United Kingdom - English - MHRA (Medicines & Healthcare Products Regulatory Agency)

pfizer ltd - fentanyl - transdermal patch - 12microgram/1hour

United Kingdom - English - MHRA (Medicines & Healthcare Products Regulatory Agency)

pfizer ltd - fentanyl - transdermal patch - 75microgram/1hour

United Kingdom - English - MHRA (Medicines & Healthcare Products Regulatory Agency)

pfizer ltd - fentanyl - transdermal patch - 100microgram/1hour

United Kingdom - English - MHRA (Medicines & Healthcare Products Regulatory Agency)

pfizer ltd - fentanyl - transdermal patch - 50microgram/1hour

United States - English - NLM (National Library of Medicine)

specgx llc - fentanyl (unii: uf599785jz) (fentanyl - unii:uf599785jz) - fentanyl 25 ug in 1 h - fentanyl transdermal system is indicated for the management of severe and persistent pain in opioid-tolerant patients that requires an extended treatment period with a daily opioid analgesic and for which alternative treatment options are inadequate. patients considered opioid-tolerant are those who are taking, for one week or longer, at least 60 mg morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. limitations of use - because of the risks of addiction, abuse, and misuse with opioids, which can occur at any dosage or duration, and because of the greater risks of overdose and death with extended-release/long-acting opioid formulations [see warnings and precautions (5.1)] , reserve fentanyl transdermal system for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain. - fentanyl transdermal system is not indicated as an as-needed (prn) analgesic. fentanyl transdermal system is contraindicated in: - patients who are not opioid-tolerant. - the management of acute or intermittent pain, or in patients who require opioid analgesia for a short period of time. - the management of post-operative pain, including use after out-patient or day surgeries, (e.g., tonsillectomies).  - the management of mild pain.  - patients with significant respiratory depression [see warnings and precautions (5.12)] . - in patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment [see warnings and precautions (5.12)] . - in patients with known or suspected gastrointestinal obstruction, including paralytic ileus [see warnings and precautions (5.19)] .  - in patients with hypersensitivity to fentanyl (e.g., anaphylaxis) or any components of the transdermal system [see adverse reactions (6.2)] . risk summary use of opioid analgesics for an extended period of time during pregnancy may cause neonatal opioid withdrawal syndrome [see warnings and precautions (5.5)]. available data with fentanyl transdermal system in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage. in animal reproduction studies, fentanyl administration to pregnant rats during organogenesis was embryocidal at doses within the range of the human recommended dosing. when administered during gestation through lactation fentanyl administration to pregnant rats resulted in reduced pup survival and developmental delays at doses within the range of the human recommended dosing. no evidence of malformations were noted in animal studies completed to date [see data] . the estimated background risk of major birth defects and miscarriage for the indicated population is unknown. all pregnancies have a background risk of birth defect, loss, or other adverse outcomes. in the u.s. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. clinical considerations fetal/neonatal adverse reactions use of opioid analgesics for an extended period of time during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. neonatal opioid withdrawal syndrome presents as irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, and failure to gain weight. the onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination of the drug by the newborn. observe newborns for symptoms of neonatal opioid withdrawal syndrome and manage accordingly [see warnings and precautions (5.5)] . labor or delivery opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. an opioid antagonist, such as naloxone, must be available for reversal of opioid-induced respiratory depression in the neonate. fentanyl transdermal system is not recommended for use in pregnant women during or immediately prior to labor, when use of shorter-acting analgesics or other analgesic techniques are more appropriate. opioid analgesics, including fentanyl transdermal system, can prolong labor through actions that temporarily reduce the strength, duration, and frequency of uterine contractions. however, this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor. monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression. data human data there are no adequate and well-controlled studies in pregnant women. fentanyl transdermal system should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. chronic maternal treatment with fentanyl during pregnancy has been associated with transient respiratory depression, behavioral changes, or seizures characteristic of neonatal abstinence syndrome in newborn infants. symptoms of neonatal respiratory or neurological depression were no more frequent than expected in most studies of infants born to women treated acutely during labor with intravenous or epidural fentanyl. transient neonatal muscular rigidity has been observed in infants whose mothers were treated with intravenous fentanyl. animal data no evidence of malformations or adverse effects on the fetus was reported in a published study in which pregnant rats were administered fentanyl continuously via subcutaneously implanted osmotic minipumps at doses of 10, 100, or 500 mcg/kg/day starting 2 weeks prior to breeding and throughout pregnancy. the high dose was approximately 2 times the daily human dose administered by a 100 mcg/hr patch on a mg/m2 basis). in contrast, the intravenous administration of fentanyl (0, 0.01, or 0.03 mg/kg) to pregnant rats from gestation day 6 to 18 suggested evidence of embryo-toxicity and a slight increase in mean delivery time in the 0.03 mg/kg/day group (0.1 times the human dose administered by a 100 mcg/hr patch on a mg/m2 basis). there was no clear evidence of teratogenicity noted. pregnant female new zealand white rabbits were treated with fentanyl (0, 0.025, 0.1, 0.4 mg/kg) via intravenous infusion from day 6 to day 18 of pregnancy. fentanyl produced a slight decrease in the body weight of the live fetuses at the high dose, which may be attributed to maternal toxicity. under the conditions of the assay, there was no evidence for fentanyl induced adverse effects on embryo-fetal development at doses up to 0.4 mg/kg (approximately 3 times the daily human dose administered by a 100 mcg/hr patch on a mg/m2 basis). the potential effects of fentanyl on prenatal and postnatal development were examined in the rat model. female wistar rats were treated with 0, 0.025, 0.1, or 0.4 mg/kg/day fentanyl via intravenous infusion from day 6 of pregnancy through 3 weeks of lactation. fentanyl treatment (0.4 mg/kg/day) significantly decreased body weight in male and female pups and also decreased survival in pups at day 4. both the mid-dose and high-dose of fentanyl animals demonstrated alterations in some physical landmarks of development (delayed incisor eruption and eye opening) and transient behavioral development (decreased locomotor activity at day 28 which recovered by day 50). the mid-dose and the high-dose are 0.4 and 1.6 times the daily human dose administered by a 100 mcg/hr patch on a mg/m2 basis. risk summary fentanyl is excreted in human milk; therefore, fentanyl transdermal system is not recommended for use in nursing women because of the possibility of effects in their infants. because of the potential for serious adverse reactions, including excess sedation and respiratory depression in a breastfed infant, advise patients that breastfeeding is not recommended during treatment with fentanyl transdermal system. clinical considerations monitor infants exposed to fentanyl transdermal system through breast milk for excess sedation and respiratory depression. withdrawal symptoms can occur in breastfed infants when maternal administration of an opioid analgesic is stopped, or when breast-feeding is stopped. infertility use of opioids for an extended period of time may cause reduced fertility in females and males of reproductive potential. it is not known whether these effects on fertility are reversible [see adverse reactions (6.2), clinical pharmacology (12.2), nonclinical toxicology (13.1)]. the safety of fentanyl transdermal system was evaluated in three open-label trials in 289 pediatric patients with chronic pain, 2 years of age through 18 years of age. starting doses of 25 mcg/hr and higher were used by 181 patients who had been on prior daily opioid doses of at least 45 mg/day of oral morphine or an equianalgesic dose of another opioid. initiation of fentanyl transdermal system therapy in pediatric patients taking less than 60 mg/day of oral morphine or an equianalgesic dose of another opioid has not been evaluated in controlled clinical trials. the safety and effectiveness of fentanyl transdermal system in children under 2 years of age have not been established. to guard against excessive exposure to fentanyl transdermal system by young children, advise caregivers to strictly adhere to recommended fentanyl transdermal system application and disposal instructions [see dosage and administration (2.7), (2.8)  and warnings and precautions (5.3)] . clinical studies of fentanyl transdermal system did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. other reported clinical experience has not identified differences in responses between the elderly and younger patients. in general, use caution when selecting a dosage for an elderly patient, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. data from intravenous studies with fentanyl suggest that the elderly patients may have reduced clearance and a prolonged half-life. moreover, elderly patients may be more sensitive to the active substance than younger patients. a study conducted with the fentanyl transdermal system in elderly patients demonstrated that fentanyl pharmacokinetics did not differ significantly from  young adult subjects, although peak serum concentrations tended to be lower and mean half-life values were prolonged to approximately 34 hours [see clinical pharmacology (12.3)] . respiratory depression is the chief risk for elderly patients treated with opioids, and has occurred after large initial doses were administered to patients who were not opioid-tolerant or when opioids were co-administered with other agents that depress respiration. titrate the dosage of fentanyl transdermal system slowly in geriatric patients and frequently reevaluate the patient for signs of central nervous system and respiratory depression [see warnings and precautions (5.12)] . fentanyl is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with impaired renal function. because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. the effect of hepatic impairment on the pharmacokinetics of fentanyl transdermal system has not been fully evaluated. a clinical pharmacology study with fentanyl transdermal system in patients with cirrhosis has shown that systemic fentanyl exposure increased in these patients. because there is in-vitro and in-vivo evidence of extensive hepatic contribution to the elimination of fentanyl transdermal system, hepatic impairment would be expected to have significant effects on the pharmacokinetics of fentanyl transdermal system. avoid use of fentanyl transdermal system in patients with severe hepatic impairment [see dosage and administration (2.5), warnings and precautions (5.17)  and clinical pharmacology (12.3)] . the effect of renal impairment on the pharmacokinetics of fentanyl transdermal system has not been fully evaluated. a clinical pharmacology study with intravenous fentanyl in patients undergoing kidney transplantation has shown that patients with high blood urea nitrogen level had low fentanyl clearance. because there is in-vivo evidence of renal contribution to the elimination of fentanyl transdermal system, renal impairment would be expected to have significant effects on the pharmacokinetics of fentanyl transdermal system. avoid the use of fentanyl transdermal system in patients with severe renal impairment [see dosage and administration (2.6), warnings and precautions (5.18)  and clinical pharmacology (12.3) ] . fentanyl transdermal system contains fentanyl, a schedule ii controlled substance. fentanyl transdermal system contains fentanyl, a substance with high potential for misuse and abuse, which can lead to the development of substance use disorder, including addiction [see warnings and precautions (5.1)]. misuse is the intentional use, for therapeutic purposes, of a drug by an individual in a way other than prescribed by a healthcare provider or for whom it was not prescribed. abuse is the intentional, non-therapeutic use of a drug, even once, for its desirable psychological or physiological effects. drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence. misuse and abuse of fentanyl transdermal system increases risk of overdose, which may lead to central nervous system and respiratory depression, hypotension, seizures, and death. the risk is increased with concurrent abuse of fentanyl transdermal system with alcohol and other cns depressants. abuse of and addiction to opioids in some individuals may not be accompanied by concurrent tolerance and symptoms of physical dependence. in addition, abuse of opioids can occur in the absence of addiction. all patients treated with opioids require careful and frequent reevaluation for signs of misuse, abuse, and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use. patients at high risk of fentanyl transdermal system abuse include those with a history of prolonged use of any opioid, including products containing fentanyl, those with a history of drug or alcohol abuse, or those who use fentanyl transdermal system in combination with other abused drugs. “drug-seeking” behavior is very common in persons with substance use disorders. drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing, or referral, repeated “loss” of prescriptions, tampering with prescriptions, and reluctance to provide prior medical records or contact information for other treating healthcare provider(s). “doctor shopping” (visiting multiple prescribers to obtain additional prescriptions) is common among people who abuse drugs and people with substance use disorder. preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with inadequate pain control. fentanyl transdermal system, like other opioids, can be diverted for nonmedical use into illicit channels of distribution. careful record-keeping of prescribing information, including quantity, frequency, and renewal requests, as required by state and federal law, is strongly advised. proper assessment of the patient, proper prescribing practices, periodic reevaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs. risks specific to the abuse of fentanyl transdermal system fentanyl transdermal system is intended for transdermal use only. abuse of fentanyl transdermal system poses a risk of overdose and death. this risk is increased with concurrent use of fentanyl transdermal system with alcohol and/or other cns depressants [see warnings and precautions (5.4), and drug interactions (7)] . intentional compromise of the transdermal delivery system may result in the uncontrolled delivery of fentanyl and pose a significant risk to the abuser that could result in overdose and death [see warnings and precautions (5.1)] . abuse may occur by applying the transdermal system in the absence of legitimate purpose, or by swallowing, snorting or injecting fentanyl extracted from the transdermal system. both tolerance and physical dependence can develop during use of opioid therapy. tolerance is a physiological state characterized by a reduced response to a drug after repeated administration (i.e., a higher dose of a drug is required to produce the same effect that was once obtained at a lower dose). physical dependence is a state that develops as a result of a physiological adaptation in response to repeated drug use, manifested by withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug. withdrawal may be precipitated through the administration of drugs with opioid antagonist activity (e.g., naloxone), mixed agonist/antagonist analgesics (e.g., pentazocine, butorphanol, nalbuphine), or partial agonists (e.g., buprenorphine). physical dependence may not occur to a clinically significant degree until after several days to weeks of continued use. do not abruptly discontinue fentanyl transdermal system in a patient physically dependent on opioids. rapid tapering of fentanyl transdermal system in a patient physically dependent on opioids may lead to serious withdrawal symptoms, uncontrolled pain, and suicide. rapid discontinuation has also been associated with attempts to find other sources of opioid analgesics, which may be confused with drug-seeking for abuse. when discontinuing fentanyl transdermal system, gradually taper the dosage using a patient-specific plan that considers the following: the dose of fentanyl transdermal system the patient has been taking, the duration of treatment, and the physical and psychological attributes of the patient. to improve the likelihood of a successful taper and minimize withdrawal symptoms, it is important that the opioid tapering schedule is agreed upon by the patient. in patients taking opioids for an extended period of time at high doses, ensure that a multimodal approach to pain management, including mental health support (if needed), is in place prior to initiating an opioid analgesic taper [see dosage and administration (2.1), and warnings and precautions (5.1)]. infants born to mothers physically dependent on opioids will also be physically dependent and may exhibit respiratory difficulties and withdrawal signs [see use in specific populations (8.1)]. instructions for use fentanyl transdermal system cii be sure that you read, understand, and follow these instructions for use before you apply fentanyl transdermal system . talk to your healthcare provider or pharmacist if you have any questions. important information about the fentanyl transdermal system appearance: - fentanyl transdermal systems are a rectangular, opaque patch with rounded corners. - fentanyl transdermal system comes in 7 different dosage strengths and sizes: 12 mcg/hr: fentanyl transdermal system 12 mcg/hr printed in green 25 mcg/hr: fentanyl transdermal system 25 mcg/hr printed in green 37.5 mcg/hr: fentanyl transdermal system 37.5 mcg/hr printed in green 50 mcg/hr: fentanyl transdermal system 50 mcg/hr printed in green 62.5 mcg/hr: fentanyl transdermal system 62.5 mcg/hr printed in green 75 mcg/hr: fentanyl transdermal system 75 mcg/hr printed in green 100 mcg/hr: fentanyl transdermal system 100 mcg/hr printed in green - 12 mcg/hr: fentanyl transdermal system 12 mcg/hr printed in green - 25 mcg/hr: fentanyl transdermal system 25 mcg/hr printed in green - 37.5 mcg/hr: fentanyl transdermal system 37.5 mcg/hr printed in green - 50 mcg/hr: fentanyl transdermal system 50 mcg/hr printed in green - 62.5 mcg/hr: fentanyl transdermal system 62.5 mcg/hr printed in green - 75 mcg/hr: fentanyl transdermal system 75 mcg/hr printed in green - 100 mcg/hr: fentanyl transdermal system 100 mcg/hr printed in green - the 12 mcg/hour system has a green border. - the 25, 37.5, 50, 62.5, 75 and 100 mcg/hour systems have green stripes that increase in number with each sequential increasing dosage strength. parts of the fentanyl transdermal system:   before applying fentanyl transdermal system - each fentanyl transdermal system is sealed in its own protective pouch. do not remove a fentanyl transdermal system from the pouch until you are ready to use it. - do not use a fentanyl transdermal system if the pouch seal is broken or the patch is cut, damaged or changed in any way. - fentanyl transdermal systems are available in 7 different dosage strengths and patch sizes. make sure you have the right dose patch or patches that have been prescribed for you. applying a fentanyl transdermal system 1. skin areas where the fentanyl transdermal system may be applied: for adults: - put the patch on the chest, back, flank (sides of the waist), or upper arm in a place where there is no hair (see figures 1-4). for children (and adults with mental impairment): - put the patch on the upper back (see figure 2). this will lower the chances that the child will remove the patch and put it in their mouth. for adults and children: - do not put a fentanyl transdermal system on skin that is very oily, burned, broken out, cut, irritated, or damaged in any way. - avoid sensitive areas or those that move around a lot. if there is hair, do not shave (shaving irritates the skin) . instead, clip hair as close to the skin as possible (see figure 5). - talk to your healthcare provider if you have questions about skin application sites. 2. prepare to apply a fentanyl transdermal system: - choose the time of day that is best for you to apply fentanyl transdermal system. change it at about the same time of day (3 days or 72 hours after you apply the patch) or as directed by your healthcare provider. - do not wear more than one fentanyl transdermal system at a time unless your healthcare provider tells you to do so. before applying a new fentanyl transdermal system, remove the patch you have been wearing. - clean the skin area with clear water only . pat skin completely dry. do not use anything on the skin such as soaps, lotions, oils, or alcohol before the patch is applied. 3. open the pouch: fold and tear at slit, or cut at line taking care not to cut the patch. remove the fentanyl transdermal system. each fentanyl transdermal system is sealed in its own protective pouch. do not remove the fentanyl transdermal system from the pouch until you are ready to use it (see figure 6). 4. peel: peel off both parts of the protective liner from the patch. each fentanyl transdermal system has a clear plastic backing that can be peeled off in two pieces. this covers the sticky side of the patch. carefully peel this backing off. throw the clear plastic backing away. touch the sticky side of the fentanyl transdermal system as little as possible (see figure 7). 5. press: press the patch onto the chosen skin site with the palm of your hand and hold there for at least 30 seconds (see figure 8). make sure it sticks well, especially at the edges. - fentanyl transdermal system may not stick to all people. you need to check the patch often to make sure that it is sticking well to the skin. - if the patch falls off right away after applying, throw it away and put a new one on at a different skin site. see the section below called "disposing of a fentanyl transdermal system". - if you have a problem with the patch not sticking apply first aid tape only to the edges of the patch. if you continue to have problems with the patch not sticking, you may cover the patch with a transparent adhesive film dressing such as bioclusive™ or tegaderm™. these are special see-through adhesive dressings. never cover a fentanyl transdermal system with any other bandage or tape. remove the backing from the bioclusive™ or tegaderm™ dressing and place it carefully over the fentanyl transdermal system, smoothing it over the patch and your skin. - apply first aid tape only to the edges of the patch. - if you continue to have problems with the patch not sticking, you may cover the patch with a transparent adhesive film dressing such as bioclusive™ or tegaderm™. these are special see-through adhesive dressings. never cover a fentanyl transdermal system with any other bandage or tape. remove the backing from the bioclusive™ or tegaderm™ dressing and place it carefully over the fentanyl transdermal system, smoothing it over the patch and your skin. - if your patch falls off before 3 days (72 hours) of use, dispose of (throw away) properly. see the section below "disposing of a fentanyl transdermal system".  apply a new fentanyl transdermal system on at a different skin site. be sure to let your healthcare provider know that this has happened, and do not replace the new patch until 3 days (72 hours) after you put it on (or as directed by your healthcare provider). 6. wash your hands when you have finished applying a fentanyl transdermal system. 7. remove a fentanyl transdermal system after wearing it for 3 days (72 hours). dispose of the used patch right away. see the section below "disposing of a fentanyl transdermal system".   choose a different skin site to apply a new fentanyl transdermal system. repeat steps 2 through 6 above when applying a new fentanyl transdermal system. do not apply the new patch to the same place as the last one. water and fentanyl transdermal system - you can bathe, swim or shower while you are wearing a fentanyl transdermal system. if the patch falls off before 3 days (72 hours) after application, dispose of properly. see the section below “disposing of a fentanyl transdermal system”.  apply a new fentanyl transdermal system on at a different skin site. be sure to let your healthcare provider know that this has happened, and do not replace the new patch until 3 days (72 hours) after you put it on (or as directed by your healthcare provider). disposing of a fentanyl transdermal system - fold the used fentanyl transdermal system in half so that the sticky side sticks to itself (see figure 9). flush the used fentanyl transdermal system down the toilet right away (see figure 10). a used fentanyl transdermal system can be very dangerous for or lead to death in babies, children, pets, and adults who have not been prescribed fentanyl transdermal system. - throw away any fentanyl transdermal systems that are left over from your prescription as soon as they are no longer needed. remove the leftover patches from their protective pouch and remove the protective liner. fold the patches in half with the sticky sides together, and flush the patches down the toilet. do not flush the pouch or the protective liner down the toilet. these items can be thrown away in a trash can. this instructions for use has been approved by the u.s. food and drug administration. mallinckrodt, the “m” brand mark and the mallinckrodt pharmaceuticals logo are trademarks of a mallinckrodt company. © 2023 mallinckrodt. bioclusive™ and tegaderm™ are trademarks of their respective owners. rx only manufactured by: lts lohmann therapy systems, corp. w. caldwell, nj 07006 manufactured for: specgx llc webster groves, mo 63119 usa printed in usa 0004608 issued: 12/2023 mallinckrodt™ pharmaceuticals

Ireland - English - HPRA (Health Products Regulatory Authority)

pfizer healthcare ireland - fentanyl - transdermal patch - 100 microgram per hour

Ireland - English - HPRA (Health Products Regulatory Authority)

pfizer healthcare ireland - fentanyl - transdermal patch - 25 microgram per hour

Ireland - English - HPRA (Health Products Regulatory Authority)

pfizer healthcare ireland - fentanyl - transdermal patch - 50 microgram per hour

Ireland - English - HPRA (Health Products Regulatory Authority)

pfizer healthcare ireland - fentanyl - transdermal patch - 75 microgram per hour

Australia - English - Department of Health (Therapeutic Goods Administration)

medis pharma pty ltd - fentanyl, quantity: 16.5 mg - drug delivery system, transdermal - excipient ingredients: titanium dioxide; polypropylene; polyethylene terephthalate; ethyl acetate; 2-ethylhexyl acrylate/2-hydroxyethyl acrylate/methyl acrylate copolymer; hexane - for the management of pain associated with cancer, palliative care, and other conditions in patients where: ? other treatment options have failed, are contraindicated, not tolerated or are otherwise inappropriate to provide sufficient management of pain, and ? the pain is opioid-responsive, and ? severe enough to require daily, continuous, long term opioid treatment. not for use in opioid-na?ve patients.