|Type of medicine||Opioid analgesic|
|Used for||Pain relief|
|Also called||Patches: Durogesic DTrans®, Fencino®, Fentalis®, Matrifen®, Mezolar®, Osmanil®, Tilofyl®, Victanyl®|
Tablets: Abstral®, Effentora®
Nasal sprays: Instanyl®, PecFent®
|Available as||Patch, lozenge, tablets to dissolve in the mouth, and nasal spray|
Fentanyl is a strong painkiller. It works by binding to certain receptors (called opioid receptors) in your brain and spinal cord. This reduces the pain you feel.
For chronic (long-lasting) pain, you will be given a patch which contains fentanyl to apply to your skin (this is called transdermal fentanyl). Patches contain the fentanyl in a reservoir and release it gradually over a period of time to give you continual pain relief. Despite this, there may be times when your pain is not fully controlled and you experience breakthrough pain. Fentanyl is also used for this type of pain but different formulations (such as lozenges, tablets and nasal sprays) are used.
Before using fentanyl
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking fentanyl, it is important that your doctor or pharmacist knows:
- If you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD).
- If you have liver or kidney problems.
- If you have prostate or thyroid problems.
- If you have epilepsy or low blood pressure.
- If you have a problem with your bile duct.
- If you have sugar diabetes.
- If you are pregnant or breast-feeding.
- If you have a blocked or inflamed bowel.
- If you have ever had a problem with addiction to drugs or alcohol.
- If you have recently had a severe head injury, or have a brain tumour.
- If you have a condition called myasthenia gravis (a muscle wasting disease).
- If you have ever had an allergic reaction to this or to any other medicine.
- If you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines.
How to use fentanyl
- Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the specific brand of fentanyl you have been given, and a full list of possible side-effects from taking it.
- When first starting this treatment, your doctor will gradually increase your dose to make sure that you have the dose that helps your condition but minimises any unwanted symptoms. Once you have been told the dose which is right for you, keep taking this dose unless you are told otherwise by your doctor.
- Your dose will be on the label of your pack. Make sure you follow the instructions your doctor has given you carefully. If you are unsure either about your dose or how to use the fentanyl preparation you have been given, ask your pharmacist to explain this to you again.
- If you are using fentanyl patches:
- Open the protective pouch carefully and remove the patch. Check that the patch has not been damaged in any way as you have opened the pouch.
- Place the patch on a dry, non-hairy, healthy area of skin on your upper arm or upper body. Press it firmly on to your skin for approximately 30 seconds to make sure that it sticks well, especially around the edges. It is important that you avoid touching the sticky side of the patch while you do this. After you've applied the patch, wash your hands to make sure you have no fentanyl on your fingers.
- When you first use a patch, it may take up to 24 hours for the patch to reach it's full effect; so, during this time, you may need alternative pain relief. Your doctor will explain this to you.
- Leave the patch in place for 72 hours (three days), then remove it and apply a new patch to a different area of skin on your upper arm or body.
- Fold the removed patch in half with the sticky side inwards and put it back into a protective pouch. Dispose of the pouch as you have been directed by your doctor, making sure it is safely out of the reach of any children.
- Try to make sure that any patch you are wearing does not come into contact with a heat source such as a heating pad, hot water bottle, electric blanket, or a heated water bed. Heated items like these may increase the amount of fentanyl that is released from the patch, which increases the risk of overdose. Having long hot baths or sunbathing for long periods of time are also best avoided.
- Let your doctor know if you develop a high temperature at any time, as this also can increase the amount of fentanyl you absorb from the patch.
- Each time you collect your prescription, check to make sure you have been given the same brand of fentanyl patches as you have had before. This is because different brands may release different amounts of fentanyl and you should keep to the same brand unless your doctor has advised you otherwise.
- Signs of having too much fentanyl include shallow or weak breathing, feeling very sleepy or confused, slurred speech and extreme dizziness. If you have any of these effects, remove the patch and contact your doctor straightaway.
- If you are using fentanyl lozenges (Actiq®):
- These lozenges have an applicator attached so that you can move the lozenge around inside your mouth as you suck. Move the applicator around so that the lozenge comes into contact as much as possible with your tongue and the inside of your cheeks. Be careful not to chew or swallow the lozenge. As the lozenge dissolves, fentanyl will be absorbed through the lining of your mouth.
- Suck one lozenge over a period of about 15 minutes. If your pain has not eased within 15 minutes after having finished this lozenge, suck another lozenge. Do not use more than two lozenges for any episode of pain, or more than four lozenges in any 24-hour period. If your pain is not controlled by this, you must let your doctor know.
- If there is still some lozenge left on the applicator once your pain is controlled, this should be disposed of carefully (you can run it under a hot tap until the lozenge has all gone and then the applicator can be thrown away).
- If you are using fentanyl sublingual tablets (Abstral®):
- Place the tablet under your tongue and allow it to dissolve completely. Do not chew, suck or swallow the tablet. You can moisten your mouth with a drink of water before placing the tablet under your tongue, but do not eat or drink anything while the tablet is dissolving.
- If your pain has not eased within 15-30 minutes, you may use another tablet. Do not use more than two tablets for any episode of pain. If your pain is not controlled by this, you must let your doctor know. Likewise, if you are having more than four episodes of breakthrough pain in any 24-hour period, you should let your doctor know about this too.
- If you are using fentanyl buccal tablets (Effontora®):
- Unless you have been told otherwise by your doctor, place the tablet between your gum and cheek and allow it to dissolve completely. Do not chew, suck or swallow the tablet. You can moisten your mouth with a drink of water before placing the tablet in your mouth, but do not eat or drink anything while the tablet is dissolving.
- If your pain has not eased within 30 minutes, you may use another tablet but use this on the other side of your mouth. Do not use more than two tablets for any episode of pain. If your pain is not controlled by this, you must let your doctor know.
- If you are using fentanyl nasal spray:
- Use one spray into one of your nostrils. It is best if you sit or stand while you use the spray. Hold the spray upright and bend your head slightly forward. Close one nostril by placing a finger against it and insert the tip of the spray into the other nostril. Press the spray once while you are breathing in through your nose.
- If your pain has not eased within 10 minutes, use a second spray into the other nostril. Do not use more than two sprays for any episode of pain and do not use the spray again within four hours. If your pain is not controlled by this, you must let your doctor know. Likewise, if you are having more than four episodes of breakthrough pain in any 24-hour period, you should let your doctor know about this too.
Getting the most from your treatment
- It is recommended that you do not drink alcohol while you are on fentanyl because it increases side-effects such as feeling dizzy and sleepy.
- Taking fentanyl regularly for a long time may lead to your body becoming dependent on it. If you then stop taking fentanyl suddenly this will lead to withdrawal symptoms such as feeling restless and irritable. If you no longer need fentanyl, your doctor will want you to reduce your dose gradually before you stop taking it. This will help to prevent any unpleasant effects.
- If you are planning a trip abroad you are advised to carry a letter with you from your doctor because fentanyl is a controlled drug. If you plan to travel for more than three months, you must check with the Home Office before you travel, as you will need to apply in writing for a licence to take fentanyl with you.
- If you are having an operation or dental treatment, tell the person carrying out the treatment that you are taking fentanyl.
- If you buy any medicines, check with a pharmacist that they are suitable to take with your other medicines.
Can fentanyl cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.
|Very common fentanyl side-effects - these effect more than 1 in 10 people who take this medicine||What can I do if I experience this?|
|Constipation||Try to eat a well-balanced diet and drink plenty of water each day. If this continues your doctor may prescribe a laxative for you|
|Feeling or being sick||This usually passes after a few days, but let your doctor know if it continues. Your doctor may prescribe a medicine to ease the sickness|
|Feeling sleepy, dizzy or tired||If this happens do not drive or use tools or machines. Do not drink alcohol|
|Difficulties sleeping, headache, increased sweating, itchy skin rash||If any of these become troublesome, speak with your doctor|
|Local irritation where a patch or tablet has been||As much as possible, vary the sites where the patches or tablets are placed. If this is becomes a problem, let your doctor know|
If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.
How to store fentanyl
- Keep all medicines out of the reach and sight of children. This includes used patches and part-finished lozenges.
- Store in a cool, dry place, away from direct heat and light.
Important information about all medicines
Further reading & references
- British National Formulary; 62nd Edition (Sep 2011) British Medical Association and Royal Pharmaceutical Society of Great Britain, London
- Manufacturer's PIL, Durogesic DTrans® 12/25/50/75/100 micrograms/hr Transdermal Patch; Manufacturer's PIL, Durogesic DTrans® 12/25/50/75/100 micrograms/hr Transdermal Patch, Janssen-Cilag Ltd, The electronic Medicines Compendium. Dated March 2011.
- Manufacturer's PIL, Actiq®; Manufacturer's PIL, Actiq®, Cephalon UK Ltd, The electronic Medicines Compendium. Dated March 2011.
- Manufacturer's PIL, Abstral® Sublingual Tablets; Manufacturer's PIL, Abstral® Sublingual Tablets, ProStrakan, The electronic Medicines Compendium. Dated March 2010.
- Manufacturer's PIL, Effentora® 100, 200, 400 600 and 800 micrograms buccal tablets; Manufacturer's PIL, Effentora® 100, 200, 400 600 and 800 micrograms buccal tablets, Cephalon (UK) Limited, The electronic Medicines Compendium. Dated July 2010.
- Manufacturer's PIL, Instanyl® 50, 100 and 200 micrograms/dose nasal spray; Manufacturer's PIL, Instanyl® 50, 100 and 200 micrograms/dose nasal spray, Nycomed UK Ltd, The electronic Medicines Compendium. Dated November 2011.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Hannah Gronow