Fentanyl (Sublimaze Injection: Duragesic Transdermal)

Category:

  • General Anesthetic

Description:

  • Narcotic analgesic

Indications:

  • Perioperative analgesia

  • Adjunct to general anesthesia (alone or combined with droperidol)

  • General anesthesia

  • Chronic pain (transdermal)

Contraindications:

  • Lozenge for child < 15kg

  • Transdermal for child < 12kg

Precautions:

  • Pregnancy category C

  • Elderly, respiratory depression, increased intracranial pressure

  • Seizure disorders, severe respiratory disorders, cardiac dysrhythmias

Adverse Reactions (Side Effects):

  • CNS: asthenia, confusion, delirium, dizziness, euphoria, somnolence

  • CV: bradycardia, hypotension or hypertension

  • EENT: blurred vision, dry mouth, miosis

  • GI: constipation, nausea, vomiting

  • GU: urinary retention

  • MS: muscle rigidity

  • RESP: laryngospasm, respiratory depression

  • SKIN: pruritis, sweating

Dosage:

Administered intramuscularly, intravenously, topically, orally

  • Adult and Child >12 years

    • Chronic pain: 

      • TRANS 25 mcg/hr system initially; initial dose may be increased after 3 days, thereafter a minimum of 6 days should elapse between dosage increases; to covert patients already receiving other narcotics, refer to manufacturer product information; change system every 72 hours

    • Sedation for minor procedure: 

      • Buccal 5 mcg/kg (max 400mcg) 20-40 minutes before surgery

    • Preoperatively: 

      • IM 50-100mcg 30-60 minutes before surgery

    • Adjunct to general anesthesia: 

      • IM/IV 50-100 mcg/kg

    • Adjunct to regional anesthesia: 

      • IV 2-50 mcg/kg

    • General anesthesia: 

      • IV 50-100 mcg/kg with oxygen and a muscle relaxant

    • Postoperatively: 

      • IM 50-100mcg every 1-2 hours as needed

  • Child 2-12 years

    • Sedation for minor procedure: 

      • Buccal 5-10 mcg/kg (max 400mcg) 20-40 minutes prior to procedure; children < 40kg may require doses of 10-15 mcg/kg (max 400mcg); do not use in child < 2 years

    • Adjunct to anesthesia: 

      • IV 2-3 mcg/kg

Note:

  • IV/IM dose of 0.1 mg fentanyl equianalgesic to 10mg morphine, 75mg meperidine

Back to Medical Corps Pharmacy Page