Work

Safety of chronic transdermal fentanyl use in patients receiving hemodialysis

Year: 2016

Type: article

Abstract: Patients with end-stage renal disease (ESRD) receiving renal replacement therapy frequently experience multifactorial chronic pain. Pain management in patients with ESRD can be challenging because certain opioids, such as codeine and morphine, have active metabolites that are excreted through the kidneys and accumulate in patients with renal impairment.1 Limited evidence supports the i.v. or subcutaneous routes of fentanyl for short-term use in patients with ESRD requiring hemodialysis.2,3 However, data on the safety of a transdermal fentanyl patch for chronic pain management in this population are lacking. We describe the cases of two patients with sickle cell disease and ESRD who were safely treated with transdermal fentanyl for chronic pain while receiving hemodialysis. The first patient was a 40-year-old woman with sickle cell disease and ESRD who was receiving hemodialysis and was hospitalized for a vasoocclusive pain crisis that was uncontrolled by methadone 20 mg orally every eight hours and hydromorphone 1 mg i.v. every two hours as needed. Methadone was discontinued on day 13 of hospitalization after the patient experienced myoclonus. Subsequently, a transdermal fentanyl patch (50 μg/hr) was added to the i.v. hydromorphone regimen, and her pain score improved from 8–10 to 6–8 on a 10-point scale within three days of therapy. The patient’s oxygen saturation remained above 96% on room air, and she was awake and alert with a sedation score of ≤1. The patient was discharged home with a fentanyl patch (75 μg/hr) along with hydromorphone 4 mg orally every four hours as needed for pain. Over the next 3 years, the dose of the transdermal fentanyl patch was gradually increased to 500 μg/hr without significant adverse effects while the patient continued hemodialysis.

Source: American Journal of Health-System Pharmacy

DOI: 10.2146/ajhp150748

Authors: Jin Han, Santosh L. Saraf, Victor R. Gordeuk, Michel Gowhari

Institution: University of Illinois Chicago

Language: English

Topic: Pain Management and Opioid Use

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Heart, Lung, and Blood Institute