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fentanyl transdermal system
Duragesic-25, Duragesic-50, Duragesic-75, Duragesic-100

fentanyl transmucosal
Fentanyl Oralet

Controlled Substance Schedule II

Pregnancy Risk Category C

How supplied
Injection:
50 mcg/ml
Transdermal system:
patches designed to release 25 mcg, 50 mcg, 75 mcg, or 100 mcg of fentanyl per hour
Transmucosal:
100 mcg, 200 mcg, 300 mcg, 400 mcg

Action
Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through an unknown mechanism.

Indications & dosage
Adjunct to general anesthetic
--
Adults:
for low-dose therapy, 2 mcg/kg I.V. For moderate-dose therapy, 2 to 20 mcg/kg I.V.; then 25 to 100 mcg I.V., p.r.n. For high-dose therapy, 20 to 50 mcg/kg I.V.; then 25 mcg to one-half initial loading dose I.V., p.r.n.
Adjunct to regional anesthesia--

Adults:
50 to 100 mcg I.M. or slowly I.V. over 1 to 2 minutes, p.r.n.
Induction and maintenance of anesthesia
--
Children ages 2 to 12:
2 to 3 mcg/kg I.V.
Postoperatively
--
Adults:
50 to 100 mcg I.M. q 1 to 2 hours, p.r.n.
Preoperatively
--
Adults:
50 to 100 mcg I.M. 30 to 60 minutes before surgery. Or, 5 mcg/kg dispensed as oralet unit, 20 to 40 minutes before need of desired effects.
Management of chronic pain
--
Adults:
one transdermal system applied to a portion of the upper torso on an area of skin that isn't irritated and hasn't been irradiated. Therapy initiated with the 25-mcg/hour system; dosage adjusted as needed and tolerated. Each system may be worn for 72 hours, although some patients may require systems to be applied q 48 hours. Upward adjustment may be done q 3 days after initial dose; then 6 days thereafter.

Adverse reactions
CNS:
sedation, somnolence, clouded sensorium, euphoria, dizziness, headache, confusion, asthenia, nervousness, hallucinations, anxiety, depression, seizures.
CV:
hypotension, hypertension, arrhythmias, chest pain.
GI:
nausea, vomiting, constipation, ileus, abdominal pain, dry mouth, anorexia, diarrhea, dyspepsia.
GU:
urine retention.
Respiratory:
respiratory depression, hypoventilation, dyspnea, apnea.
Skin:
reaction at application site, pruritus, diaphoresis.
Other:
physical dependence, increased plasma amylase and lipase levels.

Interactions
Drug-drug.
CNS depressants, general anesthetics, hypnotics, MAO inhibitors, other narcotic analgesics, sedatives, tricyclic antidepressants: additive effects. Use together with extreme caution. Fentanyl dose should be reduced by one-quarter to one-third. Also give above drugs in reduced dosages.
Diazepam:
CV depression when given with high doses of fentanyl. Monitor closely.
Droperidol:
hypotension and decreased pulmonary arterial pressure. Use together cautiously.
Drug-lifestyle.
Alcohol use: additive effects. Use together cautiously.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with known intolerance of drug. Fentanyl patch is contraindicated for pain management following surgery, mild or intermittent pain that can be managed with nonnarcotic agents, or in doses exceeding 25 mcg/hour initially.

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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