A 50-year-old man with chronic pain is started on a transdermal fentanyl patch. Which of the following is a critical consideration for safe prescribing in opioid-naive patients?

• A It can be cut to adjust the dose
• B It is appropriate for acute, fluctuating pain
• C It has a rapid onset of action (within minutes)
• D It is contraindicated in opioid-naive patients due to risk of respiratory depression ✓

Explanation

Transdermal fentanyl has a slow onset (12-24 hours) and is used for chronic, stable pain in opioid-tolerant patients. It is absolutely contraindicated in opioid-naive patients or for acute pain due to the high risk of fatal respiratory depression. The patches should never be cut.

Reference: Katzung's Basic & Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.