Fentanyl, a narcotic pain reliever, is similar to morphine but stronger. Like other narcotics it carries long-term side effects with use. Fentanyl is only for patients with documented chronic pain and narcotics tolerance. The U.S. Food and Drug Administration issued a black box warning for fentanyl saying that the side effects from inappropriate prescribing and abuse can cause life threatening consequences and death. Long-term side effects are of less concern for patients with chronic pain due to terminal illness.
Tolerance
The fentanyl patch has a role in treating documented chronic pain and terminal illnesses. Tolerance to a narcotic refers to a response in the body requiring increased doses of the narcotic to relieve pain. Fentanyl ordered with another narcotic for breakthrough pain may avoid or postpone increasing doses. The fentanyl patch is available in progressively stronger doses to aid in pain relief as the need increases.
Drug Dependence
Both physical and psychological dependence are long-term side effects of fentanyl. Taking a narcotic causes a psychological feeling of euphoria, or high, and pain relief with consistent use. Suddenly stopping fentanyl can cause withdrawal symptoms like nausea and vomiting. Progressive weaning from fentanyl can avoid these symptoms. Gradually lowering the dose over time decreases physical and psychological dependence provided chronic pain is not a factor.
Occupational Hazards
Using narcotics like fentanyl can cause difficulty with activities that require mental focus and motor skills. Patients are required to be narcotic tolerant before qualifying for fentanyl prescriptions. Individuals should not operate machines or drive a car until tolerant to fentanyl, since the ability to react appropriately in a dangerous situation may be hampered.
Constipation
Fentanyl, as well as other narcotics, decreases the ability of the smooth muscles lining the intestine to contract and move stool along the bowel, leading to constipation. Long-term use may cause chronic constipation.
Potentiation
Potentiation, defined as an increase in the action of one drug when combined with another, can occur with fentanyl. The additive effect may be desirable as in the case of medications for breakthrough pain. But it can also increase harmful side effects such as difficulty breathing, mood changes, decreased heart rate and a drop in blood pressure when standing.
References
- US Department of Justice/Drug Enforcement Administration/Office of Diversion Control: Drugs and Chemicals of Concern
- Medical Dictionary/The Free Dictionary: Potentiation
- Institute of Safe Medication Practices: Ongoing, Preventable Fatal Events With Fentanyl Transdermal Patches Are Alarming!
- Rxmed:Duragesic/Janssen-Ortho/Fentanyl/Opiod Analgesic
