Fentanyl Patch Titration in Patients with Multi-System Atrophy

Initial Assessment and Conversion

• The National Comprehensive Cancer Network recommends ensuring pain is relatively well-controlled on short-acting opioids before initiating fentanyl patches, as patches are not recommended for unstable pain requiring frequent dose changes 1, 2
• Fentanyl patches should only be used in patients already tolerant to opioid therapy to reduce the risk of respiratory depression, according to the National Comprehensive Cancer Network 3

Conversion from Other Opioids

• The following conversion table can be used to convert oral morphine dose to fentanyl patch dose:

  Oral Morphine Dose	Fentanyl Patch Dose
  60 mg/day	25 mcg/h
  120 mg/day	50 mcg/h
  180 mg/day	75 mcg/h
  240 mg/day	100 mcg/h

• For patients with multi-system atrophy, consider reducing the calculated dose by 25-50% to account for potential increased sensitivity to opioids, as suggested by the National Comprehensive Cancer Network 1

Special Considerations for Multi-System Atrophy Patients

• Consider more frequent patch changes (every 48 hours instead of 72) if pain control wanes before the 72-hour mark, as recommended by the National Comprehensive Cancer Network 2, 3

Common Pitfalls to Avoid

• Avoid applying heat to the patch area as this accelerates absorption and can cause overdose, according to the National Comprehensive Cancer Network 2, 3
• Remember that fentanyl levels continue to rise for 12-24 hours after initial application, as noted by the National Comprehensive Cancer Network 4