Fentanyl Citrate

Indications & Dose:

Adult anal Child >l2 yr

• Chronic pain:

Trans 25 μg/hr system initially; initial dose may be increased after 3 days, thereafter a minimum of 6 days should elapse between dosage increases; to convert patients already receiving other narcotics, refer to manufacturer product information; change system q72h

• Sedation for minor procedure:

Buccal 5 μg/kg (max 400 μg) 20 40 min prior to procedure

• Preoperatively:

IM 50 100 μg 30--60 min before surgery

• Adjunct to general anesthesia:

IV 2-50 μg/kg

• Adjunct to regional anesthesia:

IM/IV 50 100 μg when additional analgesia required

• General anesthesia:

IV 50 100 μg/kg with oxygen and a muscle relaxant

• Postoperatively:

IM 50 100 μg q 1 2h prn

Child 2 12 yr

• Sedation for minor procedure:

Buccal 5 10 μg/kg (max 400 μg) 20-40 min prior to procedure; children <40 kg may require doses of 10 15 μg/kg (max 400 μg); do not use in child <2 yr

• Adjunct to anesthesia:

IV 2 3 μg /kg

Notes:

1. IV/IM dose of 0.1 mg fentanyl equianalgesic to 10 mg of morphine, 75 mg of meperidine

2. Transdermal fentanyl dose of 100 μg/hr equianalgesic to 40 mg morphine IM or 360 mg morphine PO per 24hr

3. Buccal dose of 5 μg fentanyl equianalgesic to 1 μg IM fentanyl

Contraindications:

 Lozenge for child <15 kg, transdermal for child <12 yr

Side Effects:

Cautions:

Precautions:

 Elderly, respiratory depression, increased intracranial pressure, seizure disorders, severe respiratory disorders, cardiac dysrhythmias 

Interaction:

Drugs

Antihistamines, chloral hydrate, glutethimide, methocarbamol: Enhanced depressant effects

Barbiturates: Additive respiratory and CNS depressant effects

Cimetidine: Increased respiratory and CNS depression

Diazepam: Cardiovascular depression

Ethanol: Additive CNS effects

Nitrous oxide: Cardiovascular depression 

Warnings:

Adverse Effects:

Lactations:

Excreted in breast milk 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Asthenia, confusion, delirium, dizziness, euphoria, somnolence

CV: Bradycardia, hypotension or hypertension

EENT: Blurred vision, dry, mouth, miosis

GI: Constipation, nausea, vomiting

GU: Urinary retention

 MS: Muscle rigidity

RESP: Laryngospasm, respiratory depression

SKIN: Pruritis, sweating 

Patient And Carer Advice: