Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
DURAGESIC-100 vs ACTIQ
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Pure opioid agonist that binds to mu-opioid receptors in the CNS, mimicking endogenous endorphins to inhibit pain transmission. Also interacts with kappa and delta receptors. Therapeutic effects include analgesia, sedation, and euphoria.
Opioid agonist; binds to mu-opioid receptors in the CNS, altering pain perception and response.
Management of pain severe enough to require daily, around-the-clock, long-term opioid treatment in opioid-tolerant patients,Off-label: Chronic pain in non-opioid-tolerant patients (not recommended due to risk of respiratory depression)
Management of breakthrough pain in cancer patients aged 16 and older who are already receiving and tolerant to opioid therapy for their underlying persistent cancer pain
Transdermal patch; initial dose based on prior opioid use: for opioid-naive patients, 12 mcg/h every 72 hours; for opioid-tolerant patients, convert using equianalgesic tables; maximum dose 100 mcg/h per patch; apply to non-irritated, non-irradiated skin on chest, back, flank, or upper arm.
200 mcg transmucosally, titrated upward as needed; initial dose for opioid-tolerant patients is 200 mcg, with additional doses possible after 15 minutes if needed. Maximum 4 doses per episode. At least 4 hours between episodes.
Terminal elimination half-life approximately 20–27 hours after transdermal system removal (range 13–25 hours in healthy adults; prolonged in elderly, hepatic impairment, and cachexia).
Terminal half-life 0.83–2 hours (mean 1.3 h) in adults; note that context: transmucosal absorption leads to rapid onset but short duration; half-life is not correlated with clinical effect due to oral transmucosal route and rapid redistribution.
Primarily metabolized by CYP3A4 isoenzyme to norfentanyl and other inactive metabolites. Minor pathways via CYP3A5. First-pass metabolism is extensive after oral administration, but transdermal delivery bypasses this.
Primarily hepatic via CYP3A4 to inactive metabolites (norfentanyl, despropionylfentanyl, hydroxyfentanyl) and other metabolites; <7% excreted unchanged in urine.
Renal (primarily as metabolites, <10% unchanged fentanyl); fecal (about 9% of dose).
Primarily renal as metabolites (about 75% as metabolites, <10% unchanged). Fecal excretion accounts for <9%. Biliary excretion is minor.
Approximately 80–85% bound, primarily to alpha-1-acid glycoprotein (AAG) and albumin; increased free fraction in hypoalbuminemia.
Fentanyl is 80–85% bound to plasma proteins (primarily albumin and α1-acid glycoprotein).
3–8 L/kg (mean ~6 L/kg), indicating extensive tissue distribution (including deep compartments such as muscle and fat).
Approximately 4 L/kg (range 3–6 L/kg); large Vd indicates extensive tissue distribution and redistribution contributing to short duration.
Transdermal: approximately 92% of the dose over 72 hours (systemic absorption fraction).
Oral transmucosal: 50% (range 47–54%) relative to IV; variable and enhanced by rapid absorption through buccal mucosa.
GFR 30-60 m L/min: no adjustment required; GFR <30 m L/min: reduce dose by 50% and titrate cautiously; hemodialysis: not removed, avoid use or use with extreme caution.
No specific GFR-based dose adjustment recommended; use with caution in severe renal impairment (Cr Cl < 30 m L/min) and consider dose reduction due to potential accumulation.
Child-Pugh class A: no adjustment; Child-Pugh class B: reduce initial dose by 50% and titrate slowly; Child-Pugh class C: avoid use or reduce dose by 75% with careful monitoring.
Child-Pugh Class A/B: No adjustment. Child-Pugh Class C: Reduce initial dose to 100 mcg and titrate slowly; monitor closely for prolonged effects.
For children ≥2 years old: initial dose 25 mcg/h for opioid-tolerant patients; for opioid-naive, use alternative analgesic; titrate in 12-25 mcg/h increments every 72 hours; do not use in children <2 years.
Not approved for pediatric use; safety and efficacy not established in patients under 16 years.
Start at lowest available strength (12 mcg/h) and titrate slowly; monitor for respiratory depression, constipation, and cognitive effects; consider increased sensitivity to opioid effects.
Initiate at 100 mcg transmucosally; titrate slowly due to increased sensitivity and risk of respiratory depression. Monitor for adverse effects.
Risk of respiratory depression, especially in non-opioid-tolerant patients; risk of accidental exposure leading to fatal overdose; contraindicated in acute or postoperative pain; risk of neonatal opioid withdrawal syndrome with prolonged use during pregnancy; risk of interaction with CYP3A4 inhibitors leading to fatal respiratory depression; risk of death from concomitant use with benzodiazepines or CNS depressants.
Risk of respiratory depression, addiction, abuse, and misuse; accidental ingestion can be fatal; concomitant use with benzodiazepines or CNS depressants may cause profound sedation, respiratory depression, coma, and death; not for use in opioid non-tolerant patients; risk of neonatal opioid withdrawal syndrome with prolonged use during pregnancy; serious, life-threatening, or fatal respiratory depression may occur even at recommended doses.
Life-threatening respiratory depression: monitor closely, especially during initiation and dose escalation,Accidental exposure: can cause fatal overdose in children; apply patch to dry, non-irritated skin on flat surface of upper torso,Neonatal opioid withdrawal syndrome: prolonged use during pregnancy can result in withdrawal in newborns,Risks from concomitant use with benzodiazepines or CNS depressants: additive sedation and respiratory depression,Risk of hypotension, bradycardia, and seizure in patients with compromised cardiovascular or cerebrovascular function,Serotonin syndrome when co-administered with serotonergic drugs,Adrenal insufficiency and androgen deficiency with long-term use,Severe hypotension in patients with reduced blood volume or concurrent drug therapy that compromises vasomotor tone,Biliary tract spasm and increased intracholedochal pressure,Avoid in patients with head injury, increased intracranial pressure, or impaired consciousness,Do not cut, chew, or swallow patch; apply patch immediately after removal from package; wear time 72 hours,Fever or external heat can increase absorption; avoid exposing application site to direct heat sources
Risk of respiratory depression; addiction, abuse, and misuse; interactions with CNS depressants; serotonin syndrome; adrenal insufficiency; severe hypotension; seizures; withdrawal; use in patients with head injuries, increased intracranial pressure, biliary tract disease, pancreatitis; risk of choking with lozenge; oral mucosal irritation; dental caries; hypokalemia; hyponatremia; use in elderly, cachectic, or debilitated patients.
Hypersensitivity to fentanyl or any component of the patch,Significant respiratory depression,Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment,Known or suspected paralytic ileus,Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI,Non-opioid-tolerant patients: contraindicated for acute pain, postoperative pain, mild/intermittent pain, or pain that can be managed by non-opioid analgesics,Pregnancy: prolonged use can cause neonatal opioid withdrawal syndrome,Lactation: fentanyl is excreted in breast milk; use caution
Significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or without resuscitative equipment; known or suspected paralytic ileus; hypersensitivity to fentanyl or any component; opioid non-tolerant patients; management of acute or postoperative pain including headache/migraine, dental pain, or emergency department use.
Avoid grapefruit and grapefruit juice during therapy, as they can affect liver enzymes and alter fentanyl metabolism. No other specific food restrictions. However, a high-fat meal may delay absorption of oral fentanyl but this is not relevant for transdermal formulation. Maintain caution with alcohol intake as it can potentiate CNS depression.
No significant food interactions. Grapefruit juice may increase fentanyl levels, but specific studies with ACTIQ are lacking. Avoid alcohol, as it may increase sedation and respiratory depression risk.
First trimester: Data insufficient to establish specific risk; fentanyl crosses placenta. Second/third trimester: Chronic use may cause neonatal opioid withdrawal syndrome (NOWS). Use not recommended unless benefit outweighs risk.
FDA Pregnancy Category C. First trimester: limited human data; animal studies show increased resorptions and fetal growth restriction. Second/third trimester: chronic use may cause neonatal opioid withdrawal syndrome; avoid use during labor due to risk of neonatal respiratory depression.
Fentanyl excreted in breast milk; M/P ratio approximately 0.5. Limited data suggest low levels, but monitoring for infant sedation and respiratory depression recommended. Avoid use or use with caution.
Excreted in breast milk; M/P ratio not established. Limited data suggest low levels, but risk of infant sedation and respiratory depression. Avoid use while breastfeeding unless potential benefit outweighs risk.
Increased clearance during pregnancy may require dose adjustment; no specific guidelines. Close monitoring for efficacy and withdrawal; taper to avoid NOWS.
Due to increased plasma volume and hepatic metabolism in pregnancy, dose requirements may increase; adjust based on clinical response and tolerance. Avoid use during labor and delivery due to risk of neonatal respiratory depression; short-term use preferred.
Duragesic-100 is a transdermal fentanyl patch delivering 100 mcg/h. Use only in opioid-tolerant patients due to risk of respiratory depression. Do not cut or damage the patch; apply to non-irritated, non-hairy skin on upper torso. Avoid heat sources (heating pads, saunas) as increased temperature can accelerate drug absorption, leading to fatal overdose. Monitor for signs of serotonin syndrome when co-administered with serotonergic drugs. Rotate application sites to minimize skin irritation.
ACTIQ is a transmucosal immediate-release fentanyl formulation indicated for breakthrough cancer pain in opioid-tolerant patients. Initiate with the lowest strength (200 mcg) and titrate upward. Avoid use in opioid-naive patients due to risk of fatal respiratory depression. Place the unit between cheek and lower gum, not sublingually. Instruct patient not to bite or suck the unit. Monitor for sedation and respiratory depression. Multiple units may be used per episode if needed, but wait at least 4 hours before next episode. Dispose of partially used units by flushing down toilet.
Apply the patch to clean, dry, hairless skin on the chest, back, or upper arm. Do not shave the area; clip hair if necessary.,Do not cut, tear, or damage the patch. Use only as directed by your healthcare provider.,Avoid exposing the patch to direct heat sources such as heating pads, electric blankets, hot tubs, or prolonged sunbathing, as this can increase the amount of medicine absorbed and cause a fatal overdose.,Keep the patch away from children and pets, as exposure can be fatal. Dispose of used patches by folding them in half and flushing down the toilet or placing in a sealed container.,Do not stop using this medication suddenly without consulting your doctor, as withdrawal symptoms may occur.,Seek emergency help if you experience slow/shallow breathing, difficulty waking up, or extreme drowsiness.,Do not drink alcohol while using this medication, as it may increase the risk of serious side effects.
Only use ACTIQ if you are already taking regular around-the-clock opioid pain medicine and are tolerant to opioids.,Do not use ACTIQ for short-term pain like after surgery, headache, or dental pain.,Place the unit in your cheek pouch, not under your tongue. Do not chew or suck it.,If you need more than 4 units per day, contact your doctor as your dose may need adjustment.,Store ACTIQ in a safe place away from children, as accidental ingestion can be fatal.,Dispose of unused or partially used units by flushing them down the toilet.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about DURAGESIC-100 vs ACTIQ, answered by our medical review team.
DURAGESIC-100 is a Opioid Analgesic that works by Pure opioid agonist that binds to mu-opioid receptors in the CNS, mimicking endogenous endorphins to inhibit pain transmission. Also interacts with kappa and delta receptors. Therapeutic effects include analgesia, sedation, and euphoria.. ACTIQ is a Opioid Analgesic that works by Opioid agonist; binds to mu-opioid receptors in the CNS, altering pain perception and response.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between DURAGESIC-100 and ACTIQ depend on the specific clinical indication. These are both Opioid Analgesic agents and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of DURAGESIC-100 is: Transdermal patch; initial dose based on prior opioid use: for opioid-naive patients, 12 mcg/h every 72 hours; for opioid-tolerant patients, convert using equianalgesic tables; maximum dose 100 mcg/h per patch; apply to non-irritated, non-irradiated skin on chest, back, flank, or upper arm.. The standard adult dose of ACTIQ is: 200 mcg transmucosally, titrated upward as needed; initial dose for opioid-tolerant patients is 200 mcg, with additional doses possible after 15 minutes if needed. Maximum 4 doses per episode. At least 4 hours between episodes.. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between DURAGESIC-100 and ACTIQ in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. DURAGESIC-100 is classified as Category C. First trimester: Data insufficient to establish specific risk; fentanyl crosses placenta. Second/third trimester: Chronic use may cause neonatal opioid withdrawal syndrome (NOWS). . ACTIQ is classified as Category C. FDA Pregnancy Category C. First trimester: limited human data; animal studies show increased resorptions and fetal growth restriction. Second/third trimester: chronic use may cause. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.