Your activity: 4 p.v.

Commonly available fentanyl transmucosal preparations for breakthrough pain in opioid-tolerant adults

Commonly available fentanyl transmucosal preparations for breakthrough pain in opioid-tolerant adults
Fentanyl transmucosal preparation Brand name
(United States)
Starting dose in an opioid-tolerant adult* Serum half-life
(hours)
Duration of analgesic effect
(hours)
Buccal tablet Fentora 100 mcg 13.3 1 to 2
Oral lozenge Actiq 200 mcg 7.6 2
Nasal spray Lazanda 100 mcg 15 to 25 ≥1
Sublingual spray Subsys 100 mcg 5 to 12 ≥1
Sublingual tablet Abstral 100 mcg 11.5 to 25 1
An oral, immediate-release (IR) preparation (eg, oxycodone IR) is generally used for managing brief episodes of breakthrough pain not attributed to inadequate doses of scheduled long-acting opioids. A transmucosal fentanyl preparation can provide an alternative to oral IR opioid preparations in patients who may benefit from a more rapid onset of analgesia, ie, 5 to 15 minutes for transmucosal route compared with 10 to 15 minutes typically for oral IR opioids.
mcg: microgram.
* Always initiate transmucosal fentanyl preparations at the lowest starting dose for breakthrough pain, even in patients with high baseline opioid requirements. Data do not support specific transmucosal fentanyl dose equivalents to other opioids. For additional detail, including recommendations on frequency of repeat dosing, dose titration, and recommendations on converting between transmucosal forms if necessary, refer to the Lexicomp fentanyl monograph included in UpToDate.
¶ Serum half-life and duration of effect are dose dependent.
Courtesy of Kathleen Broglio, DNP, MN, ANP-BC, ACHPN and Russell K Portenoy, MD.
Additional data from:
  1. National Comprehensive Cancer Network. Adult Cancer Pain, Version 2.2016.
  2. Lexicomp Online. Copyright © 1978-2023 Lexicomp, Inc. All Rights Reserved.
Graphic 111217 Version 10.0