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Seth Acton

Titrating Off Fentanyl Patches

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This question was submitted through pcssNOW.org:

Patient was on Fentanyl 50mcg patch every 72 hours – wants to titrate slowly to zero. Just switched to 37.5mcg.  About how long should I be in the 37.5 before moving to 25 mcg, then to 12mcg and then off the patch completely?  Thinking clonidine for withdrawal assistance. What other withdrawal assistance and/or breakthrough pain meds would you recommend? Also, am very interesting in any natural/homeopathic assistance for this process. Looking forward to this for the long run but anxious on how to beat get there. Would appreciate any additional support.


Dr. Anthony Dekker provided this response:

Transderm fentanyl has some variation from person to person and some variation in the same person in regard to the skin areas used.  Titration of all opioids can be challenging for some patients.  I recommend at least two week intervals but if the patient wants to stop (or if there is a history of unintentional overdoses or symptoms of toxicity).  Buprenorphine can be used once the symptoms of withdrawal start.  Use the COWS scale and get to a COWS of 10-12 and start the buprenorphine as in any induction.  Clonidine can be used with buprenorphine as long as the systolic is over 100.

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