Dosing & Uses
Dosage Forms & Strengths
injection solution: Schedule II
50-100 mcg/dose IM or slow IV 30-60 min prior to surgery
Adjunct to regional anesthesia: 25-100 mcg/dose slow IV over 1-2 min
Minor surgical procedures: 0.5-2 mcg/kg/dose IV
Major surgery: 2-20 mcg/kg/dose initially; 1-2 mcg/kg/hr maintenance infusion IV; discontinue infusion 30-60 min prior to end of surgery; limit total fentanyl doses to 10-15 mcg/kg for fast tracking and early extubation
Adjunct to general anesthesia (rarely used): 20-50 mcg/kg/dose IV
Severe pain: 50-100 mcg/dose IV/IM q1-2hr PRN (patients with prior opioid exposure may tolerate higher initial doses)
Patient controlled anesthesia (PCA): 10 mcg/mL IV (usual concentration); 20 mcg demand dose with 5-10 min lockout time interval and base rate of ≤50mcg/hr
Dosage Forms & Strengths
injection solution: Schedule II
Surgery Premedication (Off-label)
>12 years: 0.5-2 mcg/kg/dose; not to exceed 50 mcg/dose; give 3 min prior to procedure; may repeate in 5 min if necessary; if more than two doses needed, may repeat up to 5 times at 25 mcg/dose maximum
0.5-2 mcg/kg/hr; titrate to desired effect
Elderly patients are twice as sensitive to effects of fentanyl as young patients are; take into account weight and physical status when administering the drug
Serious - Use Alternative
Significant - Monitor Closely
Frequency Not Defined
Upper respiratory tract infection
Abnormal coordination, thinking, gait, dreams
Myocardial infarction (MI)
Severe cardiac arrhythmias
Warmness of face/neck/upper thorax, urticaria
Within 2 weeks of monoamine oxidase inhibitor (MAOI) use
Caution in acute pancreatitis, Addison disease, benign prostatic hyperplasia, cardiac arrhythmias, central nervous system (CNS) depression, drug abuse or dependence, emotional lability, gallbladder disease, gastrointestinal (GI) disorder, pseudomembranous colitis, GI surgery, head injury, hypothyroidism or untreated myxedema, intracranial hypertension, brain tumor, toxic psychosis, urethral stricture, urinary tract surgery, seizures, acute alcoholism, delirium tremens, shock, cor pulmonale, chronic pulmonary disease, emphysema, hypercapnia, kyphoscoliosis, severe obesity, renal or hepatic impairment, elderly or debilitated patients
Concurrent administration of benzodiazepine or neuromuscular blocker will decrease chest wall rigidity
Caution in toxin-mediated diarrhea (until toxins are cleared), paralytic ileus, respiratory depression, acute/severe bronchial asthma
Risks of potentially fatal respiratory depression, pruritus (despite little histamine release), and abuse or addiction
May produce bradycardia, which may be treated with atropine
Can produce drug dependence
Safety and efficacy in children not established
Pregnancy & Lactation
Pregnancy category: C
Lactation: Drug enters breast milk; use not recommended
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Narcotic agonist-analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain; increases pain threshold; produces analgesia, respiratory depression, and sedation
Onset: IV, immediate; IM, 7-15 min
Duration: IV, 0.5-1 hr; IM, 1-2 hr
Peak plasma time: IV (≤100 mcg), 30-60 min; IM, 1-2 hr
Concentration: 0.2-2 ng/mL (adverse effects occur at >2 ng/mL)
Protein bound: 80-85%
Vd: 4-6 L/kg
Metabolized in liver by CYP3A4
Half-life: 2-4 hr
Total plasma clearance: 8.3 mL/min/kg
Excretion: Urine (75%), feces (9%)
Additive: Fluorouracil, lidocaine(?), methohexital, pentobarbital, thiopental
Syringe: Methohexital, pentobarbital, thiopental
Y-site: Azithromycin, methohexital(?), phenytoin, pentobarbital(?), thiopental(?)
Solution: D5W, NS
Additive: Bupivacaine, bupivacaine-clonidine, ropivacaine
Syringe (partial list): Atropine, chlorpromazine, dimenhydrinate, diphenhydramine, heparin, hydroxyzine, meperidine, metoclopramide, midazolam, morphine, ondansetron, prochlorperazine, promethazine, ranitidine
Y-site (partial list): Amiodarone, amphotericin B cholesteryl sulfate, atropine, bivalirudin, dexamethasone sodium phosphate, diazepam, diltiazem, diphenhydamine, dobutamine, dopamine, epinephrine, esmolol, furosemide, haloperidol, heparin, hydrocortisone, labetalol, lorazepam, metoclopramide, midazolam, morphine, nitroglycerin, norepinephrine, potassium chloride, propofol, vitamins B and C
Use undiluted or diluted in 250 mL of D5W
IV: Injection or continuous infusion
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