As most Duragesic/Fentanyl patch patients know, the recommended
procedure is to clean the area with water and then apply the patch.
However, for anyone who has used Fentanyl Generics or Duragesic, we
know that's ridiculous. Skin oil, patch location and hair are the 3
biggest adhesion factors for the patch adhesive to contend
Having used Duragesic 100mcg patches (x2 on occasion) for 13
years, I know of 4 good ways to keep the patch stuck:
1. If you're using Duragesic, Janssen Pharmaceuticals has long
had a program for its Duragesic users who have this problem. They
will send out free of charge 300 Bioclusive bandages (clear
adhesive bandages) that will fit over the 100mcg patch. I've used
them many times and they work well. You need to call them at the
800 number on the box. Only Duragesic users are eligible; you can
get them online or order them at a pharmacy, but they're not cheap,
around $100 a box.
Note: It's unclear as of 2013 whether or not Janssen still runs
the Bioclusive program, but it's an automatic NO if you don't ask.
You can of course just by them outright, but as I said, they're not
Worst case, you can always use medical tape to tape the edges of
2. Skin Prep - Skin Prep is a product made for Colostomy
patients. It applies a thin film to the skin that helps the
adhesive bond strongly to the skin. The tricky part is to only
apply it to the skin area where the edges of the patch are going to
be, since applying it to the transdermal area will block release of
the drug. It works fantastic though, and most pharmacies carry it.
They make 2 types, a lower cost one that stings, and a non-stinging
one for double the cost. It doesn't sting that bad compared to the
pain you're already dealing with.
2013 Note: Skin Prep works well with the older style patch type
that used an adhesive edge and gel pocket, but it's impractical if
you're using a patch such as the new Duragesic patches that are
essentially a one-piece adhesive patch. Using SP will block the
release of the Fentanyl.
3. Isopropyl Alcohol - all patch literature will tell you not to
use Iso to clean the skin and then put the patch on. The reason for
this is that Isopropyl leaves a residue on the skin that can
interfere with the drug release. However, to get around that issue,
clean the area with Iso, then rinse it with
water to remove any residue and then dry well before
applying. Iso is the only real way to get skin oil off of the skin,
which is the primary reason the patch adhesive comes unbonded from
Of course if you use Grain alcohol (purchased from a liquor
store), it leaves no residue.
The other reason is that Iso can cause skin irritation if not
rinsed prior to the patch being applied.
4. Location, Location, Location - SRE (Skin Real Estate) is a
major factor in how well your patch stays applied. The instructions
tell you not to use the patch in the same spot over and over - this
is to let the skin breathe between applications. It must be applied
on the upper torso in order for the heart to properly distribute
the drug throughout the body. I've always applied mine to my upper
biceps, as the area is flat, relatively hairless, and the skin
there doesn't flex like it does on the chest or elsewhere. Normally
my regular dose is 1 100mcg patch, so I just switch arms every 2
days when I change it out for a new one. However, there have been
times where I've needed 2 100mcg patches, and I have used them on
both arms simultaneously. In those cases, I've overlapped the
application by several hours so that the skin has time to breathe
before reapplying. I also will apply it vertically or horizontally
so that the same area isn't always completely covered. Edge
scarring on the skin from the patch will occur, but it will go away
in time if you stop using them.
If you're having difficulty with the patch staying applied and
the area doesn't appear to have any hair, keep in mind that the
small micro-hairs that we all have can interfere with the patch
adhesive. In those cases, shave the area or use a hair remover /
wax to ensure there's nothing to get in the way between the patch
and your skin. Make sure you rinse it well with warm water and dry
it well before you apply the patch though.
I know of terminal cancer patients who have required up to 6
100mcg patches, and in those cases they were applied on the back.
The problem with that is you need someone to apply it, and if
you're like me, you probably like doing it in private by
In a pinch, if your patch comes off, don't toss it. It's a
misconception that it cannot be reapplied and used; as long as it
doesn't stick to itself, you can re-use it, but if it does, of
course you're out of luck. If you're using generics, you can buy
Bioclusives yourself. Alternatively, simple transparent medical
tape on the patch edges will keep the patch in place or help you to
re-attach it. Make sure you clean the skin before reapplying, and
put it in the same place. It takes about an hour, but if there's
enough adhesive and medicine left, the body heat will start the
drug release again.
When applying your patch after you've prepped the area, make
sure you hold it between your hands for about a minute (BEFORE you
remove the backing...) to warm and soften the adhesive. After you
put it on, hold your hand over it for a minute to help the adhesive
One other bit of advice - all doctors are required by Federal
Law to only give a month's worth of Schedule 2 opiates to any
patient, making us slaves to the system, and making it a real pain
if a patch comes off and cannot be reused, especially if it was
just applied recently. I learned early on to build up an emergency
month supply of meds that will help me in such situations, or in
those rare times where you have problems with medical insurance
companies or prescription supply interruptions. It takes time, but
most Fentanyl patients have breakthrough meds like Percocet. Use
that to help you get by and try stretching your dosage in order to
bank up extras so you don't fall short if a patch does get screwed
up. If you're seeing a doctor that tells you to turn in any extras,
get another one. Federal Law prohibits transfer of any narcotic to
anyone other than whom it was prescribed for, and I know of no such
exception for doctors, even prescribing ones. I have always been up
front with my doctor about my emergency supply, and over the years
he's been willing to give me a bit more when it's run low.