Short-term analgesia during anesthetic periods, premedication, induction and maintenance; and in the immediate postoperative periods as need arises. Analgesic supplement in general or regional anesthesia. Concomitantly with neuroleptic as an anesthetic premedication, for anesthesia induction and as an adjunct in the maintenance of general and regional anesthesia. As an anesthetic in combination with oxygen in selected high risk patients (eg, undergoing open heart surgery, complicated neurological or orthopedic procedures).
Fentanyl is an opioid analgesic. Fentanyl interacts predominately with the opioid mu-receptor but also binds to kappa and delta-type opioid receptors. These mu-binding sites are discretely distributed in the human brain, spinal cord, and other tissues. In clinical settings, Fentanyl exerts its principal pharmacologic effects on the central nervous system. Its primary actions of therapeutic value are analgesia and sedation. Fentanyl may increase the patient's tolerance for pain and decrease the perception of suffering, although the presence of the pain itself may still be recognized. In addition to analgesia, alterations in mood, euphoria and dysphoria, and drowsiness commonly occur. Fentanyl depresses the respiratory centers, depresses the cough reflex, and constricts the pupils.
INTRAVENOUS Adjunct to general anaesthesia: Adult: For patients w/ spontaneous respiration: Initially, 50-200 mcg followed by supplements of 50 rncg. To be injected over 3-5 minutes. Possible increased risk of resp depression following doses >200 mcg. For patients w/ assisted ventilation: Initially, 300-3,500 mcg (up to 50 mcg/kg) followed by supplements of 100-200 mcg depending on the patient’s response. To be injected over 3-5 minutes. Child: For patients w/ spontaneous respiration: >2 yr: 3-5 mcg/ kg IV, supplements of 1 mcgl kg may be given. For patients w/ assisted ventilation: >2 yr Initially, 15 mcg/kg w/ supplements of 1-3 mcg/kg. Elderly: & debilitated patients: Dose reduction may be needed.
Co-administration of different antifungals, macrolide antibiotics, CNS depressant drugs like ketoconazole, itraconazole, troleandomycin, clarithromycin, nelfinavir, and nefazadone may enhance or prolong the effects of Fentanyl. The concomitant use of amprenavir, aprepitant, diltiazem, erythromycin, fluconazole, fosamprenavir, grapefruit juice, and verapamil with Fentanyl may also result in an increase in Fentanyl plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression.
Hypersensitivity is contraindicated. Myasthaenia gravis. Head injury; increased intracranial pressure; intracranial lesions; renal or hepatic impairment: neonates; opioid-nontolerant patients. Increased risk of resp depression in elderty, debilitated patients, patient w/ hypoxia or hypercapnia. Hypothyroidism, prostatic hyperplasia, inflammatory bowel disorders, bradycardia or bradyarrhythmias. Rapid IV infusion may cause skeletal muscle & chest wall rigidity, impaired ventilation or resp distress/arrest. Prolonged use may cause tolerance, psychological & physical dependence. Abrupt withdrawal after prolonged admin may lead to withdrawal symptoms. Lactation. Pregnancy (avoid high doses or prolonged usage).
Nausea, vomiting; bradycardia, oedema, CNS depression, confusion, dizziness,drowsiness, headache, sedation, transient hypotension, peripheral vasodilation; increased intracranial pressure. High IV dose may cause chest wall rigidity. Transdermal: Rash, erythema & itching. Respiratory depression, trunk rigidity, laryngospasm, bronchoconstriction.
This drug should be used during pregnancy only if the benefit outweighs the risk.
In insufficient overdosage, Fentanyl would produce narcosis, marked skeletal muscle rigidity. Cardio-respiratory depression and cyanosis may also occur. In the presence of hypoventilation or apnoea, oxygen should be administered and respiration should be assisted. A specific narcotic antagonist, such as naloxane, should be available for use as indicated to manage respiratory depression.
Store between 20-25°C. Protect from light.
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