Fentanyl

Fentanyl is a pain relieving medicine. It is used to manage persistent, moderate to severe chronic pain that requires continuous, around-the-clock opioid administration for an extended period of time. Your doctor will explain how to use Fentanyl.

Fentanyl is an opioid analgesic (pain reliever) which works by blocking transmission of pain signals to the brain to lower pain perception.

• Breakthrough Pain: Used for management of breakthrough pain in cancer patients who are already receiving and tolerant to opioid therapy.
• Severe Chronic Pain: Used for management of persistent, moderate to severe chronic pain.
• Surgical Anesthesia: Used as part of anesthesia during surgery.

Opioid analgesics

Opioid Agonist

Fentanyl is an opioid analgesic. Fentanyl interacts predominately with the opioid mu-receptor but also binds to kappa and delta-type opioid receptors. These mu-binding sites are discretely distributed in the human brain, spinal cord, and other tissues. In clinical settings, Fentanyl exerts its principal pharmacologic effects on the central nervous system.

Fentanyl is an opioid analgesic (pain reliever) which works by blocking transmission of pain signals to the brain to lower pain perception.

Adult Dose:

• Oral (Breakthrough Pain): Initial: 100 mcg; re-dosing may occur 30 minutes later; titration up to 200 mcg (one tablet in each side of mouth); titrate above 400 mcg by 200 mcg increments.
• Injection (Surgery): Premedicant: 1-2 mL IM 45 minutes before induction; Anesthesia: 2-10 mL IV; max 50 mcg/kg.
• Transdermal Patch (Chronic Pain): 12-100 mcg/hr; replace every 72 hr; opioid-naive: <=25 mcg/hr; dose based on prior opioid use.

Elderly and Debilitated: Reduce dosage.

Oral Tablet: Place entire tablet in buccal cavity (above a rear molar, between upper cheek and gum); do not chew or swallow; disintegrates in 14-25 minutes; remnants may be swallowed after 30 minutes with water.

Transdermal Patch: Make sure the skin is clean and dry; remove protective liner; place the patch evenly onto the skin with sticky side down.

If you miss a dose of Fentanyl, please consult your doctor.

Common Side Effects:

• Constipation
• Dizziness
• Headache
• Nausea
• Sleepiness
• Vomiting

Serious Side Effects: Respiratory depression, apnoea, muscular rigidity, myoclonic movements, bradycardia.

Precautions:

• Opioid analgesics impair mental and/or physical ability required for potentially dangerous tasks (driving or operating machinery).
• Titrate with caution in patients with chronic obstructive pulmonary disease or pre-existing conditions predisposing to respiratory depression.
• Caution in head injuries and increased intracranial pressure.
• Use with caution in patients with bradyarrhythmias.
• Caution in hepatic or renal disease.

Contraindications:

• Management of acute or postoperative pain
• Opioid non-tolerant patients
• Hypersensitivity

Drug Interactions:

• Antifungals, macrolide antibiotics, CNS depressants (ketoconazole, itraconazole, clarithromycin, nelfinavir): May enhance or prolong effects.
• Amprenavir, aprepitant, diltiazem, erythromycin, fluconazole, grapefruit juice: May increase plasma concentrations.

Food Interactions: No interaction found/established.

Use in Pregnancy: Category C; fentanyl may be unsafe; animal studies have shown harmful effects on the developing baby.

Use in Lactation: Fentanyl is probably unsafe; limited data suggests drug may pass into breastmilk and harm the baby; monitor baby for increased sleepiness or breathing problems.

Pediatric Use: Safety and efficacy not established.

Geriatric Use: Reduce dosage in elderly and debilitated patients.

Renal Impairment: Limited information available; caution required.

Hepatic Impairment: Limited information available; caution required.

Overdose: Overdose may produce narcosis, marked skeletal muscle rigidity, cardio-respiratory depression and cyanosis; administer oxygen and assisted respiration; use naloxone.

Storage: Store between 20-25 degree C. Protect from light.

Fentanyl