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5 mcg per hour to 100 mcg per hour or more The initial safe dose is determined by the amount of pain medicine that has been previously required in a typical 24-hour period The dose should not be increased more often than every 3 days after the initial dose or every 6 days thereafter What to do if you miss a dose Apply the patch as soon as remembered after removing the old patch Do not use more than the prescribed dose (just one patch at a time unless your pharmacist tells you that two patches are needed for your prescribed dose) Special instructions and precautions Prior to application, clean the skin with water (no soap), allow it to dry completely, and clip hair if necessary (do not shave the area) Apply the patch to unbroken fentanyl skin on the chest, back, flank, or upper arm; do not apply to areas getting radiation therapy Firmly press the patch in place and hold for 30 seconds Change the patch every 72 hours (or 48 hours if directed by your doctor) Remove the old patch and clean the site; apply a new patch to a different site Do not use damaged or cut patches (could result in an overdose) If gel leaks from the patch, serious effects are possible; thoroughly wash the affected skin with lots of water (not soap or alcohol, just water) Avoid heat on the site of the patch (e . , heating pad, electric blanket, hot tub, sun) Avoid drinking grapefruit juice or eating grapefruit while taking this medicine Have a family member watch you closely for side effects during the first 24 hours of wearing the first patch or if your doctor increases your dose Do not use during pregnancy; may result in newborn having withdrawal symptoms Enters breast milk, so not recommended while breastfeeding Safety during pregnancy/breastfeeding Tell your doctor if you have: Lung diseases such as asthma or sleep apnea, liver or kidney disease Been using recreational drugs or consuming alcohol Storage and disposal Do not store in temperatures above 77° (F) Dispose of patch by folding the sticky sides together and flushing it down the toilet Shallow or slow breathing, confusion, dizziness, drowsiness, poor coordination, headache, blurred vision, sweating, nausea, vomiting, constipation Side effects to report to your doctor Shallow or very slow breathing, significant dizziness, chest pain, slow or rapid fentanyl heartbeat, bad headache, confusion, swelling of extremities or unusual weight gain, temperature of 102° (F) or higher, vision changes Alcohol, St . fentanyl (pronounced FEN ta nil) transdermal system patches (generic available) Management of persistent, moderate-to-severe, long-term (chronic) pain fentanyl when around-the-clock pain control is needed for an extended period of time ONLY used if patients have previously taken high doses of opioids for more than 1 week Doses vary widely, from 12 .
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