Name: FENTANYL (SublimazeR)
Classification: narcotic analgesic
  • less cardiovascular depression and sedation than with morphine
  • no histamine release, thus preferred narcotic for asthmatic patients
Dose:
  • IV Direct:
    • 30-100mcg; titrate to individual response
  • IV Infusion
    • administer IV bolus doses prn until pain control is achieved, then start infusion to maintain pain control
    • 1.5mcg/hr; titrate to individual response
    • Titrate to pain score and target VAMAAS
Administration: IV Infusion:
1000mcg/50mL in D5W, NS, RL for syringe pump infusion
  • rapid administration may cause muscle rigidity (see adverse effects)
  • prolonged continuous infusion may require dose reductions as fentanyl undergoes redistribution
Adverse Effects:
  • respiratory depression which may last longer than analgesic effect; there may also be a biphasic respiratory depression after apparent recovery from general anaesthesia, possibly the result of fentanyl mobilization from tissue stores
  • agitation
  • bradycardia
  • hypotension 
  • pinpoint pupils
  • muscle rigidity; associated with rapid rate of administration
Antidote:
  • naloxone: 0.1-0.4mg IV (see naloxone monograph)
Caution:
  • fentanyl is contraindicated in patients who have received MAO-I within the last 14 - 21 days, due to possible severe and unpredictable potential of fentanyl effect
Monitoring Therapy:
  • HR
  • ECG
  • BP
  • analgesia response
  • respiratory rate
CCTC Protocol:
  • May be administed IV direct by an approved nurse in the CCTC providing that the physician is present for the first dose.
  • Continuous infusion must be administered via an infusion pump.

 


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 13, 2017 | © 2007, LHSC, London Ontario Canada