Select a medication above to begin.
fentanyl
generic
Black Box Warnings .
Appropriate Use
should only be admin. by healthcare professionals trained in use of IV anesthetics and management of resp. effects of potent opioids; ensure opioid antagonist, resuscitative and intubation equipment, and oxygen readily available
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
CYP450 3A4 Interaction
concomitant use w/ CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. fentanyl conc. which may incr. or prolong adverse effects incl. potentially fatal resp. depression; monitor pts receiving any concomitant CYP450 3A4 inhibitor or inducer
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 50 mcg per mL, 100 mcg per 2 mL; INJ (vial): 50 mcg per mL
analgesia, preop
- [50-100 mcg IV/IM x1]
- Start: 30-60min prior to surgery; Info: consider low dose in pts 65 yo and older
anesthesia adjunct
- [2-50 mcg/kg/dose IV x1]
- Info: 2 mcg/kg/dose for low dose, 2-20 mcg/kg/dose for mod dose, 20-50 mcg/kg/dose for high-dose; consider doses at lower end of desired range in pts 65 yo and older
regional anesthesia adjunct
- [50-100 mcg IV/IM x1]
- Info: consider low dose in pts 65 yo and older
general anesthesia
- [50-100 mcg/kg/dose IV x1]
- Info: for high-risk pts undergoing major or complicated surgical procedures; use w/ oxygen and muscle relaxant; doses up to 150 mcg/kg/dose may be needed; consider low dose in pts 65 yo and older
pain, postop
- [IV/IM route]
- Dose: 50-100 mcg IV/IM q1-2h prn; Alt: 0.5-1.5 mcg/kg/h IV prn; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older
- [PCA route (off-label)]
- Dose: 10-20 mcg IV q6-20min prn; Start: 10-50 mcg IV x1; Info: basal rate for opioid-experienced pts is up to 50 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older
pain, mod-severe acute (off-label)
- [1-2 mcg/kg/dose intranasally q1h prn]
- Max: 100 mcg/dose; Info: use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in pts 65 yo and older
rapid sequence intubation adjunct (off-label)
- [1-3 mcg/kg/dose IV x1]
- Start: 3min before induction agent; Info: see Rapid Sequence Intubation (RSI), Adult table
renal dosing
- [anesthesia]
- renal impairment: no adjustment
- HD/PD: not defined
- [pain]
- CrCl 10-50: decr. usual dose by 25%; CrCl <10: decr. usual dose by 50%
- HD: decr. usual dose by 50%; supplement after dialysis not defined; PD: decr. usual dose by 50%; supplement not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 50 mcg per mL, 100 mcg per 2 mL; INJ (vial): 50 mcg per mL
sedation/analgesia
- [1-3 yo]
- Dose: 2-3 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
- [3-12 yo]
- Dose: 1-2 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
- [>12 yo]
- Dose: 0.5-1 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
sedation during ECMO
- [1-5 mcg/kg/h IV]
- Start: 5-10 mcg/kg/dose IV x1; Info: may titrate infusion upward
pain, post-op (off-label)
- [PCA route, <50 kg]
- Dose: 0.5-1 mcg/kg/dose IV q6-20min prn; Start: 0.5-1.5 mcg/kg/dose IV x1; Max: 4 mcg/kg/h; Info: basal rate for opioid-experienced pts is up to 0.5 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration
- [PCA route, >50 kg]
- Dose: 10-20 mcg IV q6-20min prn; Start: 10-50 mcg IV x1; Info: basal rate for opioid-experienced pts is up to 50 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration
pain, mod-severe acute (off-label)
- [1-16 yo]
- Dose: 1-2 mcg/kg/dose intranasally q1h prn; Max: 50 mcg/dose up to 3 mcg/kg/24h; Info: use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration
- [>16 yo]
- Dose: 1-2 mcg/kg/dose intranasally q1h prn; Max: 100 mcg/dose; Info: use injectable form w/ mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised