FENTANYL (Sublimaze)


Name: FENTANYL (SublimazeR)
Classification: narcotic analgesic
  • less cardiovascular depression and sedation than with morphine
  • no histamine release, thus preferred narcotic for asthmatic patients
  • IV Direct:
    • 25-100mcg; titrate to individual response
  • IV Infusion
    • administer IV bolus doses prn until pain control is achieved, then start infusion to maintain pain control
    • 25mcg/hr; titrate to individual response
    • Titrate to pain score and target VAMAAS
Administration: IV Infusion:
1000mcg/50mL in dextrose 5%, normal saline 0.9% or Ringer's Lactate by 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
  • naloxone: 0.1-0.4mg IV (see naloxone monograph)
  • 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:
  • blood pressure
  • heart rate
  • respiratory rate
  • analgesic response
  • bowel elimination
Adult Critical Care Protocol
  • May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
  • Continuous infusions must be administered by infusion device with pump library enabled.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: April 26, 2021