Last Updated on July 26, 2025 by Analgesia team
Fentanyl is one of the strongest opioids available on prescription in the UK. Originally developed for surgical anaesthesia, it’s now widely used to treat severe, long-term pain, especially in patients who are already tolerant to other opioids like morphine or codeine.
Among its different delivery methods, fentanyl patches are one of the most commonly prescribed. These transdermal systems release a controlled dose of fentanyl through the skin and into the bloodstream over several days—offering continuous pain relief without the peaks and crashes of pills or injections.
In the UK, fentanyl patches are often used in palliative care, especially for managing cancer-related pain. They provide long-acting relief and are easier to manage for patients who struggle with swallowing or maintaining a regular medication schedule.
Fentanyl is also available in other forms—lozenges, nasal sprays, injections, and sublingual tablets—typically reserved for breakthrough pain or acute settings. But for chronic, stable pain, especially in opioid-tolerant patients, the patch remains one of the most effective and practical options.
What are fentanyl patches and what do they do?
Fentanyl patches are medicated adhesive strips applied directly to the skin. They’re designed to release a steady dose of fentanyl—a synthetic opioid—over a 72-hour period (some patches last 48 hours). This controlled release helps maintain a consistent level of pain relief, especially important for people with chronic, severe pain that doesn’t respond well to short-acting medications.
So, what does a fentanyl patch do? In simple terms, it blocks pain signals in the brain. Fentanyl works by binding to the body’s opioid receptors, which are found in the brain and spinal cord. This suppresses the perception of pain and also produces a calming, sedative effect.
Doctors typically prescribe fentanyl patches when other opioids—like morphine, tramadol, or oxycodone—are no longer effective or tolerated. They’re not suitable for mild or short-term pain, nor are they a first-line treatment. This is a drug for patients who are already opioid-tolerant and need round-the-clock relief.
Because the patch works through the skin, it bypasses the digestive system. That makes it an ideal option for patients who struggle with swallowing tablets or who have gastrointestinal issues. It also reduces the risk of stomach-related side effects seen with oral opioids.
In summary, fentanyl patches are used for managing persistent, severe pain—especially in cases like advanced cancer, major injury, or end-of-life care. Their strength and long-acting nature make them highly effective but also high-risk if used incorrectly.
Fentanyl patches for cancer pain
Cancer pain is often relentless, progressive, and complex. For patients with advanced or terminal cancer, fentanyl patches provide a powerful, low-maintenance option for managing chronic pain without the need for frequent dosing.
Fentanyl is especially effective in cancer patients who have already been taking other opioids like morphine but are no longer getting adequate relief. This process—known as opioid rotation—is common in oncology and palliative care. Switching to fentanyl patches can improve pain control while reducing side effects like nausea or sedation.
One of the biggest advantages of fentanyl patches in cancer treatment is convenience. A single patch provides up to 72 hours of continuous relief, making it easier for patients and caregivers to manage pain without round-the-clock pill schedules or injections. For those receiving home-based care or hospice, this simplicity is vital.
Fentanyl patches also help with sleep and movement, reducing breakthrough pain that can interrupt rest or restrict daily activities. However, doctors often prescribe short-acting opioids alongside the patch to deal with flare-ups—this is called breakthrough pain medication.
Cancer patients using fentanyl patches are closely monitored. Dosages must be carefully adjusted based on tolerance, weight, organ function, and how the pain is progressing. It’s not a set-and-forget treatment—it requires precision and oversight.
Fentanyl patch doses and strengths
Fentanyl patches come in a range of strengths, measured in micrograms (mcg) released per hour. The typical doses available in the UK include:
- 12 mcg/hour
- 25 mcg/hour
- 50 mcg/hour
- 75 mcg/hour
- 100 mcg/hour
Each patch delivers this steady dose continuously over a 72-hour period. That means a 25 mcg/hour patch will release 600 micrograms per day, or 1,800 micrograms over three days. These are powerful doses—not to be underestimated.
How is the right dose chosen?
Dosing is never arbitrary. Doctors base it on the patient’s current opioid use—often calculating oral morphine equivalent doses (OMED) to find a safe conversion. For example, someone regularly taking 60–90 mg of oral morphine daily might be switched to a 25 mcg/hour fentanyl patch.
Important: Fentanyl patches are only for people who are already opioid-tolerant. Giving them to someone who hasn’t built up a tolerance can result in respiratory depression, coma, or death—even at low strengths.
Can patches be cut for smaller doses?
No. Fentanyl patches must never be cut or altered. They’re designed to deliver precise amounts through an intact system. Cutting a patch can cause the drug to leak out rapidly—leading to a dangerous or even fatal overdose.
When does dose adjustment happen?
- If pain isn’t controlled after a few days, the dose might be increased gradually
- Doctors may also combine the patch with fast-acting opioids for breakthrough pain
- Tolerance can build over time, but dose increases must be slow and medically supervised
Self-adjusting the patch dose is dangerous and illegal. Always follow the exact instructions provided by a healthcare professional.
Who should not use fentanyl patches?
Fentanyl patches are not for everyone. Despite their effectiveness in managing severe pain, the risks are high when used in the wrong context. That’s why they’re strictly regulated and prescribed only under specific conditions.
Here’s who should not use fentanyl patches:
1. Opioid-naïve individuals
Fentanyl is too strong for people who haven’t used opioids before. Starting it without prior tolerance can cause severe respiratory depression, unconsciousness, or death. Even the lowest dose—12 mcg/hour—can be fatal if your body isn’t used to opioids.
2. Children and adolescents
Fentanyl patches are generally not suitable for patients under 18, unless in highly controlled hospital settings. Their skin absorbs the drug differently, and they are more vulnerable to overdose.
3. Elderly or frail patients
Ageing slows metabolism, meaning fentanyl can build up to dangerous levels in the blood. Elderly patients may be prescribed a patch at a reduced dose, but extreme caution is required.
4. Patients with breathing problems
Anyone with chronic respiratory conditions—like COPD, asthma, or sleep apnoea—faces a higher risk of complications. Fentanyl can suppress the respiratory system, leading to dangerous oxygen drops.
5. People with liver or kidney impairment
Since fentanyl is metabolised in the liver and excreted through the kidneys, patients with liver or kidney disease may not process the drug effectively, risking accumulation and toxicity.
6. Patients with a history of substance misuse
Fentanyl’s addictive potential is extremely high. Patients with a known history of drug misuse or untreated mental health disorders may be at greater risk for dependence, overdose, or diversion.
7. Those using CNS depressants or alcohol
Combining fentanyl patches with alcohol, benzodiazepines, sleeping pills, or antipsychotics can dangerously suppress the nervous system. This combination has led to countless overdose deaths.
Fentanyl patches side effects
Like all opioids, fentanyl patches come with a long list of potential side effects—some manageable, others life-threatening. Because the drug is delivered continuously through the skin, side effects may appear gradually but still require close monitoring.
Common side effects
These are often dose-related and may lessen as the body adjusts:
- Nausea or vomiting
- Constipation (very common with all opioids)
- Drowsiness or sedation
- Dizziness or light-headedness
- Headache
- Itching or redness at the patch site
- Dry mouth
- Sweating
While uncomfortable, these can often be managed with supportive medications (e.g. laxatives for constipation or antiemetics for nausea).
Serious side effects
Seek urgent medical attention if any of the following occur:
- Slow or shallow breathing (a sign of respiratory depression)
- Severe drowsiness or confusion
- Blue lips or fingertips (cyanosis)
- Chest pain or irregular heartbeat
- Seizures
- Severe allergic reaction: swelling of the face, lips, or throat
- Delirium or hallucinations (especially in elderly patients)
Skin reactions
Fentanyl patches can sometimes cause skin irritation at the application site. Rotate patch locations to reduce this risk. However, severe rash, blistering, or chemical burn–like reactions should be reported immediately.
Long-term use risks
Over time, fentanyl can lead to:
- Physical dependence
- Tolerance (needing higher doses)
- Withdrawal symptoms if stopped suddenly
- Hormonal imbalances, including reduced libido and testosterone levels
Fentanyl must always be tapered off gradually under supervision to avoid withdrawal symptoms like agitation, sweating, cramps, and insomnia.
Can fentanyl patches be addictive?
Yes—fentanyl patches can be highly addictive. Fentanyl is a Schedule 2 controlled drug in the UK because of its high potential for abuse, dependence, and overdose. While the patch form delivers the drug more gradually than injections or lozenges, the risk of addiction is still real—especially with long-term use.
Why is fentanyl so addictive?
Fentanyl binds to mu-opioid receptors in the brain, triggering powerful pain relief but also feelings of euphoria and relaxation. With repeated exposure, the brain starts to rely on the drug to function normally—this is called physical dependence. Over time, the user may need higher doses to feel the same effect, a process known as tolerance.
In some cases, psychological addiction can follow—where the patient craves the drug even if the original pain is under control. This is more likely if the person has a history of substance misuse or unmanaged mental health conditions.
Signs of fentanyl addiction
- Taking the patch earlier than scheduled
- Using higher doses than prescribed
- “Doctor shopping” or requesting early refills
- Withdrawing socially or becoming secretive
- Experiencing withdrawal symptoms between doses
Misuse of fentanyl patches
Some individuals have tried to cut, chew, or extract the gel from patches to get a faster, stronger high. This is extremely dangerous and often fatal. It’s also a criminal offence to use fentanyl patches in any way other than prescribed.
How addiction is managed
- Tapering off the drug gradually to minimise withdrawal
- Substituting with opioid replacement therapy (like methadone or buprenorphine)
- Counselling and support programmes
- GP supervision and controlled prescriptions
Doctors weigh the benefit of pain relief against the risk of dependence very carefully. When used correctly, fentanyl patches can be safe and effective—but they require close monitoring and clear boundaries.
How and where should fentanyl patches be applied?
Correct application of a fentanyl patch is essential—not just for effective pain control, but also to avoid overdose or skin irritation. These patches are engineered to deliver a steady, controlled dose of fentanyl through the skin and into the bloodstream over 72 hours.
Where can fentanyl patches be applied?
Apply the patch to a flat, non-irritated, hairless area of skin, such as:
- Upper outer arm
- Upper chest (away from the heart)
- Back (shoulder blade area)
- Side of the torso (flank)
Tips for proper application:
- Clean the skin with water only—no soaps, oils, creams, or alcohol
- Shave any hair with scissors (not razors) to avoid skin abrasions
- Let skin dry fully before applying
- Press the patch firmly for 30 seconds to ensure it sticks
Avoid placing patches on broken, irritated, or hot skin, as heat increases drug absorption and can cause an accidental overdose.
Should patch sites be rotated?
Yes—rotate the site with each new patch to prevent skin irritation. Don’t reapply to the same area within several days. If a patch falls off, apply a new one to a different location and contact your prescriber.
Can fentanyl patches be cut?
No. Fentanyl patches must never be cut, torn, or altered. Doing so compromises the patch’s time-release mechanism, which can cause the entire dose to enter the bloodstream all at once—a potentially fatal overdose.
Only use whole patches, and never try to “customise” the dosage by trimming them. If your dose needs adjusting, consult your doctor.
Heat and patch safety
Avoid external heat sources while wearing a fentanyl patch. That includes:
- Hot baths or saunas
- Heating pads or electric blankets
- Direct sunlight
Heat increases skin permeability, which accelerates drug absorption and heightens the risk of overdose.
Fentanyl patch brands available in the UK
There are several brands of fentanyl patches available in the UK, all regulated under the same standards but manufactured by different pharmaceutical companies. While the active ingredient—fentanyl—is the same, the patch design, adhesives, and release systems may vary slightly from brand to brand.
Here are the most commonly prescribed fentanyl patch brands in the UK:
1. Durogesic DTrans
One of the original and most widely used branded fentanyl patches. Known for reliable drug delivery and strong clinical data in pain management, especially in cancer and palliative care.
2. Matrifen
A generic fentanyl patch often prescribed on the NHS. It uses a similar transdermal delivery system to Durogesic but may be more affordable in certain settings.
3. Fencino
Another generic option that’s gaining popularity in NHS formularies. Often chosen for cost-effectiveness and comparable absorption rates.
4. Mezolar Matrix
This patch uses a matrix system, where the drug is embedded directly into the adhesive layer—making it thinner and less bulky than reservoir-type patches.
5. Tilofyl and Fentalis
Other licensed brands occasionally seen in UK pharmacies. Used interchangeably depending on local supply and prescriber preference.
Are generic brands as effective?
Yes. All fentanyl patches, whether branded or generic, must meet MHRA (Medicines and Healthcare products Regulatory Agency) standards. The active drug delivery must fall within strict bioequivalence limits, meaning there should be no significant difference in how they perform.
However, some patients report variation in how adhesives feel or how well the patch stays on—so if switching brands, monitor for changes in pain control or side effects.
Fentanyl patches cost in the UK
In the UK, fentanyl patches are available on prescription only, and the cost to patients depends on whether the medicine is dispensed through the NHS or privately.
NHS prescription cost
If you’re receiving fentanyl patches via the NHS, you’ll typically pay the standard NHS prescription charge, which is currently:
- £9.90 per item (as of 2025 in England)
- Free in Scotland, Wales, and Northern Ireland
This applies whether you’re getting one patch or a box of five—the fee is per item, not per unit. Many cancer patients, elderly individuals, and people with chronic conditions are exempt from paying, under various medical exemption criteria.
Private prescription cost
For those without NHS access or using private healthcare, the cost of fentanyl patches can vary:
- A box of 5 fentanyl patches (e.g. 25 mcg/hour) costs between £20 and £80, depending on the brand and pharmacy
- Higher strength patches (e.g. 75 mcg or 100 mcg/hour) are more expensive
- Private GP fees and prescription writing charges may apply on top of the medication price
Important: You must have a valid UK prescription to buy fentanyl patches—whether online or in person. It is illegal and dangerous to obtain these without a prescription.
Are fentanyl patches covered for cancer pain?
Yes. In cases of advanced cancer, palliative care, or other severe chronic pain, fentanyl patches are almost always covered by the NHS. Patients receiving end-of-life care will typically receive them free of charge, often through hospital trusts, community pharmacies, or hospice services.
Fentanyl patches schedule and prescription rules
Fentanyl is a Class A drug and a Schedule 2 controlled substance under the UK’s Misuse of Drugs Act 1971 and Misuse of Drugs Regulations 2001. That means strict legal controls apply to the prescribing, storage, and disposal of fentanyl patches.
What does Schedule 2 mean?
Schedule 2 drugs have:
- Recognised medical use
- High potential for abuse and addiction
- Strict legal restrictions
This category includes other opioids like morphine, oxycodone, and methadone. For fentanyl patches, it means:
- Only prescribable by a qualified medical professional
- Prescriptions must meet special formatting rules, including full dosage instructions and quantity in words and figures
- Repeat prescriptions are not allowed unless specified
- Pharmacists must log and track dispensing records
How must fentanyl patches be stored?
- Store in a locked cabinet or out of reach of children and pets
- Do not expose to heat, sunlight, or moisture
- Never share with anyone, even if they have similar pain
How should used or unused patches be disposed?
Used fentanyl patches still contain active drug—enough to harm or kill a child, pet, or opioid-naïve adult. Always:
- Fold the patch in half, sticky sides together
- Return it to a pharmacy for safe disposal
- Do not flush or throw in the bin
Improper disposal has led to accidental poisonings and overdoses, including in hospitals and care homes.
Legal consequences of misuse
Unlawful possession, sale, or sharing of fentanyl patches is a criminal offence. Offenders can face:
- Up to 7 years in prison and an unlimited fine for possession
- Life imprisonment for illegal supply or trafficking
Final thoughts: what to ask your doctor before starting fentanyl
Fentanyl patches can be life-changing for people living with unrelenting pain. But they come with serious risks and strict rules, so they’re not a casual treatment option. If your doctor recommends fentanyl, ask the right questions before saying yes.
Questions to ask:
- Is fentanyl the right option for my condition?
(Have other painkillers stopped working? Am I opioid-tolerant?) - What dose will I start on, and how will it be adjusted?
(You should never self-adjust or switch patches early.) - What side effects should I expect, and how do I manage them?
(Ask specifically about constipation, drowsiness, and breathing issues.) - Can I use anything else for breakthrough pain?
(Often a short-acting opioid is prescribed alongside.) - What should I do if a patch falls off or I miss a dose?
(The wrong action here can trigger withdrawal or overdose.) - How do I safely store and dispose of the patches?
(Every used patch is still dangerous—treat them like live medicine.) - What are the signs of overdose or addiction?
(And who should I call if they occur?)
If you or a loved one is being considered for fentanyl treatment, don’t just focus on the pain relief—ask about the monitoring, support, and safeguards in place. Used correctly, fentanyl patches can provide dignity and comfort in the face of severe pain. Used carelessly, they can do the opposite.
Final note:
Fentanyl patches are powerful, effective, and dangerous—all at once. Make sure your decision to use them is based on sound medical advice, not desperation or hearsay. Always follow your prescriber’s instructions to the letter.