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FentanylAka: Transdermal Fentanyl, Fentanyl Patch, Duragesic, Sublimaze

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  1. Class
    1. Short acting Narcotic (except transdermal fentanyl)
  2. Indication
    1. Chronic Pain (especially Cancer Pain Management)
    2. Short-acting Labor Analgesia
  3. Dosing: Child (for anesthesia or Sedation)
    1. Dose: 1-3 mcg/kg/dose (maximum: 50 ug) IV or IM
      1. May repeat fentanyl (same dose) q2 minutes to effect
      2. Most patients require 3-5 fentanyl doses (3-5 ug/kg)
    2. Consider administering with Versed
      1. Versed: 0.1 mg/kg (maximum: 2 mg)
  4. Dosing: Adult
    1. Transdermal Fentanyl (Duragesic)
      1. Available strengths: 25, 50, 75, 100 mcg/hour
      2. Onset of full effect only after 24 hours (steady state may not be reached for 1 week)
      3. Change patch ever 72 hours
        1. In atypical cases may need to be changed every 48 hours for end-of-dose pain
        2. Should not be changed more often than every 48 hours
      4. Conversions from prior morphine (total per 24 hours)
        1. Fentanyl 25 mcg/h: MS 37.5 mg PO or 12.5 mg IV
        2. Fentanyl 50 mcg/h: MS 75 mg PO or 25 mg IV
        3. Fentanyl 75 mcg/h: MS 112 mg PO or 37.5 mg IV
        4. Fentanyl 100 mcg/h: MS 150 mg PO or 50 mg IV
    2. Transmucosal Lozenge (Actiq)
      1. Available strengths: 200, 400, 800, 1200, 1600 ug
      2. Maximum: 4 lozenges per day
  5. Pharmacokinetics
    1. Intramuscular
      1. Onset: 7 to 15 minutes
      2. Peak: 15 minutes
      3. Duration: 1 to 2 hours
    2. Intravenous
      1. Onset: minutes
      2. Peak: minutes
      3. Duration: 30 to 60 minutes
  6. Precautions: Oversedation
    1. Antagonist: Naloxone (Narcan)
  7. Efficacy: Non-Cancer Chronic Pain
    1. Transdermal Fentanyl preferred over oral morphine
      1. Better pain relief
      2. Improved quality of life
    2. Reference
      1. Allan (2001) BMJ 322:1154

Sublimaze (C0015845)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishSublimaze
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Fentanyl (C0015846)

Definition (MSH)A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Fentanyl is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078)
Definition (CSP)potent narcotic analgesic, abuse of which leads to habituation or addiction; primarily a mu-opioid agonist, used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance.
Definition (NCI)A narcotic opioid drug that is used in the treatment of pain.
Definition (NCI)A synthetic, lipophilic phenylpiperidine opioid agonist with analgesic and anesthetic properties. Fentanyl selectively binds to the mu-receptor in the central nervous system (CNS) thereby mimicking the effects of endogenous opiates. Stimulation of the mu-subtype opioid receptor stimulates the exchange of GTP for GDP on the G-protein complex and subsequently inhibits adenylate cyclase. This results in a decrease in intracellular cAMP and leads to a reduction in the release of neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline. The analgesic effect of fentanyl is likely due to its metabolite morphine, which induces opening of G-protein-coupled inwardly rectifying potassium (GIRK) channels and blocks the opening of N-type voltage-gated calcium channels, thereby resulting in hyperpolarization and reduced neuronal excitability.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishFentanyl, FENTANYL PREPARATION, Fentanyl product, Fentyl, Phentanyl
Spanishfentanilo
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Durogesic (C0591423)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishDuragesic, Durogesic
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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