Moderate-to-severe chronic pain
Second line
Transdermal fentanyl is used in stable chronic pain in opioid-tolerant patients who do not manage on oral opioids or have intake problems. NCCN Adult Cancer Pain 2024 and 2018 do not prescribe the patch to opioid-naive patients or for acute pain. Starting dose 25 mcg/h with patch change every 72 hours. Peak concentration is reached at 17–48 hours after the first patch – a short-acting opioid is needed in this window for breakthrough pain.