Fentanyl

Fentanyl

[patch $27.97, 500mcg ampoule $2.17, 100mcg ampoule 93 cents, 500mcg in 50ml premixed syringe]

ADMINISTRATION ROUTES:

• IV, transdermal

ALTERNATIVE NAMES:

• Fentanyl, Durogesic, Sublimaze

ICU INDICATIONS:

1. opioid analgesia
2. induction of anaesthesia

PRESENTATION AND ADMINISTRATION:

• IV:
  100mcg in 2ml (50mcg/ml), 500mcg in 10ml (50mcg/ml) 500mcg in 50ml 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:
  12.5mcg/hour, 25mcg/hour, 50mcg/hour, 75mcg/hour, and 100mcg/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:
  Infusion doses are typically 0-100mcg/hr Doses as part of induction of anaesthesia are typically 50-200mcg in ICU patients; much higher doses are occasionally required.
• Transdermal:
  Usually commence with 25mcg/hour or less in the opioid naïve.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]
  <10: 50% of normal dose
  10-20: 75% of normal dose
  >20-50: dose as in normal renal function
• Dose in renal replacement therapy
  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:
  1-10 mcg/kg; infusion 5-10 mcg/kg/hr

  For infusion in paediatrics:
  <10kg 100mcg/kg in 50ml 5% dextrose at 1-2ml/hr >10kg 50mcg/ml at 0.04-0.08ml/kg/hr

CLINICAL PHARMACOLOGY:

• Fentanyl citrate is a narcotic analgesic. A dose of 100 mcg is approximately equivalent in analgesic activity to 10 mg of morphine.

CONTRAINDICATIONS

1. hypersensitivity to fentanyl

WARNINGS

• May cause muscle rigidity, particularly involving the muscles of respiration, when given rapidly.

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 FOR THE ICU

• Other CNS depressant drugs (e.g., barbiturates, tranquilizers, narcotics and general anesthetics) 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 apnea
• Gastrointestinal System:
  Nausea, emesis,
  
• Neurological System:
  Dizziness, blurred vision, extrapyramidal symptoms (dystonia, akathisia and oculogyric crisis)