Non sedating ssris
The dose should be titrated individually on the basis of average daily use of supplemental analgesics, until a balance between analgesic efficacy and tolerability is attained.
Dosage titration should normally be performed in 12 mcg/h or 25 mcg/h increments, although the supplementary analgesic requirements (oral morphine 45/90 mg/day ≈ Durogesic DTrans 12/25 mcg/h) and pain status of the patient should be taken into account.
To prevent overdose it is recommended that opioid-naïve patients receive low doses of immediate-release opioids (eg, morphine, hydromorphone, oxycodone, tramadol, and codeine) that are to be titrated until an analgesic dosage equivalent to Durogesic DTrans with a release rate of 12 mcg/h or 25 mcg/h is attained. In the circumstance in which commencing with oral opioids is not considered possible and Durogesic DTrans is considered to be the only appropriate treatment option for opioid-naïve patients, only the lowest starting dose (ie, 12 mcg/h) should be considered.
After an increase in dose, it may take up to 6 days for the patient to reach equilibrium on the new dose level.
Therefore after a dose increase, patients should wear the higher dose patch through two 72-hour applications before any further increase in dose level is made.
If discontinuation of Durogesic DTrans is necessary, replacement with other opioids should be gradual, starting at a low dose and increasing slowly.
This is because fentanyl concentrations fall gradually after Durogesic DTrans is removed.
Some patients may require additional or alternative methods of opioid administration when the Durogesic DTrans dose exceeds 300 mcg/h.