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Fentanyl titration for cancer pain: continuous subcutaneous injection and a once-daily transdermal patch – case series
  1. Tatsuma Sakaguchi1,
  2. Toru Kajiyama1,
  3. Mafumi Miyake2 and
  4. Toshiro Katayama3
  1. 1Department of Palliative Care, Kitano Hospital, Osaka, Japan
  2. 2Department of Pharmacology, Kitano Hospital, Osaka, Japan
  3. 3Department of Medical Engineering, Morinomiya University of Medical Sciences, Osaka, Japan
  1. Correspondence to Dr Tatsuma Sakaguchi, Department of palliative care, Kitano Hospital, Osaka 530-8480, Japan; sakaguchi.tatsuma{at}


Objectives Continuous subcutaneous injection (CSCI) followed by a once-daily transdermal patch is a reasonable strategy for rapid titration of fentanyl in patients with cancer pain who are unable to take oral medication or have renal impairment, but the effectiveness and safety have not been demonstrated.

Methods Medical records of patients with moderate to severe cancer pain who underwent titration of fentanyl by CSCI between October 2019 and October 2021 at Kitano Hospital, Osaka, Japan, were retrospectively reviewed. The dose of fentanyl was increased to a maximum of 0.05 mg/hour. If the dose was inadequate, the fentanyl patch was added on CSCI. When pain relief was adequate, CSCI was completely converted to the patch.

Results Thirty-three patients were enrolled. Titration was completed successfully in 28 patients (85%) over a median of 2 days. The average Numeric Rating Scale for pain decreased by at least 66% in 22 patients (67%) and by at least 33% in 7 (21%). After conversion to the patch, two patients (6.1%) required to increase the dose of fentanyl within a week. Two patients (6.1%) experienced moderate drowsiness during titration.

Conclusions Fentanyl titration by CSCI is an effective and safe method for achieving rapid pain control.

  • Cancer
  • Pain
  • Supportive care
  • Pharmacology

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  • Contributors T. Sakaguchi and T. Kajiyama contributed equally to the conception and design of the study, collection and analysis of the study data, interpretation, and drafting of the manuscript. M. Miyake and T. Katayama contributed to the collection, analysis of research data, and critical revision of the manuscript for important intellectual content. All authors gave final approval of the manuscript for submission and publication and take accountability for the study.

  • Funding This research was supported by a grant from the Osaka Cancer Society in 2021.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.