What advice can you offer when patients have difficulty with fentanyl patch adherence?

Many factors can contribute to poor patch adherence. Individual skin characteristics, such as skin oiliness or propensity to sweat, may interfere with adhesion. A particular brand of patch may not be suited to that individual, in which case, it may be worth trying a patch manufactured by another company.

The following is a list of considerations to optimize patch adherence:

Select the site:

  • Choose a flat surface on the upper torso (back or front), arms or thighs where skin movement is limited. Avoid areas where the skin wrinkles or folds with body movement.
  • Select a new site different from the previous location to avoid skin discomfort and changes in medication blood levels due to medication/reservoir build-up in the subcutaneous tissues.
  • Do not apply to broken, irritated or scarred skin or areas affected by radiation treatments as this can affect adherence and absorption.
  • Avoid hairy, edematous or bony/cachectic areas that will interfere with adherence and absorption.

Prepare the site:

  • Trim hair with scissors. Avoid shaving the area prior to application of the patch.
  • Cleanse the area with water and allow to dry completely.
  • Avoid the use of soaps, cleansers, oils, lotions, alcohol or other agents that might interfere with adhesion, irritate the skin or alter the drug's ability to penetrate the skin. While patients should avoid alcohol-based products, individuals with oily skin have reported success with isopropyl alcohol if they gently cleanse skin first, then wash the area well with water to remove the residual alcohol, allowing it to dry completely before applying the patch.
  • Avoid the use of “skin prep” products (such as those used to protect skin surfaces or increase adhesion before ostomy appliance or dressing applications). These products create a barrier on the skin that will interfere with absorption of the medication. However, in cases where patch adherence has been difficult, individuals have reported success with cleansing the area with water, allowing to it dry, then carefully applying the “skin prep” just to the area where the adhesive border of the patch will be situated, beyond the skin that will be in contact with the medicated area of the patch (i.e., only under the edge of the patch’s adhesive border).

Apply the patch:

  • Warm the patch by holding it between the palms of your hands for a few seconds before applying, and then press the patch firmly in place with the palm of your hand for 30 seconds. Make sure that contact is complete around the entire circumference of the patch. This step is particularly important because the contact adhesive is pressure sensitive and the warmth activates the contact adhesive.
  • Apply tape to increase adherence of the patch, if required in particular cases. Manufacturers recommend the use of a microporous tape applied around the edges of the patch only.

Avoid a covering dressing because it may apply pressure and alter drug release depending on the type used. This advice may vary according to the type and manufacturer of the patch. Please visit the manufacturer’s website and/or call their medical information line for further direction.