A 65-year-old patient with chronic cancer pain is switched from oral morphine to a transdermal fentanyl patch. Which clinical situation is the most appropriate indication for transdermal fentanyl?

• A Acute postoperative pain requiring rapid dose titration
• B First-line treatment for mild-to-moderate chronic pain
• C Breakthrough pain episodes in a patient on baseline morphine
• D Patients with chronic stable pain who are on long-term opioids and have difficulty swallowing ✓

Explanation

Transdermal fentanyl is indicated for chronic stable pain in opioid-tolerant patients, particularly when oral administration is not feasible. The patch takes 12 to 24 hours to reach steady state, making it inappropriate for acute pain or breakthrough pain. It is never first-line for mild pain and requires prior opioid tolerance to reduce overdose risk.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.