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Patch $3.85, Vial $0.97

Fentanyl

Editor: Updated Class:

ADMINISTRATION ROUTES:

IV, transdermal

ALTERNATIVE NAMES:

Fentanyl, Durogesic, Sublimaze

ICU INDICATIONS:

  1. Opioid analgesia
  2. 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:

  1. 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)