Fentanyl
Trade names: Actiq, Duragesic, Fentanyl Oralet,
Fentanyl
Transdermal, Fentanyl Transmucosal, Sublimaze
Drug class
Narcotic agonist analgesic
Pregnancy: (Category C/ D if used
for prolonged periods or in high doses at term) Therapeutic actions
§ Acts
at specific opioid receptors, causing analgesia, respiratory depression,
physical depression, euphoria.
Indications
• Analgesic action of short duration during anesthesia and
immediate postop period
• Analgesic supplement in general or regional anesthesia
•
Administration with a
neuroleptic as an anesthetic premeditation, for induction of anesthesia, and as
an adjunct in maintenance of general and regional anesthesia
• For use as an anesthetic agent with oxygen in selected high-risk
patients
• Transdermal system: management of chronic pain in patients
requiring opioid analgesia
• Treatment of breakthrough pain in cancer patients being treated
with narcotics
Contraindications/cautions
• Contraindications:
hypersensitivity to narcotics, diarrhea caused by poisoning, acute bronchial
asthma, upper airway obstruction, pregnancy.
• Use cautiously with bradycardia,
history of seizures, lactation.
Dose
by intravenous injection, with
spontaneous respiration, 50–200 micrograms, then 50 micrograms as
required; CHILD
3–5 micrograms/kg, then 1 microgram/kg as required
With assisted ventilation, 0.3–3.5 mg,
then 100–200 micrograms as required; Child: 15 micrograms/kg,
then 1–3 micrograms/kg as required
By intravenous infusion In ICU: 0.5 – 1
micrograms/kg/ hour
Adverse effects
• CNS: Sedation, clamminess,
sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion,
light-headedness, nervousness, unusual dreams, agitation, euphoria,
hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired
mental and physical performance, coma, mood changes, weakness, headache,
tremor, convulsions
• GI: Nausea, vomiting, dry mouth,
anorexia, constipation, biliary tract spasm
•
CV: Palpitation, increase or decrease in BP,
circulatory depression, cardiac arrest, shock, tachycardia, bradycardia,
arrhythmia, palpitations
•
Respiratory:
Slow, shallow respiration, apnea, suppression of cough reflex, laryngospasm,
bronchospasm
•
GU: Ureteral spasm, spasm
of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic
effect, reduced libido or potency
• EENT: Diplopia, blurred vision
• Dermatologic: Rash, hives,
pruritus, flushing, warmth, sensitivity to cold
•
Local:
Phlebitis following IV injection, pain at injection site; tissue irritation and
induration (SC injection)
• Other: Physical tolerance and
dependence, psychological dependence; local skin irritation with transdermal
system
Clinically important interactions
• Drug-drug
o
Potentiation of effects
when given with barbiturate anesthetics; decrease dose of fentanyl when
coadministering
• Drug-lab test
o
Elevated biliary tract
pressure may cause increases in plasma amylase, lipase; determinations of these
levels may be unreliable for 24 h after administration of narcotics
Nursing
Considerations
v Administer to women who are nursing a baby 4---6 h before the
next scheduled feeding to minimize the amount in milk.
v Provide narcotic antagonist, facilities for assisted or
controlled respiration on standby during parenteral administration.
v Prepare site by clipping (not shaving) hair at site; do not use
soap, oils, lotions, alcohol; allow skin to dry completely before application.
Apply immediately after removal from the sealed package; firmly press the
transdermal system in place with the palm of the hand for 10---20 sec, making
sure the contact is complete. Must be worn continually for 72 h.
v Use
caution with Actiq form to keep this drug out of the reach of children (looks
like a lollipop) and follow the distribution restrictions in place with this
drug very carefully.
