Home Drug Guide Fentanyl Hydrochloride

Drug Guide

Generic Name

Fentanyl Hydrochloride

Brand Names Ionsys

Classification

Therapeutic: Pain Management (Analgesic)

Pharmacological: Opioid Agonist

FDA Approved Indications

Management of acute post-operative pain in hospitalized patients

Mechanism of Action

Fentanyl is a potent synthetic opioid that acts on the central nervous system by binding to the mu-opioid receptor, producing analgesia and euphoria.

Dosage and Administration

Adult: Administer as a patch on intact skin; specific dosing depends on patient's opioid tolerance and pain level.

Pediatric: Not FDA approved for pediatric use; consult specific guidelines for off-label or experimental use.

Geriatric: Use cautiously; start at lower dose due to increased sensitivity.

Renal Impairment: Adjust dosing based on patient response; monitor closely.

Hepatic Impairment: Use with caution; may require dose adjustment due to altered metabolism.

Pharmacokinetics

Absorption: Absorbed through the skin from the transdermal patch.

Distribution: Widely distributed in body tissues and fluids, crosses the blood-brain barrier.

Metabolism: Metabolized primarily in the liver via CYP3A4 to inactive metabolites.

Excretion: Primarily excreted in the urine; small amounts in feces.

Half Life: Approximately 7 hours in healthy individuals.

Contraindications

Known hypersensitivity to fentanyl or other opioids.
Acute or severe bronchial asthma in an unmonitored setting.

Precautions

Use with caution in patients with respiratory depression, head injury, increased intracranial pressure, hepatic impairment, or psychiatric disorders.

Adverse Reactions - Common

Nausea (Common)
Sedation (Common)
Dizziness (Common)
Constipation (Common)

Adverse Reactions - Serious

Respiratory depression (Serious)
Hypotension (Serious)
Anaphylaxis (Serious)

Drug-Drug Interactions

CNS depressants, including benzodiazepines, other opioids, alcohol

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor pain relief, respiratory status, blood pressure, sedation levels.

Diagnoses:

Ineffective airway clearance
Risk for falls due to sedation

Implementation: Apply patch to intact skin; rotate sites; monitor for signs of overdose.

Evaluation: Assess pain relief and monitor for adverse effects, especially respiratory depression.

Patient/Family Teaching

Instruct on proper use of the transdermal system.
Warn about respiratory depression and to seek immediate help if symptoms occur.
Advise against use of alcohol or CNS depressants with fentanyl.

Special Considerations

Black Box Warnings:

High risk of overdose and death due to respiratory depression, especially if used improperly.

Genetic Factors: CYP3A4 interactions may affect metabolism.

Lab Test Interference: Potential interference with certain hormonal and metabolic assays.

Overdose Management

Signs/Symptoms: Respiratory depression, extreme somnolence, muscle flaccidity, pinpoint pupils, unconsciousness, coma.

Treatment: Administer opioid antagonists such as naloxone, ensure airway patency, provide supportive ventilation.

Storage and Handling

Storage: Store at room temperature away from moisture and sunlight.

Stability: Stable under recommended storage conditions for the duration of the prescribed use.