Fentanyl

A to Z Drug Facts

Fentanyl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(FEN-tuh-nill)

Sublimaze, Fentanyl Oralet, Actiq

Class: Narcotic analgesic

Action A potent, short-acting, rapid-onset opiate agonist that relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting, and increased bladder tone.

Indications Short-term analgesia before, during, and after anesthesia; supplement to general or regional anesthesia; for administration with neuroleptic during anesthesia; anesthesia with oxygen for high-risk patients.

Contraindications Known intolerance to fentanyl.

Route/Dosage

Premedication

ADULTS: IM 0.05 to 0.1 mg 30 to 60 min before surgery. Elderly patients may need reduced dose.

Postoperative (Recovery Room)

IM/IV 0.05 to 0.1 mg for pain control, tachypnea, or emergent delirium. May repeat in 1 to 2 hr.

Adjunct to Regional Anesthesia

IM/IV 0.05 to 0.1 mg; dose administered over 1 to 2 min prn.

Adjunct to General Anesthesia

See dosage information in table below.

General Anesthesia

IV 0.05 to 0.1 mg/kg with oxygen and muscle relaxant. Maximum of IV 0.15 mg/kg. CHILDREN 2 to 12 YR: For induction and maintenance, reduce dose as low as IV2 to 3 mcg/kg.

Interactions

Amiodarone: Profound bradycardia, sinus arrest, and hypotension may occur. Barbiturate anesthetics, other CNS depressants: May have additive effects. Dose of fentanyl required will be less than usual. Diazepam: Diazepam may produce cardiovascular depression when given with high doses of fentanyl. Droperiodol: May cause hypotension and decrease pulmonary arterial pressure. Nitrous oxide: Nitrous oxide may cause cardiovascular depression with high-dose fentanyl. Protease inhibitors: Monitor for increased CNS and respiratory depression.

Lab Test Interferences Increased amylase and lipase may occur up to 24 hr after dose.

Adverse Reactions

CV: Hypotension; hypertension; bradycardia; tachycardia; chest wall rigidity. CNS: Lightheadedness; dizziness; sedation; disorientation; incoordination; seizures. DERM: Sweating; pruritus; urticaria. GI: Nausea; vomiting; constipation; abdominal pain. GU: Urinary retention or hesitancy. RESP: Laryngospasm; depression of cough reflex; respiratory depression; rebound respiratory depression postoperatively. OTHER: Skeletal muscle rigidity; tolerance; psychological and physical dependence with chronic use.

Precautions

Pregnancy: Category C. Fentanyl has been shown to impair fertility and to have an embryocidal effect in rats at doses 0.3 times the upper human dose for 12 days. The use of fentanyl is not recommended in labor. Lactation: Excreted in breast milk. Children: Not recommended for children < 2 yr. Special risk patients: Use with caution in elderly patients and patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, bradycardia, supraventricular tachycardia, depleted blood volume or circulatory shock. Hypoventilation: Naloxone and intubation equipment must be available. Skeletal muscle rigidity: Fentanyl may cause skeletal muscle rigidity, particularly of the truncal muscles. Renal or hepatic impairment: Duration of action may be prolonged; may need to reduce dose.

Adjunct to General Anesthesia
Depth of anesthesia	Total dose	Maintenance*
Low	0.002 mg/kg	Usually not needed
Moderate	0.002 to 0.02 mg/kg	0.025 to 0.1 mg IV/IM
High	0.02 to 0.05 mg/kg	0.025 mg to 50% of induction dose
*

PATIENT CARE CONSIDERATIONS

Administration/Storage

Use medication immediately after dilution.
Check calculated dose volume carefully.
Administer IV dose slowly over 1 to 2 minutes.
Store at room temperature and protect from light.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess pain type and intensity prior to administration; assess effectiveness of pain relief shortly after administration.
Assess respiratory rate, heart rate, and BP frequently. Report significant changes to physician.
Assess for confusion; implement safety precautions as needed.
Monitor GI, urinary, and bowel function (urinary retention commonly occurs).
Take precautions to prevent falls secondary to lightheadedness, dizziness, confusion, and/or hypotension.
Ensure that naloxone and intubation/airway management equipment are available in event of overdose.

OVERDOSAGE: SIGNS & SYMPTOMS
	Miosis, respiratory depression, CNS depression, circulatory collapse, seizures, cardiopulmonary arrest, death

Patient/Family Education

Instruct patient about adverse effects, and identify signs and symptoms that should be reported.
Explain that lightheadedness and dizziness are frequently experienced and that transfer assistance should be used as needed.
Instruct patient to avoid use of other CNS depressants or alcohol and to avoid driving after administration.
Explain potential for tolerance with continued use.