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                           :336.5

%Protein binding                           :80–85

%Excreted unchanged in urine     : <7

Volume of distribution (L/kg)       :4

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

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

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

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

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

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

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

CAV/VVHD      :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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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