NPS received the following correspondence from Janssen-Cilag in response to the RADAR article Fentanyl patches (Durogesic) for chronic pain, published August 6, 2006. NPS's reply is underneath.
Janssen-Cilag welcomes the release of this NPS RADAR in conjunction with the 1 August 2006 broadening of the PBS listing for transdermal fentanyl (Durogesic) to include treatment of chronic pain due to all causes. The sections on dosage and patient information are timely reminders to prescribers on ways to ensure safe and appropriate usage.
Janssen-Cilag would like to bring to the attention of prescribers that the PBAC recommendation permits the use of Durogesic patches to treat opioid-tolerant patients with chronic pain when considered necessary and appropriate by the clinician, rather than only in patients in whom morphine cannot be used because of renal impairment or difficultly in swallowing as suggested by the NPS (refer Public Summary Document http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pbac-psd-fentanylpatch-mar06). Oral morphine is frequently used to initiate and titrate dose in a chronic pain patient. It may be appropriate to switch to another long-acting opioid, such as Durogesic, in the event of poor analgesic response, intolerable adverse events or patient preference for a patch.
Date received: 25 July 2006
The PBS listing allows use of fentanyl patches in opioid-tolerant patients with chronic pain but does not indicate when they should be used. Providing advice on the place in therapy of new drugs and listings is one aim of NPS RADAR.
Oral morphine is generally preferred because it is familiar and has a variety of doses and formulations. As Janssen-Cilag note, it will frequently be used for initiation and titration when opioid analgesia is indicated. Renal impairment and swallowing difficulties are two examples of when a patch might be useful, and as mentioned in the RADAR review, where there are “uncontrollable adverse effects or poor analgesic response to morphine….. fentanyl is one of several alternative opioids that might be considered”.