Fatal Respiratory Arrest Due to Transdermal Fentanyl

1980s’ in the postoperative setting, where its safety and efficacy could be evaluated under controlled clinical conditions and with intensive monitoring.1 Soon thereafter, clinical trials demonstrated that transdermal fentanyl was safe and efficacious for the outpatient treatment of chronic cancer pain.2 TFP releases 12, 25, 50, 75, 100 μg.h-1 doses. TFP, which provide steady-state fentanyl concentrations for 72 hours, are an attractive alternative treatment compared to multiple daily oral medications especially in malign and non malign cancer patients.3 But the dosage must be increased by titrating because it is 50-100 times more powerful than morphine and absorbed rapidly. Pharmacologically, fentanyl, like all μ agonists, acts on the central nervous system causing analgesia, sedation, severe respiratory depression, muscle rigidity, seizures, coma and hypotension. Intentional or unintentional misuse, as well as abuse, may lead to significant clinical consequences, including death.4