Transmucosal fentanyl preparations are licensed for breakthrough pain in patients receiving opioid therapy for chronic cancer pain.
These preparations are considered where pain is related to an incident cause e.g. wound dressing change, movement where usual opioids such as morphine or oxycodone liquid may take too long to work and by the time they do, the pain has disappeared.
Such patients should already be receiving a strong opioid for background pain and should have been receiving oral morphine of at least 60mg /24hours (or equivalent dose of an alternative strong opioid) for the previous week before being commenced on an immediate release fentanyl preparation.
Initiation of these products needs to be done under the instruction of the specialist palliative care team as these medications all require careful individual dose titration according to the product literature and patient response.
Various transmucosal fentanyl preparations are available with similar onset of action and alternative routes of delivery:
- Buccal or sublingual tablet
- Buccal films
- Intranasal spray
- Lozenges
The most appropriate choice of route of administration will depend on:
- Local formularies
- Clinical circumstances e.g. mouth cancers where the buccal and sublingual areas are affected will need the intranasal spray
- Manual dexterity – blister packs, spray activation
Transmucosal fentanyl citrate preparations:
Oro-mucosal products:
Abstral®
100, 200, 300, 400, 600 and 800 microgram sublingual tablets
Actiq® lozenges with applicator
200, 400, 600, 800, 1200, 1600 micrograms buccal lozenges
Breakyl® film (buccal)
200, 400, 800 microgram films
Cynril®
200, 400, 600, 800, 1200, 1600 micrograms buccal lozenges
Fenhuma®
100, 200, 300, 400, 600 and 800 microgram sublingual tablets
Effentora® buccal/sub-lingual tablets
100, 200, 400, 600 and 800 microgram tablets
Recivit® sub-lingual tablets
133, 267, 400, 533, 800 microgram tablets
Nasal Sprays:
PecFent® nasal spray:
100 , 400 microgram metered sprays
Please see http://www.medicines.org.uk/emc/
Summary of Product characteristics (SPC) for details of administration for the individual preparations.
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.