I’ve seen numerous mistakes involving these two pain medications that come in a patch formulation. Between drug diversion (fentanyl – Duragesic), inappropriate time intervals for changing (lidocaine – Lidoderm), as needed use (fentanyl), and lost patches (both), there are plenty of easy mistakes and misconceptions about these two pain patches that I’ve seen folks from every profession make.
I figured that a nice table with a few comparisons would help educate those of you who may not be up too familiar on the differences of fentanyl versus Lidoderm patches.
| Medication or Patch | Use | Application Site | How often to Switch | Can we use As Needed? | Mistakes or Problems | Can I cut it? |
| Fentanyl(Duragesic) | Pain (opioid) chronic, systemic | Usually chest, back, flank, upper arm (systemic effects, not local!) | Usually every 72 hours (have seen every 48 hours occasionally) | No (time to peak is 20-72 hours) also many short acting opioids available! | Cutting patch, Drug Diversion, Used as needed or increased too quickly, not for acute pain, placed at site of pain (i.e. knee) | No |
| Lidocaine (Lidoderm) | PainLocalized, postherpetic neuralgia | Site of Pain! | Usual dosing on 12 hours then off for 12 hours | Yes, but can take a little while to work (about 4 hours to onset) | Leaving on for 24 hours(Keep both patches away from kids/pets!), it is NOT a controlled substance | Yes |
I hope you find this table helpful! For more medication mistakes and real world info from my practice as a clinical pharmacist, please check out the 30 medication mistakes PDF – a free resource for subscribers!
Hi Eric,
I am a community Rph with a major chain in Georgia and enjoy learning from your experience. I would like your input and didn’t know how to reach you so am putting it here. My 85 y/o mother has been unable to consistently lower her blood pressure for many years. She experiences unusual side effects and has many drug allergies. Currently, her PCP has her on: HCTZ 12.5mg QD, Carvedilol 25mg BID, Metoprolol succinate 50mg QD, Edarbi 80mg QD, and Clonidine 0.2 mg BID for HTN. She also has depression and back pain (scoliosis) and is on Duloxetine 60mg and just Tuesday started Sertraline 25mg as she’s become very depressed lately with crying which she rarely does. She’s also on Nexium, very occasional Xanax 0.125mg HS for anxiety plus Vit D 4,0000 IU.
She’s diagnosed with pulmonary hypertension. Her systolic ranges from 120-170 while her diastolic is fairly normal around 80. She has elevated cholesterol and had side effects with statins so remains untreated. She smoked heavily and quit 30 years ago. Naturally she does not want to have a stroke. Her PCP and I would like to see her blood pressure be lower and remain consistent. She says previous physicians referred to it as window shade B/P.
This past Monday she fell going up two steps without her cane. She says she’s had balance issues for years. She fell again Thursday evening – thankfully no broken bones either fall.
I know beta blockers have been associated with depression, but she’s been on them over 20 years with no worsening of depression, so I’m not convinced that’s the culprit.
Any thoughts on how to treat her B/P and depression. She’s taken many different meds and is sensitive to many of their side effects, such as ankle swelling with amlodipine. Bystolic gave her visual disturbance, and the list goes on.
I’m wondering if clonidine could be causing the balance problem. Originally she was told to take it if her B/P was over 160, but then recently was told to start taking it twice a day. Her main complaints are feeling dragged down, low energy, tired, and low motivation.
Thanks greatly for any input.
Peggy Frazeur
Atlanta
Hi Peggy,
I am not nearly as good as Eric, but would like to add to the comments if you don’t mind.
I would like to add that your mom is taking 3 medications that are on the Beers list. According to updated Beers criteria, sertraline is on the list of potentially inappropriate medications to use in those with a history of falls or fractures (Strength of Recommendation: strong; Quality of Evidence: moderate). Alprazolam should be avoided at all cost (Strength of Recommendation: strong; Quality of Evidence: high) due to increased risk of cognitive impairment, delirium, falls, fractures. Clonidine should be avoided due to its high potential to cause adverse CNS effects. It may also cause bradycardia and orthostatic hypotension ( Strength of Recommendation: strong; Quality of Evidence: low). These 3 meds could add up to the risk of fall and could have been a tipping point for your mom’s falls.
I would recommend to switch HCTZ to chlorthalidone, if it hasn’t been tried yet due to evidence that it’s more effective for BP purposes.
Hope it helps.