ADMINISTRATION ROUTES:
IV, transdermal
ALTERNATIVE NAMES:
Fentanyl, Durogesic, Sublimaze
ICU INDICATIONS:
- Opioid analgesia
- Induction of anaesthesia
PRESENTATION AND ADMINISTRATION:
IV:
100 mcg in 2 mL (50 mcg/mL), 500 mcg in 10 mL (50 mcg/mL)
500 mcg in 50 mL premixed syringes
Compatible with the following IV fluids:
Normal saline, 5% glucose, Glucose and Sodium Chloride
Store at room temperature
Use pre-mixed syringes for IV infusions; can be given either diluted or undiluted by IV push if required
Transdermal:
12.5 mcg/hour, 25 mcg/hour, 50 mcg/hour, 75 mcg/hour, and 100 mcg/hour patches Apply to clean, dry, non hairy, non-irritated skin of the torso or upper arm.
Rotate application site.
Wear patch continuously for 72 hours.
DOSAGE:
IV:
Analgesia as bolus:
10-30 mcg PRN
Analgesia by infusion:
10-100 mcg/hr
Anaesthesia induction for intubation:
50-200 mcg bolus
Much higher doses are occasionally required
Transdermal:
Commence with 25 mcg/hour
Titrate upwards as required. Commence with lower dose patch if opioid naïve
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | 50% of normal dose |
| 10-20 | 75% of normal dose |
| >20-50 | dose as in normal renal function |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | 50% of normal dose |
| HD | 50% of normal dose |
| CVVHDF | 75% of normal dose |
Note: although these dosages provided here are indicative, fentanyl is titrated to effect and the required dose to achieve the desired effect is the correct dose (irrespective of the renal function)
DOSAGE IN PAEDIATRICS:
IV:
Analgesia as bolus:
0.05 - 2 mcg/kg IV slow push (max 50 mcg)
Sedation by infusion:
0.5 - 5 mcg/kg/hr
Anaesthesia induction for intubation:
3-5 mcg/kg
CLINICAL PHARMACOLOGY:
Fentanyl citrate is a narcotic analgesic. A dose of 100 mcg is approximately equivalent in analgesic activity to 10 mg of morphine. For more information see Appendix 6
CONTRAINDICATIONS:
- Hypersensitivity to fentanyl
WARNINGS:
May cause muscle rigidity, particularly involving the chest wall, when given rapidly and at higher doses. If the patient is unable to be ventilated, naloxone should be administered.
PRECAUTIONS:
General:
Fentanyl may produce bradycardias
Laboratory Tests:
No tests additional to routine ICU tests are required
Drug/Laboratory Test Interactions:
None of note
IMPORTANT DRUG INTERACTIONS IN ICU:
Other CNS depressant drugs (e.g. barbiturates, tranquilisers, narcotics and general anaesthetics) will have additive or potentiating effects with fentanyl
ADVERSE REACTIONS:
Body as a Whole:
Anaphylaxis, pruritus, urticaria
Cardiovascular System:
hypertension, hypotension, and bradycardia
Respiratory System:
Laryngospasm, respiratory depression, and apnoea
Gastrointestinal System:
Nausea, emesis
Neurological System:
Dizziness, blurred vision, extrapyramidal symptoms (dystonia, akathisia and oculogyric crisis)