Adult Dosing
Preoperative analgesia
- 50-100 mcg IM 30-60 mins before surgery
Adjunct to general anesthesia
- Low dose (minor surgery): 2 mcg/kg IV
- Moderate dose (major surgery): 2-20 mcg/kg IV
- High dose (major surgery): 20-50 mcg/kg IV
Adjunct to regional anesthesia
- 50-100 mcg IM/IV over 1-2 minutes
Postoperative recovery
- 50-100 mcg IM q1-2 hrs PRN
General anesthesia (Induction and maintenance)
- 50-100 mcg/kg (up to 150 mcg/kg) IV
Testicular Torsion [Non-FDA Approved]
- 0.25-1 mcg/kg IV every 1-2 hrs PRN
Pain [Non-FDA Approved]
Acute Coronary Syndromes [Non-FDA Approved]
- 25-50 mcg IV, may repeat q5 mins as needed
Pediatric Dosing
Preoperative analgesia
- Child >12 yrs: 50-100 mcg IM 30-60 mins before surgery
Adjunct to general anesthesia
- Child >12 yrs
- Low dose (minor surgery): 2 mcg/kg IV
- Moderate dose (major surgery): 2-20 mcg /kg IV
- High dose (major surgery): 20-50 mcg /kg IV
Adjunct to regional anesthesia
- Child >12 yrs: 50-100 mcg IM/IV over 1-2 minutes
Postoperative recovery
- Child >12 yrs: 50-100 mcg IM q1-2 hrs PRN
General Anesthesia (Induction and maintenance)
- Child >12 yrs: 50-100 mcg /kg (up to 150 mcg/kg) IV
- Child 2–12 yrs: 2-3 mcg/kg IV
Testicular Torsion [Non-FDA Approved]
- Neonate and younger infant: 1-2 mcg/kg/dose IV q2-4 hr PRN
- Older infant and child: 0.5-1 mcg/kg/dose IV/IM q30-60 min PRN
Pain [Non-FDA Approved]
- Neonate and younger infant: 0.5-2 mcg/kg/dose IV PRN
- Older infant and child: 0.5-2 mcg/kg/dose IV PRN
[Outline]
- Fentanyl should be administered only by physicians specifically trained in the use of IV anesthetics and management of the respiratory effects of potent opioids. Opioid antagonists, resuscitative and intubation equipment and oxygen should be readily available
- Dosage must be individualized based upon the status of each patient and should be assessed at regular intervals
- Use with caution in patients with evidence of increased intracranial pressure, impaired consciousness, or coma, brain tumors
- Respiratory depression is associated with the use of this drug; more likely to occur in elderly/debilitated, and in patients suffering from conditions accompanied by hypoxia or hypercapnia
- Slowly taper to discontinue if at risk for physical dependence. Abrupt cessation can cause a withdrawal syndrome or precipitate seizures
- Therapy may produce bradycardia. Use with caution in patients with cardiac bradyarrhythmias
- Fentanyl may impair the mental or physical abilities required for the performance of certain tasks such as driving and operating dangerous machinery
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Hx of cardiac disease
- Bradyarrhythmias
- Hx of pancreatic/biliary tract disease
- Bladder &/or Bowel obstruction
- Head injury
- Intracranial tumor
- Alcohol or substance abuse
- CNS depressant use
- Asthma
- COPD
- Impaired pulmonary function
- Elderly population
Pregnancy Category:C
Breastfeeding: Possibly safe; when given epidurally or intravenously during labor or for a short time post partum, amounts of the drug ingested by the neonate are small and would not be expected to cause any adverse effects in breastfed infants. No published data for repeated doses of IV fentanyl; hence alternative agents may be preferred (especially when nursing a newborn or preterm infant). This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 18 February 2011). Manufacturer advises caution.
US Trade Name(s)
US Availability
fentanyl citrate (generic)
- INJ: 50 mcg/mL (2, 5, 20 mL amp)
- INJ: 50 mcg/mL (2, 5, 10, 20, 50 mL single dose vial)
Sublimaze
- INJ: 50 mcg/mL (2, 5, 10, 20 mL amp)
Canadian Trade Name(s)
Canadian Availability
fentanyl (generic)
- INJ: 50 mcg/mL (2, 5, 10, 20 mL amp)
- INJ: 50 mcg/mL (5, 10, 20, 50 mL vials)
UK Trade Name(s)
UK Availability
fentanyl (generic)
- INJ: 50 mcg/mL (2, 10 mL amp)
Sublimaze
- INJ: 50 mcg/mL (2, 10 mL amp)
Australian Trade Name(s)
Australian Availability
fentanyl (generic)
- INJ: 50 mcg/mL (2,10 mL amp)
Sublimaze
- INJ: 50 mcg/mL (2, 10, 20 mL amp)
[Outline]
