| Drug Index |
| GENERIC NAME : |
| fentanyl |
| BRAND NAMES : |
| Sublimaze (injectable), Actiq (lozenge on a stick), Fentora (buccal tablets), Sufenta (sufentanyl), Ultiva (remifentanyl), Duragesic Patches (fentanyl skin patches) |
| STREET NAMES : |
| synthetic heroin, China white |
| BRIEF DESCRIPTION : |
| Fentanyl is an opiate (narcotic) analgesic (painkiller) that binds to the mu (?) opiate receptor and has potency approximately 81 times that of morphine. It is an opioid agonist. It is considered a central nervous system depressant and slows the action of smooth muscle. Examples of other powerful opioid agonists include hydromorphone, methadone, morphine, oxycodone, and oxymorphone. The LD50 (dose that is lethal to half of individuals receiving the medication) in humans, by intravenous injection in an opiate-naive individual (without tolerance), is 0.5-1 milligrams. |
| INDICATIONS FOR USE : |
| Fentanyl is an opiate (narcotic) analgesic (painkiller) that binds to the mu (?) opiate receptor and has potency approximately 81 times that of morphine. It is an opioid agonist. It is considered a central nervous system depressant and slows the action of smooth muscle. Examples of other powerful opioid agonists include hydromorphone, methadone, morphine, oxycodone, and oxymorphone. The LD50 (dose that is lethal to half of individuals receiving the medication) in humans, by intravenous injection in an opiate-naive individual (without tolerance), is 0.5-1 milligrams. Indications for Use: Short-term analgesia before, during, and after anesthesia; supplement to general or regional anesthesia; for administration with neuroleptic during anesthesia; anesthesia with oxygen for high-risk patients ( Sublimaze ) . Management of breakthrough cancer pain in patients with malignancies who are already receiving and are tolerant to opioid therapy for their underlying cancer pain ( Actiq , Fentora ). The Actiq ("fentanyl on a stick") unit should be sucked, not chewed. The Actiq unit should be placed between the cheek and lower gum, occasionally moving the drug matrix from 1 side to the other, using the handle. The Actiq unit should be consumed over a 15-min period. Fentora tablets (tablets designed for slow absorption in the mouth by placing between cheek and gum) should be left between the cheek and gum until disintegrated, which usually takes 14 to 25 min. If remnants remain after 30 min, they may be swallowed with a glass of water. Duragesic Patches (fentanyl skin patches) provide a continuous, 24 hour a day delivery of fentanyl via absorption through the skin. This form of fentanly is indicated for treatment of chronic pain. Sufentanil (trade name Sufenta), a potent analgesic (5 to 10 times more potent than fentanyl) for use primarily in heart surgery. Remifentanil (trade name Ultiva), currently the shortest acting opioid, has the benefit of rapid offset, even after prolonged infusions. |
| ABUSE AND ADDICTIVE POTENTIAL : |
Use of injectable fentanyl for management of pain during and after surgery under the direction of a physician poses very little risk of dependence. When used for treatment of chronic pain, it should be used with caution in patients with a history of alcohol or substance dependence as this may highly predispose to becoming addicted to this drug. A symptom that is easily detected with opiate use is pinpoint pupils (miosis). Psychological dependence may occur early in use of this medication, but physical dependence and tolerance may develop upon repeated administration (requiring larger or more frequent dosages of fentanyl to produce relief of pain or achieve a state of euphoria). . When fentanyl is abused, the individual is seeking the euphoric effect ("high"). Mild signs of withdrawal can occur in some individuals after using meperdine for several days consecutively. Addiction to this drug can occur, even if taken as prescribed, when used for several weeks consecutively. When taken for treatment of chronic pain for several weeks or months consecutively, tolerance and dependence often occur. Once an individual has become dependent on fentanyl, a primary driving force to continue using fentanyl (or substituting other opiate agonists) is to prevent the very unpleasant neurochemical and physical withdrawal syndrome associated with discontinuing this drug. Symptoms usually associated with withdrawal may include: • Abdominal pain • Muscle aches • Joint pain • Sleep problems (insomnia) • Agitation, Restlessness • Diarrhea • Dilated pupils • Goose bumps • Nausea • Runny nose • Sweating • Vomiting • Restlessness • Yawning • Loss of appetite (anorexia) • Rapid heart rate • Elevated blood pressure • Rapid breathing • Eyes or nose watering (Note: the term "going cold turkey" comes from the gooseflesh that occurs during withdrawal that looks like the skin of a plucked turkey) Withdrawal of fentanyl is best handled by a physician that is skilled at assisting patients with opiate detoxification. Medications are often necessary to help control symptoms of withdrawal. |
| OVERDOSAGE : |
| Acute overdose of fentanyl can cause respiratory depression, extreme drowsiness or prolonged sleeping, stupor or coma, muscle flaccidity, cold/clammy skin, constricted pupils, slow heart rate (bradycardia), low blood pressure (hypotension), and death. When fentanyl is used in combination with alcohol or other central nervous system depressants, the two drugs potentiate one another and can greatly enhance the risk for overdose. Because of the dangers associated with overdose, immediate medical attention should be sought. |
| CAUTIONS : |
| Any patient with a history of alcohol or substance dependence has a very high risk for developing addiction to fentanyl. If use of this medication is considered necessary for the management of pain, the lowest dose of this medication that is sufficient to provide pain relief is warranted. It is also recommended that use of this medication in an addict be discontinued as soon as possible and pain management thereafter managed with non-addictive medications. Respiratory depression is the chief hazard from all opioid agonist medications. Caution should be exercised when prescribing this medication to individuals with impaired lung function or low blood pressure. There may be serious problems also with use of this medication an individual with a closed head injury. It can elevate cerebrospinal fluid pressure and mask symptoms of closed head injury that could require immediate medical measures. The administration of fentanyl, like all opioid analgesics, may obscure the diagnosis or clinical course in patients with acute abdominal conditions. Individuals with kidney (renal) or liver (hepatic) impairment must be monitored closely because the concentration of fentanyl in the bloodstream can be higher than in subjects with normal kidney or liver function. Use of fentanyl with other sedative/hypnotic drugs, opiates (narcotics), muscle relaxers, sedating "street drugs", or alcohol can cause a multiplied effect of the potency of each drug. Taking these types of drugs with fentanyl is considered dangerous. There are also other prescription medications that may interact negatively with fentanyl. Certain medications may either increase or decrease plasma level of fentanyl when used together. Use of alcohol, drugs, or other medications should be discussed with your physician or pharmacist before using fentanyl. Fentanyl is excreted in human breast milk. |
| SIDE EFFECTS : |
| Side effects of fentanyl use may include nausea, constipation, vomiting, headache, and itching (pruritus), hypotension (low blood pressure). Adverse effects may include allergic reaction, irregular heartbeat, migraine, confusion, temporary hallucination, dry mouth, nervousness, tremor, rash, blurred vision, mental clouding, lethargy, mood changes, urinary retention, anxiety, fear, respiratory depression, and personality changes. |
| FOR MORE INFORMATION : |
| This is a condensed description of fentanyl. For more details check with your physician, pharmacist, or resources such as The Physicians' Desk Reference (PDR) or http://www.drugs.com |
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