FENTANYL
Standard Prescription
fentanyl__mcg IV x 1 dose
fentanyl__mcg IV Q__H PRN
fentanyl__mcg/hr patch: apply__patch(s) topically Q__days and remove patch.
fentanyl__mcg IV Q__H PRN
fentanyl __to__mcg/kg/hr continuous IV infusion
fentanyl __mcg {intranasal or buccal}
Dosages
Intermittent dosing:
Infants: 1 to 2 mcg/kg/dose IV Q2-4H PRN (usual max 4 mcg/kg/dose)
Children: 1 to 2 mcg/kg/dose IV Q30-60 minutes PRN. (usual adolescent starting dose: 25-50 mcg)
1 to 2 mcg/kg/dose buccal Q30-60 min. PRN. Maximum initial dose 50 mcg*
Epidural Infusion (with ropivacaine)
0.25-1 mcg/kg/hour
5 to 10 mcg/kg/dose buccal. Maximum 400 mcg/dose*
Transdermal patches (by APS and Palliative & Complex Pain services only).
Change patch every 72 hours (in some cases, pain specialists may advise to change patch every 48 hours).
Refer to Health Canada product monograph and dosage table when converting patient to fentanyl patch.
Do NOT cut transdermal patches. If less than a full patch is required for the prescribed dose, cover the appropriate fraction of the underside of the patch before application, thereby preventing contact with skin.
Infants: 1 to 2 mcg/kg/dose IV Q2-4H PRN (usual max 4 mcg/kg/dose)
Children: 1 to 2 mcg/kg/dose IV Q30-60 minutes PRN. (usual adolescent starting dose: 25-50 mcg)
1 to 2 mcg/kg/dose buccal Q30-60 min. PRN. Maximum initial dose 50 mcg*
Continuous IV infusion (by Acute Pain Service, ICU or Palliative Care Specialists only. Use BCCH order set):
Usual dose: 1 -4 mcg/kg/hr (titrate to effect). Higher doses may be required in palliative care or end of life symptom management with monitored titration.
0.25-1 mcg/kg/hour
Intubation dose:
2 to 5 mcg/kg/dose IV over 1-2 min.Procedural pain:
1.5 mcg/kg/dose intranasal. Maximum 100 mcg (50 mcg per nostril)*5 to 10 mcg/kg/dose buccal. Maximum 400 mcg/dose*
Transdermal patches (by APS and Palliative & Complex Pain services only).
Change patch every 72 hours (in some cases, pain specialists may advise to change patch every 48 hours).
Refer to Health Canada product monograph and dosage table when converting patient to fentanyl patch.
Do NOT cut transdermal patches. If less than a full patch is required for the prescribed dose, cover the appropriate fraction of the underside of the patch before application, thereby preventing contact with skin.
Mechanism of Action
Opioid analgesic
Forms Supplied
Injection: 0.05 mg/mL 2 mL, 5 mL, 20 mL amp.
Patches: 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr (not all sizes kept in stock)
Patches: 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr (not all sizes kept in stock)
Standard concentration for IV infusion: 25 mcg/mL
Comments
CAUTION: Fentanyl is 100x more potent than morphine
Rapid IV injection and/or large doses may cause respiratory depression, bradycardia and chest wall rigidity.
Antidote for opioid overdose is naloxone.
Refer to “Postoperative Disposition Guidelines for infants” for continuous opioid infusions in infants on SHOP.
See Opioid Administration Guidelines (white pages in print copy)
Fentanyl is primarily metabolized by CYP3A4 to inactive metabolites. Caution with concurrent CYP3A4 inhibitors and inducers; therapy modification may be necessary.
Acts as a weak serotonin re-uptake inhibitor. Caution with concurrent use of serotonergic drugs and contraindicated if MAO inhibitors used within 14 days.
Transdermal patches are not suitable for acute pain, rapid dose titration for severe uncontrolled pain, or opioid naive patients due to risk of respiratory depression and death.
Accumulation may occur with prolonged IV infusion.
Use extreme caution when converting from one opioid to another. Consult with APS/Palliative Care when converting opioids. Cross-tolerance at the opioid receptor may not occur and equianalgesic opioid dosing tables may overestimate opioid requirements.
Rate of transdermal absorption may be increased if covered skin becomes vasodilated, or if an external heat source is applied.
Refer to guidelines for intranasal fentanyl.
*Use IV formulation for buccal or intranasal administration. Buccal pharmacokinetics variable and dosing not well established in children. Monitor and record vital signs (HR, RR, BP, SpO2), pain score and arousal score every 10 minutes for 30 minutes following administration of buccal or intranasal fentanyl.
Rapid IV injection and/or large doses may cause respiratory depression, bradycardia and chest wall rigidity.
Antidote for opioid overdose is naloxone.
Refer to “Postoperative Disposition Guidelines for infants” for continuous opioid infusions in infants on SHOP.
See Opioid Administration Guidelines (white pages in print copy)
Fentanyl is primarily metabolized by CYP3A4 to inactive metabolites. Caution with concurrent CYP3A4 inhibitors and inducers; therapy modification may be necessary.
Acts as a weak serotonin re-uptake inhibitor. Caution with concurrent use of serotonergic drugs and contraindicated if MAO inhibitors used within 14 days.
Transdermal patches are not suitable for acute pain, rapid dose titration for severe uncontrolled pain, or opioid naive patients due to risk of respiratory depression and death.
Accumulation may occur with prolonged IV infusion.
Use extreme caution when converting from one opioid to another. Consult with APS/Palliative Care when converting opioids. Cross-tolerance at the opioid receptor may not occur and equianalgesic opioid dosing tables may overestimate opioid requirements.
Rate of transdermal absorption may be increased if covered skin becomes vasodilated, or if an external heat source is applied.
Refer to guidelines for intranasal fentanyl.
*Use IV formulation for buccal or intranasal administration. Buccal pharmacokinetics variable and dosing not well established in children. Monitor and record vital signs (HR, RR, BP, SpO2), pain score and arousal score every 10 minutes for 30 minutes following administration of buccal or intranasal fentanyl.
References
32, 44, 455, 456, 457, 458, 459, 579, 580
Last Edited
2022-06-25 03:22:25