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FENTANYL CITRATE (FENTANYL CITRATE)
- Breakthrough cancer pain in opioid-tolerant patient
fentanyl 1,200 mcg lozenge on a handle
- Place 1,200 mcg by buccal route 4 times per day as needed for breakthrough pain
fentanyl 1,600 mcg lozenge on a handle
- Place 1,600 mcg by buccal route 4 times per day as needed for breakthrough pain
fentanyl 200 mcg lozenge on a handle
- Place 200 mcg by buccal route 4 times per day as needed for breakthrough pain
fentanyl 400 mcg lozenge on a handle
- Place 400 mcg by buccal route 4 times per day as needed for breakthrough pain
fentanyl 600 mcg lozenge on a handle
- Place 600 mcg by buccal route 4 times per day as needed for breakthrough pain
fentanyl 800 mcg lozenge on a handle
- Place 800 mcg by buccal route 4 times per day as needed for breakthrough pain
1,200 mcg lozenge on a handle
- Place 1,200 mcg by buccal route 4 times per day as needed for breakthrough pain
1,600 mcg lozenge on a handle
- Place 1,600 mcg by buccal route 4 times per day as needed for breakthrough pain
200 mcg lozenge on a handle
- Place 200 mcg by buccal route 4 times per day as needed for breakthrough pain
400 mcg lozenge on a handle
- Place 400 mcg by buccal route 4 times per day as needed for breakthrough pain
600 mcg lozenge on a handle
- Place 600 mcg by buccal route 4 times per day as needed for breakthrough pain
800 mcg lozenge on a handle
- Place 800 mcg by buccal route 4 times per day as needed for breakthrough pain
Breakthrough cancer pain in opioid-tolerant patient
- Place 200 mcg by buccal route 4 times per day as needed for breakthrough pain
- Place 400 mcg by buccal route 4 times per day as needed for breakthrough pain
- Place 600 mcg by buccal route 4 times per day as needed for breakthrough pain
- Place 800 mcg by buccal route 4 times per day as needed for breakthrough pain
- Place 1,200 mcg by buccal route 4 times per day as needed for breakthrough pain
- Place 1,600 mcg by buccal route 4 times per day as needed for breakthrough pain
- Azilect
- Depade
- Eldepryl
- isocarboxazid
- linezolid
- Marplan
- Matulane
- methylene blue (antidote)
- naltrexone
- naltrexone microspheres
- Nardil
- Parnate
- phenelzine
- procarbazine
- rasagiline
- Revia
- selegiline HCl
- tranylcypromine
- Vivitrol
- Zelapar
- Zyvox
Contraindicated
- amiodarone
- amiodarone in dextrose,iso-osm
- amoxicil-clarithromy-lansopraz
- Biaxin
- Biaxin Xl
- Biaxin Xl Pak
- boceprevir
- Buprenex
- buprenorphine
- buprenorphine-naloxone
- butorphanol tartrate
- Butrans
- clarithromycin
- conivaptan in 5 % dextrose
- Cordarone
- Crixivan
- Diflucan
- elvitegr-cobicist-emtric-tenof
- enzalutamide
- Erythrocin
- erythromycin
- erythromycin-sulfisoxazole
- fluconazole
- fluconazole in dextrose(iso-o)
- fluconazole in NaCl (iso-osm)
- Incivek
- indinavir
- Invirase
- itraconazole
- Kaletra
- Ketek
- ketoconazole
- lopinavir-ritonavir
- nalbuphine
- nefazodone
- nelfinavir
- Nexterone
- Norvir
- Norvir Soft Gelatin
- Noxafil
- Omeclamox-pak
- omeprazole-clarith-amoxicillin
- Onmel
- Pacerone
- posaconazole
- Prevpac
- ritonavir
- saquinavir mesylate
- sodium oxybate
- Sporanox
- Sporanox Pulsepak
- Stribild
- Suboxone
- telaprevir
- telithromycin
- Vaprisol
- Vfend
- Vfend Iv
- Victrelis
- Viracept
- voriconazole
- Xtandi
- Xyrem
- Zubsolv
Severe
Moderate
- Acid Reducer (cimetidine)
- Acid Relief (cimetidine)
- Anafranil
- aprepitant
- atazanavir
- Brintellix
- Brisdelle
- Calan
- Calan Sr
- Cardizem
- Cardizem Cd
- Cardizem La
- Cartia Xt
- Celexa
- cimetidine
- Cipro
- Cipro In D5W
- Cipro Xr
- ciprofloxacin
- ciprofloxacin (mixture)
- ciprofloxacin in D5W
- citalopram
- clomipramine
- Cymbalta
- darunavir
- desvenlafaxine
- desvenlafaxine fumarate
- desvenlafaxine succinate
- Dilacor Xr
- Dilt-xr
- diltiazem HCl
- Diprivan
- dronedarone
- duloxetine
- Effexor Xr
- Emend
- escitalopram oxalate
- Fanatrex
- Fetzima
- fluoxetine
- fluvoxamine
- fosamprenavir
- fosaprepitant
- gabapentin
- gabapentin enacarbil
- Gleevec
- Gralise
- Gralise 30-day Starter Pack
- Heartburn Relief
- Horizant
- imatinib
- isoniazid-rifamp-pyrazinamide
- Khedezla
- levomilnacipran
- Lexapro
- Lexiva
- Luvox Cr
- Matzim La
- milnacipran
- Multaq
- Neurontin
- olanzapine-fluoxetine
- paroxetine HCl
- paroxetine mesylate
- Paxil
- Paxil Cr
- Pexeva
- Prezista
- Pristiq
- propofol
- Prozac
- Prozac Weekly
- Reyataz
- Rifadin
- Rifamate
- rifampin
- rifampin-isoniazid
- Rifater
- Sarafem
- Savella
- sertraline
- Symbyax
- Tagamet Hb
- Tarka
- Taztia Xt
- Tiazac
- trandolapril-verapamil
- venlafaxine
- verapamil
- Verelan
- Verelan Pm
- Viibryd
- vilazodone
- vortioxetine
- Zoloft
- Acute asthma attack
- Alcoholism
- Gastrointestinal obstruction
- Headache disorder
- Migraine
- Paralytic ileus
- Postoperative acute pain
- Respiratory depression
- Sleep apnea
Contraindicated
- Adrenal cortical insufficiency
- Asthma
- Cardiogenic shock
- Chronic disease of respiratory system
- Chronic obstructive pulmonary disease
- Cor pulmonale
- Drug abuse
- History of opioid overdose
- Hypotension
- Inflammatory bowel disease
- Intracranial hypertension
- Kidney disease with reduction in GFR
- Respiratory depression
Severe
Moderate
- Adrenal cortical insufficiency
- Alcoholism
- Benign prostatic hyperplasia
- Biliary tract disorder
- Bradycardia
- Chronic obstructive pulmonary disease
- Disease of liver
- Drug abuse
- Intracranial hypertension
- Kidney disease with likely reduction in GFR
- Lower seizure threshold
- Seizure disorder
- Urethral stricture
FENTANYL CITRATE (FENTANYL CITRATE)
- Breakthrough cancer pain in opioid-tolerant patient
- Bradycardia
- CNS depression
- Dyspnea
- Hypotension
- Respiratory depression
- Constipation
- Dizziness
- Drowsy
- Nausea
- Vomiting
More Frequent
Severe
Less Severe
- Acute confusion
- Cardiac arrhythmia
- Circulatory depression
- False sense of well-being
- Hallucinations
- Hypotension
- Respiratory depression
- Urinary retention
- Cough
- Dehydration
- Depression
- General weakness
- Headache disorder
- Nervousness
- Symptoms of anxiety
- Xerostomia
Less Frequent
Severe
Less Severe
Rare / Very Rare
Severe
- Acute confusion
- Adrenal cortical insufficiency
- Allergic dermatitis
- Anaphylaxis
- Bronchospastic pulmonary disease
- Circulatory depression
- Deep venous thrombosis
- Delirium
- Depression
- Disorder of adrenal gland
- Excitement
- Gastrointestinal obstruction
- Hypertension
- Intracranial hypertension
- Laryngismus
- Myoclonus
- Paresthesia
- Pruritus of skin
- Serotonin syndrome
- Shock
- Skin rash
- Sleep apnea
- Tonic clonic seizure
- Urticaria
Less Severe
- Agitation
- Androgen deficiency
- Ataxia
- Biliary spasm
- Blurred vision
- Chills
- CNS depression
- Constipation
- Dental caries
- Diplopia
- Erectile dysfunction
- Gait abnormality
- Hyperhidrosis
- Hypertonia
- Infertility
- Insomnia
- Libido changes
- Nightmares
- Orthostatic hypotension
- Pruritus of skin
- Skin rash
- Tooth disorder
- Tremor
- Ureteral spasm
- Vasodilation of blood vessels
- Vertigo
- Visual changes
- Weight loss
Contraindicated
None
Severe Precaution
Fentanyl (Loz,Eff,Film,SL)
Risk of severe respiratory depression. Restricted to opioid tolerant patient.
Not indicated in pediatrics age < 16 years. Potentially fatal if opiate naive.
- 16 Years – 18 Years
- Risk of severe respiratory depression. Restricted to opioid tolerant patient.
- 1 Day – 16 Years
- Risk of severe respiratory depression. Restricted to opioid tolerant patient.
Fentanyl (Lozenge)
Risk of severe respiratory depression. Restricted to opioid tolerant patient.
Not indicated in pediatrics age < 16 years. Potentially fatal if opiate naive.
- 16 Years – 18 Years
- Not indicated in pediatrics age < 16 years. Potentially fatal if opiate naive.
- 1 Day – 16 Years
- Not indicated in pediatrics age < 16 years. Potentially fatal if opiate naive.
Management or Monitoring Precaution
None
Fentanyl
- Severity Level:
2
- Additional Notes: Neonatal withdrawal/resp.depress. w/chronic or high dose
Contraindicated
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Precaution Exists
Fentanyl
Insufficient data avail; low levels excreted with short term use
| General | Excretion Potential | Effect on Infant | Notes |
| Evaluate use carefully | Excreted | Not known; no or inclusive data | Insufficient data avail; low levels excreted with short term use |
No Known Risk
None
| General | Excretion Potential | Effect on Infant | Notes |
| None |
Contraindicated
None
Precaution Exists
Fentanyl (buccal)
Pulmonary-DO NOT USE in opioid intolerance. Life-threatening respiratory depression due to altered clearance. Use cautiously with respiratory disease, when initiating and titrating. Consider naloxone Rx. Neuro/Psych-Risk for confusion, delirium and falls. Avoid treatment with 3 or more CNS active agents. Gastrointestinal-Increased rate of constipation in the elderly. Cardiovascular-Vasodilation may predispose to orthostatic hypotension.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | Y | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
Fentanyl (systemic)
Pulmonary-DO NOT USE in opioid intolerance. Life-threatening respiratory depression due to altered clearance. Use cautiously with respiratory disease, when initiating and titrating. Consider naloxone Rx. Neuro/Psych-Risk for confusion, delirium and falls. Avoid treatment with 3 or more CNS active agents. Gastrointestinal-Increased rate of constipation in the elderly. Cardiovascular-Vasodilation may predispose to orthostatic hypotension.
General-Consider adding naloxone Rx. Pulmonary-Life threatening respiratory depression risk with high doses, cachexia, or debilitation due to altered pharmacokinetics (poor fat stores, muscle wasting, or altered clearance). Monitor closely at initiation and dose titration. Neuro/Psych-Risk for increased confusion and delirium. May increase fall risk. Avoid treatment with 3 or more CNS active drugs. Gastrointestinal-Constipation risk. Urogenital-Urinary retention risk.
| Organ / System | HEP | REN | CARD | ENDO | NEURO / PSYCH | PULM |
| Increased Risk / Adverse Effects | N | Y | Y | Y | Y | N |
BEERS: Y HEDIS: N STOPP: Y
No Known Risk
None
- See also Uses section. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. Fentanyl may also cause severe, possibly fatal, breathing problems.<br /><br />Do not use fentanyl lozenges unless you have been regularly taking moderate to large amounts of opioid pain medication. Otherwise, it may cause overdose (even death). To lower your risk, your doctor should have you use the smallest dose of fentanyl that works, and use it for the shortest possible time.<br /><br />See also How to Use section for more information about addiction. The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you use the wrong dose/strength. Using this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.<br /><br />Be sure you know how to use fentanyl and what other drugs you should avoid using with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.<br /><br /> Carefully follow the specific directions for using fentanyl lozenges. Since they are not taken the same way, different forms of fentanyl (including lozenges, buccal tablets, patches) do not have the same effects at equal strengths and should not be substituted for each other. Tell your doctor or pharmacist of all medications that you use, especially of drugs that can affect how fentanyl works.<br /><br />Do not start, stop, or change the dosage of any medicines you are using without your doctor's approval. Keep this medicine in a safe place to prevent theft, misuse, or abuse. Properly throw away all opened units of this drug.<br /><br />If someone accidentally swallows this drug, get medical help right away. Because of the risk of misuse, abuse, and overdose, you will need to register with a special distribution program before receiving your prescription. Only doctors and pharmacies enrolled in this program may prescribe or dispense this medication.<br /><br />Ask your doctor or pharmacist for details. Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant.<br /><br /> During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby.<br /><br />To lessen the risk, use the smallest effective dose for the shortest possible time. Babies born to mothers who use this drug for a long time may develop severe (possibly fatal) withdrawal symptoms. Tell the doctor right away if you notice any symptoms in your newborn baby such as crying that doesn't stop, slow/shallow breathing, irritability, shaking, vomiting, diarrhea, poor feeding, or difficulty gaining weight.
| Breakthrough cancer pain in opioid-tolerant patient | |
| G89.3 | Neoplasm related pain (acute) (chronic) |
| Z79.891 | Long term (current) use of opiate analgesic |
| 0-9 | A-Z |
|---|---|
| G89.3 | Neoplasm related pain (acute) (chronic) |
| Z79.891 | Long term (current) use of opiate analgesic |
Formulary Reference Tool