considering stopping treatment, talk with your doctor. If you both agree to stop the medication, your doctor will lower your dose slowly. Doing so will help you avoid withdrawal symptoms.

How fentanyl is applied

Apply fentanyl transdermal patch to a clean, dry area on your skin. This can be your arm, chest, back, or your side between the waist and lower back. Apply a new patch once every 72 hours. Be sure to remove the old patch when you apply a new one.

Do not use the fentanyl transdermal patch if the seal is broken. And do not use it if the patch is damaged or cut.

To avoid irritating your skin, apply the patch to a different area with each application. After applying a fentanyl transdermal patch, wash your hands with soap and water right away.

Fentanyl has a boxed warning about increased absorption with heat. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). The patch can release too much fentanyl if it’s exposed to direct heat. This increases the risk of drug overdose. Do not expose your patch to direct or excessive heat while you’re wearing it. Examples of heat sources are a heating pad, sauna, electric blanket, or other external heat sources.

To avoid accidental exposure, keep fentanyl transdermal patch in a secure location away from children, other adults, and pets. Ask your pharmacist or doctor how to safely dispose of fentanyl transdermal patch.

To learn more about applying a fentanyl transdermal patch, see “Instructions for Use” in the drugmaker’s prescribing information.

Be sure to talk with your doctor or pharmacist if you’re having difficulty applying your medication. They can offer recommendations to help.

Fentanyl coupon

Visit this page to access Optum Perks coupons and get price estimates for fentanyl when you use the coupons. These coupons can provide significant savings on your prescription costs. 

Note: Optum Perks coupons cannot be used with insurance copays or benefits.

Overdose of fentanyl

Do not apply more fentanyl transdermal patch than your doctor prescribes or more often than they prescribe. Doing so can lead to harmful effects.

Symptoms of fentanyl overdose

Symptoms of an overdose can include:

• cold and clammy skin
• confusion
• serious heart problems
• extreme tiredness and drowsiness
• irritability
• very low blood pressure
• muscle weakness
• pinpoint pupils
• bluish skin color or skin discoloration
• slow heart rate
• slowed breathing or changes in normal breathing pattern
• difficulty speaking

In extreme cases or if untreated, overdose can lead to coma or death.

What to do if you apply too much fentanyl

If you think you’ve applied too much fentanyl or applied it too often, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have severe symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

What to ask your doctor

This article describes the usual recommended dosages for fentanyl transdermal patch. If your doctor prescribes this medication, they’ll determine the dosage that’s best for you.

Do not change your dosage of fentanyl transdermal patch without your doctor’s recommendation. You should apply fentanyl transdermal patch exactly as your doctor prescribes it. Let your doctor know if you have concerns or questions about your treatment plan.

Here’s a list of some possible questions you may want to ask your doctor:

• Does my dosage of fentanyl transdermal patch increase my risk of addiction?
• How will I know if I’ve become dependent on my dosage of fentanyl transdermal patch?
• What should I do if my dosage of fentanyl transdermal patch doesn’t manage my pain?

Boxed warnings for fentanyl

Fentanyl transdermal patch has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). These warnings are for the following:

Risk of misuse and addiction. Fentanyl transdermal patch can increase your risk of misuse and addiction. Misuse is taking a drug in a way other than how a doctor prescribes it. Addiction is feeling unable to stop using a drug even though it may be causing harm. Applying fentanyl transdermal patch long term increases these risks.

Tell your doctor if you have a history of substance misuse (sometimes called abuse). Also tell them if you have a history of addiction. They’ll discuss the risks of the medication with you before prescribing it.

Risk of serious breathing difficulty called respiratory depression. Fentanyl transdermal patch can lead to a serious breathing difficulty called respiratory depression. This condition causes slowed or shallow breathing and can be fatal in rare cases. Your risk is higher when you begin treatment if you’re not tolerant to opioids. With opioid tolerance, you need a higher opioid dose to feel the effect you had before with a lower dose.

Your risk is also higher if you have certain long-term lung problems, such as chronic obstructive pulmonary disease (COPD). And it’s higher if you drink alcohol or take certain other medications along with fentanyl transdermal patch. These medications include central nervous system (CNS) depressant medications. 

Due to this risk, your doctor will likely recommend having naloxone nasal spray (Narcan) available. It’s used as an emergency treatment to restore breathing in an opioid overdose situation. Ask your doctor or pharmacist for more information about naloxone nasal spray.

Risk of accidental exposure. Being accidentally exposed to fentanyl transdermal patch can lead to drug overdose. This risk is especially high in children who are accidentally exposed to fentanyl transdermal patch. It’s also higher in people who’ve never taken an opioid medication in the past.

To prevent accidental exposure, store the medication safely out of the reach of children, pets, and other adults. Do not dispose of the medication in household trash. Ask your pharmacist or doctor how to safely dispose of the medication.

Risk of neonatal opioid withdrawal syndrome (NOWS). Applying fentanyl transdermal patch during pregnancy may increase the risk of NOWS in an unborn baby. This means the newborn may have opioid withdrawal symptoms that will require treatment in the hospital. 

Symptoms of NOWS include:

• diarrhea
• vomiting
• inability to gain weight
• tremors
• trouble sleeping
• unusual crying and irritability

Due to this risk, your doctor will monitor you and your unborn baby if you’ve received fentanyl during pregnancy. They’ll also monitor the newborn closely for NOWS symptoms and treat them accordingly.

If you can become pregnant, your doctor may suggest birth control options to help prevent pregnancy if they prescribe fentanyl treatment.

Risk of drug interactions. Applying fentanyl transdermal patch while taking other CNS depressants can increase your risk of slowed brain function. (Fentanyl is a CNS depressant.) This is called CNS depression. CNS depressants include alcohol and drugs called benzodiazepines, such as diazepam. CNS depression can lead to breathing problems, severe drowsiness, and coma. In rare cases, it can also cause death.

Applying fentanyl transdermal patch while taking certain medications may change fentanyl levels in your body. This can lead to a fatal drug overdose. These medications include drugs that affect the CYP3A4 enzyme, which is a type of protein.

Due to this risk, it’s important to tell your doctor and pharmacist about everything you take or use. This includes prescription drugs, over-the-counter medications, vitamins, herbs, or supplements. Sharing this information can help avoid harmful interactions.

Risk of increased absorption with heat. The medication can release too much fentanyl if it’s exposed to direct or excessive heat. If this occurs while you’re wearing it, your body may absorb too much of the medication. This causes an overdose, which could cause death in rare cases.

Do not expose your patch to direct or excessive heat while you’re wearing it. Examples of heat sources are a heating pad, sauna, electric blanket, or other external heat sources.

Opioid Risk Evaluation and Mitigation Strategy (REMS). The FDA requires a REMS program for safe treatment with fentanyl transdermal patch. A REMS program helps ensure that the benefits of prescribing the fentanyl transdermal patch outweigh its risks.

You can learn more about the opioid REMS program here.

Fentanyl transdermal patch is a Schedule II controlled substance due to its risks. This means the federal government regulates the drug due to the risk of dependence or misuse. With dependence, your body needs the drug to function as usual. Misuse is taking a drug in a way other than how a doctor prescribes it.

To learn more about these boxed warnings, talk with your doctor.

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.