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fentanyl (Rx)Brand and Other Names:Sublimaze

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injection solution: Schedule II

  • 0.05mg/mL
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Surgery Premedication

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

General Anesthesia

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

Analgesia (Off-label)

Analgesia: 1-2 mcg/kg IV bolus or 25-100 mcg/dose PRN or 1-2 mcg/kg/hr by continuous IV infusion or 25-200 mcg/hr 

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

  • 0.05mg/mL
more...

Surgery Premedication (Off-label)

1-12 years: 0.5-2 mcg/kg IV given 3 min prior to procedure; may repeat q1-2hr 

>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

Continuous Sedation/Analgesia

0.5-2 mcg/kg/hr; titrate to desired effect

Adjunct Anesthesia

<2 years: Safety and efficacy not established

>2 years: 2-3 mcg/kg IV/IM q1-2hr PRN 

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

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Interactions

Interaction Checker

fentanyl and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Asthenia

            Confusion

            Constipation

            Dry mouth

            Nausea

            Somnolence

            Sweating

            Vomiting

            Abdominal pain

            Anorexia

            Anxiety

            Apnea

            Depression

            Diarrhea

            Dizziness

            Dyspepsia

            Dyspnea

            Euphoria

            Fatigue

            Hallucinations

            Headache

            Hemoptysis

            Hypoventilation

            Influenzalike symptoms

            Nervousness

            Pharyngitis

            Pruritus

            Upper respiratory tract infection

            Urinary retention

            Abnormal coordination, thinking, gait, dreams

            Accidental injury

            Agitation

            Amnesia

            Angina pectoris

            Application-site reaction

            Back pain

            Bradycardia

            Bronchitis

            Cardiac arrest

            Coma

            Dysphoria

            Faintness

            Fever

            Flatulence

            Flushing

            Hiccups

            Mental clouding

            Micturition disorder

            Myocardial infarction (MI)

            Oliguria

            Paranoid reaction

            Paresthesia

            QT-interval prolongation

            Rash

            Respiratory arrest

            Respiratory/circulatory depression

            Rhinitis

            Sedation

            Seizures

            Severe cardiac arrhythmias

            Shock Sinusitis

            Speech disorder

            ST-segment elevation

            Sweating

            Syncope

            Tremor

            Urinary retention

            Ventricular tachycardia

            Visual disturbances

            Warmness of face/neck/upper thorax, urticaria

            Weakness

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            Warnings

            Contraindications

            Hypersensitivity

            Within 2 weeks of monoamine oxidase inhibitor (MAOI) use

            Cautions

            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

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Drug enters breast milk; use not recommended

            Pregnancy Categories

            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.

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            Pharmacology

            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

            Absorption

            Bioavailability: 50%

            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) 

            Distribution

            Protein bound: 80-85%

            Vd: 4-6 L/kg 

            Metabolism

            Metabolized in liver by CYP3A4 

            Elimination

            Half-life: 2-4 hr

            Total plasma clearance: 8.3 mL/min/kg

            Excretion: Urine (75%), feces (9%) 

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            Administration

            IV Incompatibilities

            Additive: Fluorouracil, lidocaine(?), methohexital, pentobarbital, thiopental

            Syringe: Methohexital, pentobarbital, thiopental

            Y-site: Azithromycin, methohexital(?), phenytoin, pentobarbital(?), thiopental(?)

            IV Compatibilities

            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

            IV Preparation

            Use undiluted or diluted in 250 mL of D5W

            IV/IM Administration

            IM: Injection

            IV: Injection or continuous infusion

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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