High Alert
Absorption: Well absorbed after IM administration. IV administration results in complete bioavailability.
Distribution: Extensively distributed to CNS and tissues.
Half-Life: Children: Bolus dose: 2.4 hr; long-term continuous infusion: 1136 hr; Adults: 24 hr (↑ after cardiopulmonary bypass and in geriatric patients).
(analgesia*)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
IM | 715 min | 2030 min | 12 hr |
IV | 12 min | 35 min | 0.51 hr |
*Respiratory depression may last longer than analgesia.
Contraindicated in:
Use Cautiously in:
Use during pregnancy only if potential maternal benefit justifies potential fetal risk. Chronic maternal treatment with opioids during pregnancy may result in neonatal opioid withdrawal syndrome
;CV: arrhythmias, bradycardia, hypotension
Derm: facial itching
EENT: blurred/double vision
Endo: adrenal insufficiency
GI: biliary spasm, nausea, vomiting
MS: skeletal and thoracic muscle rigidity (with rapid IV infusion)
Neuro: confusion, paradoxical excitation/delirium, postoperative drowsiness
Resp: allergic bronchospasm, APNEA, LARYNGOSPASM, RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA)
Misc: allodynia, opioid-induced hyperalgesia,
physical dependence
,psychological dependence
Drug-drug:
CYP3A4 inhibitors, including ritonavir, ketoconazole, itraconazole, clarithromycin, nelfinavir, nefazodone, diltiazem, aprepitant, fluconazole, fosamprenavir, verapamil, and erythromycin, may ↑ levels and risk of CNS and respiratory depression.
CYP3A4 inducers, including barbiturates, carbamazepine, efavirenz, corticosteroids, modafinil, nevirapine, oxcarbazepine, phenobarbital, phenytoin, rifabutin, or rifampin, may ↓ levels and analgesia; if inducers are discontinued or dosage ↓, patients should be monitored for signs of opioid toxicity, and necessary dose adjustments should be made.
Use with benzodiazepines or other CNS depressants, including other opioids, nonbenzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle relaxants, antipsychotics, and alcohol, may cause profound sedation, respiratory depression, coma, and death; reserve concurrent use for when alternative treatment options are inadequate.
Drug-Food:
Preoperative Use
Adjunct to General Anesthesia
Adjunct to Regional Anesthesia
Postoperative Use (Recovery Room)
General Anesthesia
Sedation/Analgesia
Assess BP, HR, and respiratory rate before and periodically during administration. If respiratory rate <10/min, assess level of sedation. Dose may need to be ↓ by 2550%. Respiratory depression does not ↑ in severity, only in duration, with ↑ dose. Monitor for respiratory depression, especially during initiation or following dose ↑; serious, life-threatening, or fatal respiratory depression may occur. The respiratory depressant effects of fentanyl may last longer than the analgesic effects. May cause sleep-related breathing disorders (central sleep apnea, sleep-related hypoxemia).
Assess risk for opioid addiction, abuse, or misuse prior to administration.
Lab Test Considerations:
Toxicity and Overdose:
IV Administration:
Inform patient of potential for neonatal opioid withdrawal syndrome with prolonged use during pregnancy. Monitor neonate for signs and symptoms of withdrawal symptoms (irritability, hyperactivity and abnormal sleep pattern, high-pitched cry, tremor, vomiting, diarrhea, failure to gain weight); usually occur the first days after birth. Monitor infants exposed to fentanyl through breast milk for excess sedation and respiratory depression.
NDC Code