High Alert
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
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.
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