Dangerous Drug: Fentanyl(fen’ ta nil)
Abstral, Actiq; Duragesic 12, 25, 50, 75 100; Duragesic Patch; Fentora, Lazanda, Onsolis, SUBSYS
PREGNANCY CATEGORY C
CONTROLLED SUBSTANCE C-II
Drug Class
Opioid agonist analgesic
Therapeutic Actions
Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.
Indications
Analgesic action of short duration during anesthesia and immediate postoperative period
Analgesic supplement in general or regional anesthesia
Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia
For use as an anesthetic drug with oxygen in select high-risk patients
Transdermal system: Management of chronic pain in patients requiring continuous opioid analgesia over an extended period of time who cannot be managed by other means and who are already receiving opioid therapy
Abstral, Actiq, Fentora, Lazanda, Onsolis, SUBSYS: Treatment of breakthrough pain in cancer patients being treated with and tolerant to opioids for underlying cancer pain
Contraindications and Cautions
Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy. Transdermal and nasal forms contraindicated in patients not opioid-tolerant and not meeting indication criteria.
Use cautiously with bradycardia, history of seizures, lactation, renal impairment; history of drug addiction.
Available Forms
Lozenge on a stick (Actiq)—200, 400, 600, 800, 1,200, 1,600 mcg; transdermal—12.5, 25, 50, 75, 100 mcg/hr; injection—50 mcg/mL; buccal tablets—100, 200, 400, 600, 800 mcg; buccal soluble film—200, 400, 600, 800, 1,200 mcg; sublingual tablets—100, 200, 300, 400, 600, 800 mcg; nasal spray—100, 400 mcg; sublingual spray—100, 200, 400, 600, 800 mcg/spray
Dosages
Individualize dosage; monitor vital signs.
Adults
Parenteral
Premedication: 50–100 mcg IM 30–60 min before surgery.
Adjunct to general anesthesia: Initial dosage is 2–20 mcg/kg. Maintenance dose, 2–50 mcg IV or IM; 25–100 mcg IV or IM when changes in vital signs indicate surgical stress or lightening of analgesia.
With oxygen for anesthesia: Total high dose is 50–100 mcg/kg IV.
Adjunct to regional anesthesia: 50–100 mcg IM or slowly IV over 1–2 min.
Postoperatively: 50–100 mcg IM for the control of pain, tachypnea, or emergence delirium; repeat in 1–2 hr if needed.
Transdermal
Initiate therapy with 25 mcg/hr system; adjust dose as needed and tolerated. Apply to nonirritated and nonirradiated skin on a flat surface of the upper torso; may require replacement in 72 hr if pain has not subsided; do not use torn or damaged systems, serious overdose can occur.
Lozenges
Actiq: Place unit in mouth between cheek and lower gum. Start with initial dose of 200 mcg. Until appropriate dose is reached, an additional dose can be used to treat an episode of breakthrough pain. Redosing may start 15 min after the previous lozenge has been completed. No more than two lozenges should be used for each breakthrough pain episode. Can consider increasing dose if requiring more than one lozenge for treatment of several consecutive breakthrough pain episodes. If more than four lozenges are needed daily, increase the dosage of long-acting opioid. Actiq should be sucked slowly over 15 min.
Buccal forms
Buccal tablets: Initially, 100-mcg tablet between cheek and gum for 14–25 min; may be repeated in 30 min if needed. Adjust slowly to control pain.
Buccal soluble film: Remove film and place inside cheek; will dissolve within 5–30 min. Available only through FOCUS program.
Sublingual tablets: Initially, 100 mcg sublingually; increase dose to achieve control of pain. Once at maintenance dose, wait at least 2 hr between doses when treating breakthrough pain.
Sublingual spray: 100 mcg by sublingual spray; if pain is not relieved within 30 min, repeat dose. Wait at least 4 hr before
treating another episode of pain. Individualize dose based on patient report; up to 800 mcg/spray has been used.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
