Fentanyl Patches, Topical Creams, Pet Safety

This is my first blog addressing safety concerns which are relevant for the person living with persistent pain.  I was moved to write this after reviewing the last bulletin from the Institute for Safe Medication Practices (ISMP). This particular issue highlighted safety concerning heat and Fentanyl patches.

Fentanyl Patches

If you use “pain patches”, you hopefully remember being taught to never to put a heating pad over them or if you are running a fever to notify your clinician who has prescribed this for you. After all, heat can increase the speed in which the medication is absorbed from the patch. Recently a woman had been started on a low dose patch.  All went well for a couple of weeks until the family started to noticed that she seemed to be disoriented, was losing her balance, and had nausea and vomiting.  It turned out she was spending time in a recliner chair with heat and vibration options. She had been sitting there most of the time with the heat on.  Her patch was placed on her back. The chair was acting like a heating pad under the patch.  After the patch was moved to a new location–to the front of her body–her problems ceased.

Bottom line: Be careful with patches and any heat source, like heating pads, electric blankets, heat or tanning lamps, sunbathing (even if the patch is under clothing or a bathing suit), hot baths, saunas, hot tubs, heat wraps, heated water beds, and even vehicles with heated seats. All of these could increase the rate of drug delivery from the patch into the body. Also, avoid tight coverings over the patch and strenuous exercise, which heats up the body. Place the patches where they can be safe. They don’t have to be placed over or near where it hurts as they absorb into the blood stream. The medication affects the whole body not just the local area where it is applied.

Medications and Sun

The next issue of concern is seasonal in nature. With spring in full swing and summer on the doorstep, the warm sunshine is at its peak, remember many medications can cause you to be sensitive to the sun (appropriately called “photosensitivity”).  While opioids are usually not in that group, other pain medications are, such as, non-steroidal anti-inflammatories (NSAIDs), steroids, tricyclic antidepressants (TCA) like amitriptyline (Elavil), and methotrexate which is commonly used for rheumatoid arthritis.  There are other medications you may take your heart, blood pressure, antibiotics, and antivirals can be included in this list.

Bottom line: It is best to talk with your pharmacist and assume you may be at risk while taking these medications until verified otherwise.  Avoid direct UV exposure from natural sunlight especially between 10 am and 3 pm, when the heat of the sun is at its peak. Avoid the use of tanning beds. When going outdoors on sunny days, wear sun-protective clothing. If possible, wear shirts with high collars and long sleeves, pants or a long skirt, socks and shoes, a wide-brimmed hat, and sunglasses. Use a UV-A and UV-B combination sunscreen with at least a SPF 15 rating.

Medications and Pet Safety

How about keeping your pets safe? Cats and dogs, like children, require that we are on the alert to protect them. A recent FDA safety alert warned that three cats died from licking Flurbiprofen (Ansaid) Cream off their owners’ legs. Others have become ill.  Flurbiprofen is a NSAID cream which can be applied directed to the painful area(s) and used for arthritis and pain caused by inflammation. It only takes a small amount to be toxic to animals.  There are other medicated creams as well as pills that can be toxic to your animals. I remember while my mother was alive that her cats would go crazy trying to lick Ben Gay off her legs. One of the scariest stories ever told to me was by a patient’s wife who was getting her husband’s thalidomide for cancer treatment out of the blister packs.  She set the first one down and was opening the second when she noticed their cat about to eat the capsule! That could have been a tragic turn of events.

Bottom line: The FDA recommends that patients:

• Store all medications safely out of the reach of pets (and children).
• Safely discard or clean any cloth or applicator that may retain medication and avoid leaving any residues of the medication on clothing, carpeting, or furniture.
• Consult their healthcare provider on whether it is appropriate to cover the treated area.
• Bathe or clean the pet as thoroughly as possible and consult a veterinarian if your pet becomes exposed to a topical medications containing flurbiprofen.
• Seek immediate veterinary care if your pet shows signs such as sluggishness, lack of appetite, vomiting, or other illness if exposure to a medication is suspected. Be sure to provide any known details of the exposure.

Safe & Sound will be a blog series created to address safe and effective use of various pain treatments –the full range of multi-modality and integrative options. Our wish is that you can use effective pain relief options to their fullest and hopefully with less risks and side effects. If you have further concerns, suggested topics or additional ideas, please comment on this blog. We will create future blogs to address them.