Purpose: Transdermal fentanyl (TF) is the most commonly used opioid in Germany although it is associated with an increased risk for hypoventilation and potentially life-threatening respiratory depression if used inappropriately. The objective of this study was to characterize nursing home residents newly receiving TF with regards to (1) patients' conditions at patch initiation, (2) previous analgesic treatment, and (3) the initial TF dose.
Methods: Using claims data (2010-2014), we studied a cohort of new nursing home residents aged greater than or equal to 65 years initiating TF.
Results: TF was the most commonly prescribed opioid in nursing home residents. During their nursing home stay, 8571 persons (median age: 86 years, 79.2% female and 28.6% with a diagnosis of cancer) started TF (6.7% of all residents). Almost half of the new TF users were opioid-naïve and 56.2% of those who had been treated with opioids in the 180 days before TF initiation had only received low potency opioids such as tilidine/naloxone or tramadol. Opioid-naïve TF users more often were care dependent and had a higher prevalence of dementia than patients previously treated with opioids. Overall, patients often received anxiolytic/hypnotic (29.7%) or antipsychotic (31.4%) comedication. About 61% of opioid-naïve users started with the lowest available dose (12.5 μg/h), followed by 32% treated with 25 μg/h.
Conclusions: TF as a noninvasive treatment option is the first-choice opioid in German nursing homes. Although initial doses seemed more appropriate than those identified in previous studies, the large proportion of opioid-naïve patients in this vulnerable population warrants attention, given the limited controllability of the treatment.
Keywords: aged; fentanyl; nursing home; pharmacoepidemiology.