FENTANYL

Opioid analgesic

Dosage Forms

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Solution for Injection

50 microgram/ml

Uses

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  • Intra-operative analgesia
  • Enhancement of analgesia
  • Analgesia and respiratory depression in assisted respiration in intensive care

Dose and Duration

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Spontaneous respiration: analgesia and enhancement of anaesthesia during operation
Adult and child over 12 years: initially 50–100 micrograms (max 200 micrograms) by slow IV injection, then 25–50 micrograms as required
By IV infusion, 3–4.8 micrograms/kg/hour adjusted according to response
Child 1 month–12 years: 1–3 micrograms/kg, then 1 microgram/kg as required
Assisted ventilation: analgesia and enhancement of anaesthesia during operation
Adult: initially 300–3500 micrograms by slow IV injection, then 100–200 micrograms as required
By IV infusion, initially 10 micrograms/kg over 10 minutes, then 6 micrograms/kg/hour adjusted according to response; may require up to 180 micrograms /kg/hour during cardiac surgery
Child 12–18 years: 1–5 micrograms/kg, then 50–200 micrograms as required
Neonate and child 1 month–12 years: 1–5 micrograms/kg initially, then 1–3 micrograms/kg as require
Assisted ventilation: analgesia and respiratory depression in intensive care
Adult: same dose as above
Child 1 month–18 years: 1–5 micrograms/kg by IV injection, then 1–6 micrograms/kg/hour by IV infusion, adjusted according to response

Contraindications

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  • Obstructive airways disease
  • Respiratory depression
  • Concurrent administration with MAOI or within 2 weeks of their discontinuation
  • Brain trauma
  • Known intolerance to fentanyl, methadone, pethidine or tramadol
  • Hypersensitivity to fentanyl

Side Effects

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  • Muscle rigidity
  • Sedation, dizziness, dyskinesia
  • Post-operative confusion
  • Visual disturbance
  • Tachycardia, bradycardia, arrhythmias, hypotension, hypertension, vein pain
  • Laryngospasm, bronchospasm, apnoea
  • Nausea, vomiting
  • Allergic dermatitis

Interactions

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  • Fluconazole, itraconazole (plasma concentration of fentanyl possibly increased)
  • Ritonavir (plasma concentration of fentanyl increased)
  • Saquinavir (increased risk of ventricular arrhythmias)
  • Sodium oxybate (enhanced effects of sodium oxybate)

Patient Instructions

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  • Do not drive unless sufficient time has elapsed since administration of fentanyl

Pregnancy

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  • Do not use

Breast-feeding

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  • Do not use

⚠️ Caution

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  • Calculate dose on basis of ideal body weight in order to avoid excessive dosing
  • Higher doses may be required in patients with chronic opioid therapy or with a history of opioid abuse
  • Repeat use may result in tolerance and dependence
  • Avoid rapid bolus injections in patients with compromised intracerebral compliance due to risk of reduction of cerebral perfusion pressure
  • Reduce dose in the elderly and debilitated patients
  • Titrate with caution in patients with uncontrolled hypothyroidism, pulmonary disease, decreased respiratory reserve, alcoholism or impaired renal or hepatic function. Prolonged postoperative monitoring is often required
  • Fentanyl is excreted in breast milk; the child should not be breast-fed for 24 hours following use of fentanyl