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It may take 20 hours or more for the fentanyl serum concentrations to decrease 50%.

In such circumstances, the patient must be closely monitored.

Elderly patients Elderly patients should be observed carefully and the dose should be individualised based upon the status of the patient (see sections 4.4 and 5.2).

In opioid-naïve elderly patients, treatment should only be considered if the benefits outweigh the risks.

If discontinuation of Durogesic DTrans is necessary, replacement with other opioids should be gradual, starting at a low dose and increasing slowly.

This is because fentanyl concentrations fall gradually after Durogesic DTrans is removed.

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