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Transdermales Fentanyl in der Karzinomschmerztherapie

Transdermal fentanyl for the treatment of cancer pain

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Abstract

Up to 70% of cancer patients in the terminal phase of their disease complain of moderate or severe pain. Pain therapy in these patients follows the analgesic ladder of the WHO. Many cancer patients will need a strong opioid to get sufficient pain relief. Fentanyl-TTS (transdermal therapeutic system) may be a new alternative for chronic pain therapy in cancer patients. Analgesic rates of fentanyl are released from the patch over a period of 72 h. After application, peak serum concentrations of fentanyl are measured after 8–16 h. Serum half-life time is prolonged (16–21 h) because of the intradermal depot of fentanyl. The efficacy of Fentanyl-TTS in pain therapy for cancer patients was demonstrated in clinical studies, which showed a good analgesic effect over a long period of time. Like the chronic therapy of cancer pain with conventional opioid routes, dose escalation was necessary in most patients. In most studies the application of another opioid in a second route of application was necessary as a rescue medication. During therapy of cancer pain with Fentanyl-TTS, 3 of 246 patients developed a bradypnea (respiratory rate <10/min). In contrast, respiratory depression in chronic cancer pain was never reported when the opioid was administered orally or regionally and when technical faults were excluded. The side effects during therapy with Fentanyl-TTS were those accompanying chronic opioid therapy (constipation, vomiting, nausea). The patch was well tolerated by the skin. Local side effects were minor (erythema, pruritus, pustules) and disappeared within a few hours after removal of the patch. The transdermal application of a strong opioid may be an alternative, especially for patients with cancer of the head and neck or in the gastrointestinal tract. Because of the pharmacokinetic laziness of the system the use of Fentanyl-TTS should be limited to patients with stable tumor pain. In these patients Fentanyl-TTS might be valuabe on step III of the analgesic ladder of the WHO or as an alternative to invasive methods when it is impossible to administer oral opioids.

Zusammenfassung

Die Wirksamkeit von Fentanyl-TTS in der Karzinomschmerztherapie wurde in einer Reihe von klinischen Studien belegt. Auch in der Langzeittherapie erwies sich diese Therapieform als wirksam. Eine analgetische Zusatzmedikation mit einem zweiten Opioid über einen anderen Applikationsweg war allerdings in den meisten Studien notwendig. Unter der Fentanyl-TTS-Therapie wurde bei 3 von 246 Patienten eine Bradypnoe (Atemfrequenz <10/min) beobachtet. Einer dieser Patienten befand sich zum Zeitpunkt dieser Komplikation im Finalstadium seiner Tumorerkrankung. Andere beobachtete Nebenwirkungen entsprachen denen einer “konventionellen” chronischen Opioidtherapie (Übelkeit, Erbrechen, Obstipation, Sedierung). Die Hautverträglichkeit des Pflasters war gut. Das Therapieverfahren kann zu den bisher angewendeten Verfahren vor allem bei Patienten mit Tumoren im Kopf- und Halsbereich oder im Gastrointestinaltrakt eine Alternative darstellen. Fentanyl wird kontinuierlich über das transdermale System abgegeben. Da es sich aber um ein relativ schlecht steuerbares Therapieverfahren mit einer Fentanylhalbwertzeit von durchschnittlich 16 h handelt, sollte die Anwendung von Fentanyl-TTS nach unserer Meinung auf Patienten mit einem stabilen Tumorschmerzsyndrom beschränkt werden.

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  1. Intensiv- und Schmerztherapie “Bergmannsheil”, Universitätsklinik für Anaesthesiologie, Gilsingstraße 14, W-4630, Bochum

    B. Donner, M. Zenz, M. Tryba & M. Strumpf

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  1. B. Donner
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  2. M. Zenz
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  3. M. Tryba
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  4. M. Strumpf
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Donner, B., Zenz, M., Tryba, M. et al. Transdermales Fentanyl in der Karzinomschmerztherapie. Schmerz 7, 18–24 (1993). https://doi.org/10.1007/BF02527634

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