Fentanyl citrate
Fentanyl citrate (Sublimaze)
Fentanyl Citrate
( FEN-tah-nil)
Pregnancy Category: C Sublimaze (C-II) (Rx)
Fentanyl transmucosal system
Fentanyl transmucosal system (Actiq, Fentanyl Oralet)
( FEN-tah-nil)
Pregnancy Category: C Actiq Fentanyl Oralet (C-II) (Rx)

Classification: Narcotic analgesic, morphine type

See Also: See also Narcotic Analgesics .

Action/Kinetics: Similar to those of morphine and meperidine. IV. Onset: 7-8 min. Peak effect: Approximately 30 min. Duration: 1-2 hr. t 1/2: 1.5-6 hr. When the oral lozenge (transmucosal administration) is sucked, fentanyl citrate is absorbed through the mucosal tissues of the mouth and GI tract. Peak effect, transmucosal: 20-30 min. Actiq resembles a lollipop; sucking provides a rapid onset of action. Faster-acting and shorter duration than morphine or meperidine.

Uses: Parenteral: Preanesthetic medication, induction, and maintenance of anesthesia of short duration and immediate postoperative period. Supplement in general or regional anesthesia. Combined with droperidol for preanesthetic medication, induction of anesthesia, or as adjunct in maintenance of general or regional anesthesia. Combined with oxygen for anesthesia in high-risk clients undergoing open heart surgery, orthopedic procedures, or complicated neurologic procedures.
Oral (transmucosal): Actiq: Severe pain associated with cancer treatment in those tolerant to opiates and experience breakthrough pain. Fentanly Oralet: Only for use in the hospital as an anesthetic premedication in the OR or to induce conscious sedation prior to a diagnostic or therapeutic procedure in monitored hospital settings.

Contraindications: The transmucosal form is contraindicated in children who weigh less than 10 kg, for the treatment of acute or chronic pain (safety for this use not established), and for doses in excess of 15 mcg/kg in children and in excess of 5 mcg/kg (maximum of 400 mcg) in adults. Use outside the hospital setting is contraindicated. Myasthenia gravis and other conditions in which muscle relaxants should not be used. Clients particularly sensitive to respiratory depression. Use during labor. Lactation.

Special Concerns: Safety and effectiveness have not been determined in children less than 2 years of age. Use with caution and at reduced dosage in poor-risk clients, children, the elderly, and when other CNS depressants are used. Use of the transmucosal form carries a risk of hypoventilation that may result in death.

Additional Side Effects: Skeletal and thoracic muscle rigidity, especially after rapid IV administration. Bradycardia, seizures diaphoresis. Transmucosal form may cause life-threatening hypoventilation.

Additional Drug Interactions: Diazepam / Risk of CV depression Droperidol / Hypotension and pulmonary arterial pressure Nitrous oxide / Risk of CV depression Protease inhibitors / CNS and respiratory depression

How Supplied: Injection: 0.05 mg/mL; Lozenge (Oralet): 100 mcg, 200 mcg, 300 mcg, 400 mcg; Lozenge on a stick (Actiq): 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg, 1600 mcg

Dosage
?IM, IV Preoperative medication.
Adults: 0.05-0.1 mg IM 30-60 min before surgery.
Adjunct to anesthesia, induction.
Adults: 0.002-0.05 mg/kg IV, depending on length and depth of anesthesia desired; maintenance: 0.025-0.1 mg/kg when indicated.
Adjunct to regional anesthesia.
Adults: 0.05-0.1 mg IM or IV over 1-2 min when indicated.
Postoperatively.
Adults: 0.05-0.1 mg IM q 1-2 hr for control of pain, tachypnea, and emergence delirium.
As general anesthetic with oxygen and a muscle relaxant.
0.05-0.1 mg/kg (up to 0.15 mg/kg may be required).
Children, induction and maintenance of anesthesia.
Pediatric, 2-12 years: 2-3 mcg/kg.
Children, general anesthetic, induction and maintenance.
2-3 mcg/kg. Safety and efficacy have not been determined in children less than 2 years of age.
?Transmucosal (Oral Lozenge)
Individualize according to weight, age, physical status, general condition and medical status, underlying pathology, use of other drugs, type of anesthetic to be used, and the type and length of the surgical procedure. Doses of 5 mcg/kg are equivalent to IM fentanyl, 0.75-1.25 mcg/kg. Clients receiving more than 5 mcg/kg should be under the direct observation of medical personnel. Children may require up to 15 mcg/kg, provided their body weight is not less than 10 kg. Clients over 65 years of age should receive a dose from 2.5 to 5 mcg/kg. The maximum dose for adults and children, regardless of weight, is 400 mcg.