Fentanyl
Narcotic Analgesic · Opioid analgesic
Indications
Chronic intractable malignant and non-malignant pain.
Dosage
Adults: PATCHES: Apply to dry, non-irritated, non-irradiated, non-hairy skin on torso or upper arm, removing after 72 hr and apply new patch on a different area (avoid using the same area for several days). Patients who have not previously received a strong opioid analgesic, initial dose, one 25 mcg/hr patch replaced after 72 hr. Patients who have received a strong opioid analgesic, initial dose based on previous 24-hr opioid requirement (oral morphine sulphate 90 mg over 24 hr is approximately equivalent to one 25 mcg/hr patch). INJECTION: With spontaneous respiration: By slow IV injection, initially 50-100 mcg (max 200 mcg on specialist advice), then 25-50 mcg as required. By IV infusion, 3-4.8 mcg/kg/hr adjusted according to response. With assisted ventilation: By slow IV injection, initially 0.3-3.5 mg, then 100-200 mcg as required. By IV infusion, initially 10 mcg/kg over 10 min…
Administration
Administered by IM or IV injection. Compatibility: Stable in dextrose 5%, NaCl 0.9%. Y-site administration: Drug to Drug IV Compatibility: Acyclovir, amikacin, amiodarone, aztreonam, bumetanide, calcium gluconate, cephazolin, ceftriaxone, cimetidine, cisatracurium, dexamethasone, digoxin, diltiazem, diphenhydramine, dobutamine, dopamine, enalapril, epinephrine, esmolol, famotidine, fluconazole, furosemide, gentamicin, heparin, hydrocortisone, hydromorphone, imipenem, insulin regular, ketorolac, labetalol, lansoprazole, levofloxacin, linezolid, lorazepam, magnesium sulphate, methylprednisolone, metoclopramide, midazolam, milrinone, morphine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, phenylephrine, piperacillin/tazobactam, propofol, ranitidine, tobramycin, vancomycin, vasopressin, vecuronium. Drug to Drug IV Incompatibility: Azithromycin, pantoprazole. In syringe:…
Adverse Effects
Hypotension, sedation, tachycardia, palpitations, dry mouth, visual disturbances, conjunctivitis, asthenia, fatigue, anxiety, anorexia, insomnia, somnolence, dizziness, hallucinations, pruritus, sweating, bradycardia, GI upset, urinary retention, headache, confusion, dyspnoea, tremor, paraesthesia, muscle spasm, respiratory depression. Tolerance and dependence. Rash, erythema and itching.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Severe respiratory depression, severe obstructive lung conditions, severe CNS impairment, bradycardia, paralytic ileus. Precautions: COPD, raised intracranial pressure, impaired consciousness, head injury, bradyarrhythmia, renal or hepatic impairment, hypovolaemia, hypotension, chronic constipation. Myasthenia gravis. Monitor for signs of respiratory depression. Brain tumour. Risk of tolerance and dependence. Elderly or debilitated patients. Dispose of patches and oral units with care. Fever, avoid exposure of application site to direct heat.
Interactions
MAOIs, CNS depressants, CYP3A4 inhibitors or inducers, grapefruit juice, narcotic antagonists, SSRIs, SNRIs, other serotonergic drugs.
Advice to Patient
Avoid alcohol during therapy. Contact prescriber if there is difficulty in breathing, acute headache, changes in vision, chest pain, slow or fast heartbeat, changes in mental status, confusion, change in urinary pattern, unusual weight gain, swelling of ankles/hands/feet. If constipation is unrelieved in few days, consult prescriber for suitable laxative or stool-softener. Do not take OTC medications especially tranquilizers, sedatives, antihistamines, pain medications without consulting prescriber. Maintain good mouth hygiene to prevent dental caries as transmucosal preparation contains sugar. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Change position slowly when rising from sitting or lying position.
Pharmacokinetics
Onset of action: Children 3-12 yrs: Intranasal: 5-10 mins. Adults: Analgesic: IM: 7-8 mins; IV: Almost immediate; Transdermal patch (initial placement): 6 hrs; Transmucosal: 5-15 mins. Duration: IM: 1-2 hrs; IV: 0.5-1 hr; Transdermal (removal of patch/no replacement): Related to blood level; some effects may last 72-96 hrs due to extended half-life and absorption from the skin , fentanyl concentrations reduce by approx. 50% in 20-27 hrs; Transmucosal: Related to blood level; respiratory depressant effect may last longer than analgesic effect. Absorption: Transdermal, patch: Initial application: Drug is released at a nearly constant rate from the transdermal matrix system into the skin, where it accumulates; this results in a depot of fentanyl in the outer layer of skin. Fentanyl is absorbed into systemic circulation from the depot. This results in a gradual increase in serum conc over…
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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