fentanyl

• Risk factors: Personal or family history of substance or alcohol abuse | History of mental health conditions | Not storing, using, or disposing the fentanyl patch properly

The fentanyl patch is a controlled substance that has a risk for misuse and addiction. This can lead to serious and possibly life-threatening consequences, such as dangerously slow breathing and overdose.

Use the fentanyl patch exactly as prescribed. Don't place the patch in your mouth for any reason. Chewing or swallowing the patch or using the patch in any other way than prescribed is considered misuse. This can lead to choking, overdose, and death. Also don't change how much or how often you use the patches without talking to your prescriber first.

Because of the risk for misuse and addiction, the fentanyl patch is only available through a Risk Evaluation and Mitigation Strategy (REMS) program called the Opioid Analgesic REMS program. Your prescriber and pharmacy must register with the program, receive training on proper medication use, and discuss with you about how to take the fentanyl patch safely.

• Risk factors: First starting the fentanyl patch | Dose changes | High doses | Children | Age 65 years or older | Weak or frail people | People who aren't opioid tolerant | Medical conditions that cause breathing problems (e.g., COPD, asthma, sleep apnea, head injury) | Taking other medications that slow down brain function

The fentanyl patch patch can cause serious, fatal slowed breathing (respiratory depression), even when they're used as recommended. Respiratory depression is a medical emergency that must be managed and treated right away. Call 911 as soon as possible if you or someone around you notices that you have shortness of breath, slow or shallow breathing, extreme tiredness or sleepiness, or confusion, or bluish skin or lips.

Avoid alcohol and medications that slow down brain function, such as benzodiazepines, other opioids, and muscle relaxants, while you're taking the fentanyl patch. These substances slow down your breathing even more and put you at even higher risk for serious respiratory depression, extreme sleepiness, and overdose.

To lower the risk for respiratory depression, your prescriber will work very closely with you to adjust your fentanyl patch dose depending on your needs. Your prescriber will recommend that you have naloxone (Narcan) with you at all times. Naloxone is a medication that can reverse slowed breathing from opioids. Use naloxone, call 911, and get medical help right away if you have signs or symptoms of dangerously slowed breathing.

• Risk factors: History of opioid use disorder | Previous opioid overdose | Taking high doses of the fentanyl patch | Taking more opioids than prescribed | Alcohol use

Take the fentanyl patch exactly as prescribed. Taking too much, taking it more often than prescribed, or taking it any other way than prescribed can lead to a life-threatening overdose. Symptoms of an opioid overdose include not responding to sound or touch, extremely slow breathing, slow heartbeat, extreme sleepiness, and cold or clammy skin.

Be sure you and your loved ones know how to recognize an opioid overdose. Your prescriber will recommend getting naloxone (Narcan) — either by prescription or over the counter. Naloxone can help treat an opioid overdose. Carry naloxone with you at all times; use it and call 911 right away if an overdose happens.

It can be very dangerous if someone accidentally touches, uses, chews, or swallows the fentanyl patch. Accidental exposure to the medication can lead to seriously harmful consequences, such as extremely slowed breathing, overdose, and even death.

It's important to keep fentanyl patches out of reach from children, visitors, and pets to prevent accidental exposure and potential overdose. Also be sure to safely dispose used and unused patches to prevent people, especially children, from getting exposed to the medication by mistake. Used fentanyl patches still have medication left on them.

• Risk factors: Exposing the fentanyl patch to external heat sources | High fever of 104 degrees Fahrenheit or greater | Very rigorous movement or exercise (leading to a high body temperature)

Exposing the fentanyl patch to heat or having areas of skin around your patch that's hot greatly raises the risk for potential overdose and death. High temperatures — including when you have a high fever or when you've exercised rigorously – cause more medication to get released from the patch and into the body, which can lead to overdose.

Don't use any external heat sources, like heating pads, electric blankets, heat or tanning lamps, heated beds or water beds, over the fentanyl patch and the area of skin around it. Also avoid sunbathing, hot baths, hot tubs, and saunas. Try to avoid extreme workouts, exercise, or movement that can make you get very hot. Contact a healthcare professional as soon as you can if you have a high fever for appropriate treatment. Call 911 right away if you have any symptoms of overdose, like extreme sleepiness or slowed breathing.

• Risk factors: Taking high doses of the fentanyl patch | Age 65 years or older | Drinking alcohol | Taking other medications that can cause sleepiness

The fentanyl patch can cause extreme sleepiness and lower your ability to think, react, and focus. Don't drink alcohol with the fentanyl patch. Also don't take other medications that can cause sleepiness or "brain fog" (e.g., benzodiazepines, muscle relaxants, sleep medications). Otherwise, these side effects might be more intense.

Make sure you know how the fentanyl patch affects you before driving a car or doing activities that require your concentration. Talk to your prescriber right away if you feel too sleepy from the medication or if you're having a hard time thinking clearly.

• Risk factors: Long-term treatment with fentanyl patches

When fentanyl patches are regularly used to treat chronic pain, the medication can cause physical dependence. This means that your body relies on the medication to function. And you might experience withdrawal if you lower your dose too quickly or suddenly stop using the medication. Withdrawal symptoms include anxiety, restlessness, irritability, runny nose, yawning, sweating, and chills.

Don't suddenly lower your dose or stop using the fentanyl patch suddenly without talking to your prescriber first. If needed, your prescriber will slowly lower your dose over time to prevent withdrawal symptoms. Talk to your prescriber if you have concerns about fentanyl patches because of the risk for withdrawal.

Long-term use of the fentanyl patch during pregnancy can cause your unborn baby to become dependent on the medication. This is because fentanyl can pass through the placenta to your unborn baby.

Once your baby is born, they can experience withdrawal symptoms, such as high-pitched crying, poor feeding behavior, trembling, abnormal sleep patterns, and even seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if it isn't recognized and treated in time. Let your healthcare professional know if you've used the fentanyl patch during pregnancy or if you notice these symptoms in your baby.

The fentanyl patch can interact with several medications. Let your care team know what medications you're taking to make sure they're safe for you to take together. Also speak with your care team first before making any changes to your medications because sudden dose adjustments can be harmful.

Some medications can raise the fentanyl levels in your body, which can raise your risk for serious side effects like potentially life-threatening slowed breathing. Medications that can lead to this type of interaction include erythromycin and ritonavir (Norvir), among others.

Other interactions, such as with rifampin (Rifadin) or carbamazepine (Tegretol), can lower fentanyl levels in your body. This can cause the opioid medication to work less well to manage your pain. These interactions might also lead to withdrawal symptoms.

• Risk factors: Using the fentanyl patch with medications that raise serotonin levels

Using the fentanyl patch with other medications that raise the serotonin levels in your brain can put you at risk for a life-threatening condition called serotonin syndrome. Some of these medications include fluoxetine (Prozac), duloxetine (Cymbalta), amitriptyline (Elavil), sumatriptan (Imitrex), and trazodone (Desyrel). Let your prescriber or pharmacist know if you start a new medication to make sure it's safe to take with the fentanyl patch.

Symptoms of serotonin syndrome generally appear within a few hours or a few days of taking these medications together but can also start later. Call for emergency medical help right away, take off the fentanyl patch, and stop using the medication if you have symptoms of serotonin syndrome. These symptoms include nausea, vomiting, diarrhea, fever, sweating, shivering, distress, hallucinations, restlessness, fast heart rate, or stiff muscles.

• Risk factors: Age 65 years or older | History of low blood pressure | History of slow heart rate or heart problems | Dehydration | Starting the fentanyl patch or have dose changes | Taking other medications that lower blood pressure

The fentanyl patch patch can cause severely low blood pressure, including a drop in blood pressure when you stand from a sitting or lying position. This can lead to dizziness and fainting. Be careful as you stand up after sitting for some time. Make sure to sit back down or lie down if you feel faint or dizzy. The chances of low blood pressure are greater when you first start using fentanyl patch or with dose changes.

The fentanyl patch can also slow your heart rate, particularly when you start treatment. Let your care team know if you have any heart problems, like abnormal heart rate (arrhythmias), before you start treatment. Call your prescriber if you have unexplained fatigue, dizziness or lightheadedness that doesn't go away, shortness of breath, or chest pain while you're taking this medication. These might be symptoms of an unusually slow heart rate.

• Risk factors: Taking the fentanyl patch for longer than 1 month

Some people taking opioids like the fentanyl patch had low adrenal hormone levels. This might be more likely to happen after taking opioids for longer than 1 month. Let your prescriber know if you have symptoms like tiredness, dizziness, weakness, not feeling hungry, nausea, and vomiting. If your adrenal hormone levels are too low, you might need to stop taking the fentanyl patch and get treated with corticosteroids.

• Risk factors: History of seizures | Taking other medications or having health conditions that raise your risk of seizures

If you've had a seizure in the past, opioids like the fentanyl patch can raise the risk of having seizures more often. The fentanyl patch can also put you at risk of seizure in certain situations. Get medical help if you have a seizure while you're taking this medication.