BRANDS OF FENTANYL IN KENYA
Durogesic®, Janssen Pharmaceutica pty Ltd
Fentavera®, Acino Pharma AG
Fentanyl®, Martindale Pharmaceuticals
Trofentyl®, Troikaa Pharmaceuticals Limited
Verfen®, Verve Human Care Laboratories
MODE OF ACTION
Fentanyl is a potent µ-opioid analgesic with rapid onset of analgesia and short duration of action. Fentanyl is approximately 100-fold more potent than morphine as an analgesic. Secondary effects of fentanyl on central nervous system (CNS), respiratory and gastro-intestinal function are typical of opioid analgesics and are considered to be class effects. These can include respiratory depression, bradycardia, hypothermia, constipation, miosis, physical dependence and euphoria.
Management of breakthrough pain in adult patients using opioid therapy for chronic cancer pain. Breakthrough pain is a transient exacerbation of otherwise controlled chronic background pain.
DOSAGE AND ADMINISTRATION
should only be administered to patients who are considered tolerant to their opioid therapy for persistent cancer pain. Patients can be considered opioid tolerant if they take at least 60 mg of oral morphine daily, at least 25 micrograms of transdermal fentanyl per hour, at least 30 mg of oxycodone daily, at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer.
Hypersensitivity to the active substance or to any of the excipients listed in the manufacturer’s leaflet.
Patients without maintenance opioid therapy as there is an increased risk of respiratory depression.
Severe respiratory depression or severe obstructive lung conditions.
Treatment of acute pain other than breakthrough pain.
Fentanyl is metabolised by CYP3A4. Active substances that inhibit CYP3A4 activity such as macrolide antibiotics (e.g. erythromycin), azole antifungal agents (e.g. ketoconazole, itraconazole) or certain protease inhibitors (e.g. ritonavir) may increase the bioavailability of fentanyl by decreasing its systemic clearance, potentially enhancing or prolonging opioid effects. Grapefruit juice is also known to inhibit CYP3A4. Coadministration with agents that induce CYP3A4 activity such as antimycobacterials (e.g. rifampin, rifabutin), anticonvulsants (e.g. carbamazepine, phenytoin, and phenobarbital) herbal products (e.g. St John’s wort, Hypericum perforatum) may reduce the efficacy of fentanyl. CYP3A4 inducers exert their effect in a time-dependent manner, and may take at least 2 weeks to reach maximal effect after introduction. Conversely, on discontinuation, CYP3A4 induction may take at least 2 weeks to decline. Patients receiving fentanyl who stop therapy with, or decrease the dose of CYP3A4 inducers may be at risk of increased fentanyl activity or toxicity. Fentanyl should therefore be given to patients with caution if administered concomitantly with CYP3A4 inhibitors and/or inducers.
Concomitant use of other CNS depressants, such as other morphine derivatives (analgesics and antitussives), general anaesthetics, skeletal muscle relaxants, sedative antidepressants, sedative H1 antihistamines, barbiturates, anxiolytics (ie benzodiazepines), hypnotics, antipsychotics, clonidine and related substances may produce increased CNS depressant effects. Respiratory depression, hypotension and profound sedation may occur.
Alcohol potentiates the sedative effects of morphine-based analgesics, therefore concomitant administration of alcoholic beverages or medicinal products containing alcohol with Fentanyl is not recommended.
Fentanyl is not recommended for use in patients who have received monoamine oxidase (MAO) inhibitors within 14 days because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.
The concomitant use of partial opioid agonists/antagonists (e.g. buprenorphine, nalbuphine, pentazocine) is not recommended. They have high affinity to opioid receptors with relatively low intrinsic activity and therefore partially antagonise the analgesic effect of fentanyl and may induce withdrawal symptoms in opioid dependent patients.
Co-administration of fentanyl with a serotoninergic agent, such as a Selective Serotonin Re-uptake Inhibitor (SSRI) or a Serotonin Norepinephrine Re-uptake Inhibitor (SNRI) or a Monoamine Oxidase Inhibitor (MAOI), may increase the risk of serotonin syndrome, a potentially life-threatening condition.
Cardiac disorders: bradycardia, tachycardia.
Eye disorders: vision blurred.
Gastrointestinal disorders: abdominal pain, abdominal pain upper, aphthous stomatitis, constipation, dry mouth, dyspepsia, gingival ulceration, impaired gastric emptying, lip ulceration, mouth ulceration, nausea, stomach discomfort, stomatitis, tongue disorder, vomiting.
General disorders and administration site conditions: asthenia, drug withdrawal syndrome, fatigue, malaise.
Immune system disorders: drug hypersensitivity.
Injury, poisoning and procedural complications: accidental overdose.
Metabolism and nutrition disorders: anorexia, decreased appetite.
Nervous system disorders: amnesia, disturbance in attention, dizziness, dysgeusia, headache, hypoesthesia, lethargy, parosmia, somnolence, tremor.
Psychiatric disorders: affect lability, anxiety, confusional state, depression, disorientation, dysphoria, euphoric mood, insomnia, mental status changes, paranoia, sleep disorder.
Reproductive system and breast disorders: erectile dysfunction.
Respiratory, thoracic and mediastinal disorder: dyspnea, oropharyngeal pain, throat tightness.
Skin and subcutaneous disorders: hyperhidrosis, night sweats, pruritus, rash, skin lesion.
Vascular disorders: hypotension.
Reporting of suspected adverse reactions:
The PPB Department of Pharmacovigilance was set up with a vision to develop, implement and continuously upgrade an appropriate system for detecting, reporting and monitoring adverse drug reactions (ADRs) and other relevant problems with medicines in Kenya. The department strives to ensure the safety and efficacy of pharmaceutical products in Kenya.
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals/ Patients are encouraged to report any suspected adverse reactions via Pharmacovigilance Yellow Form, firstname.lastname@example.org or clicking below button:
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Clinical | Pharmacokinetic data
Pregnancy Category: C
Routes of Administration: Buccal, epidural, IM, IT, IV, sublingual, skin patch
Bioavailability: 92% (transdermal) 89% (intranasal) 50% (buccal) 33% (ingestion) 100% (intramuscular)
Protein Binding: 80–85%
Metabolosim: Liver, primarily by CYP3A4
Onset of Action: 5 minutes
Elimination Half life: IV: 6 mins (T1/2 α) 1 hours (T1/2 β) 16 hours (T1/2 ɣ) Intranasal: 6.5 hours Transdermal: 20–27 hours Sublingual/buccal (single dose): 2.6–13.5 hours[
Excretion: Mostly urinary (metabolites,
Legal Status | Dosage forms & Strengths
Prescription only Medicine (POM) , ℞-only
Narcotic Drugs and Psychotropic Substances (Control ) Act Schedule:
This is a controlled Schedule 1 Drug ,Narcotic Drugs and Psychotropic Substances (Control ) Act
Dosage Forms | Strengths:
|CompTox Dashboard (EPA)|
- Chia, Yuan-Yi, et al. “Intraoperative high dose fentanyl induces postoperative fentanyl tolerance.” Canadian journal of anesthesia 46.9 (1999): 872.
- Célèrier, Evelyne, et al. “Long-lasting hyperalgesia induced by fentanyl in rats preventive effect of ketamine.” Anesthesiology: The Journal of the American Society of Anesthesiologists 92.2 (2000): 465-465.
- Koehntop, Douglas E., et al. “Pharmacokinetics of fentanyl in neonates.” Anesthesia & Analgesia 65.3 (1986): 227-232.
- Peng, Philip WH, and Alan N. Sandler. “A review of the use of fentanyl analgesia in the management of acute pain in adults.” Anesthesiology: The Journal of the American Society of Anesthesiologists 90.2 (1999): 576-599.