Fentanyl

CLINICAL USE

Opioid analgesic:Short surgical procedures Ventilated patients Chronic intractable pain

DOSE IN NORMAL RENAL FUNCTION

IV injection: with spontaneous respiration: 50– —200 mcg, then 50 mcg as requiredwith assisted ventilation: 0.3–3.5 mg, —then 100–200 mcg as required

IV infusion

: with spontaneous respiration: —50–80 nanograms/kg/minute adjusted according to responsewith assisted ventilation: 10 mcg/kg —over 10 minutes, then 0.1–3 mcg/kg/minuteTopical (chronic pain): 12–300 mcg/hour, patches changed every 72 hoursLozenges: 200–800 mcg over 15 minutes repeated after 15 minutes if required; maximum 2 doses per pain episode and 4 doses daily

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :336.5

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :80–85

%Excreted unchanged in urine &nbsp &nbsp : <7

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :4

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2–7/Possibly increased

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function Titrate according to response

10 to 20 &nbsp &nbsp : 75% of normal dose. Titrate according to response

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : 50% of normal dose. Titrate according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Not dialysed. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Antidepressants: possible CNS excitation or depression (hypertension or hypotension) in patients also receiving MAOIs (including moclobemide) – avoid concomitant use; possibly increased sedative effects with tricyclics

Antivirals: concentration increased by ritonavirSodium oxybate: enhanced effect of sodium oxybate – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

IV, IM, topically, oral

Rate of Administration

–

Comments

Compatible with sodium chloride 0.9% and glucose 5%

OTHER INFORMATION

For short surgical procedures the degree of renal impairment is irrelevantFor other indications, renal impairment may have a moderate effect on the elimination of the drug; however, as fentanyl is titrated to response the usual dose and method of administration remains valid.

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