Fentanyl Citrate

  • Generic Name or Active Ingridient: Fentanyl
Drug Class: Fentanyl Citrate > Fentanyl > Fully Synthetic Opioid > Opioids > Opioid Agonist > Analgesic.

Uses

Doctors prescribe fentanyl citrate to treat patient's breakthrough pain from cancer in patients with malignancies and who are already tolerant to 24-hour a day opioid coverage, such as from codeine or morphine. Medical professionals consider a patient opioid tolerant if they are already taking around-the-clock medication consisting of at least 25 mcg of transdermal fentanyl per hour. A patient is considered opioid tolerant if they are taking another narcotic, such as at least 60 mg of oral morphine daily, at least 30 mg of oral oxycodone daily, at least 8 mg oral hydromorphone daily, at least 25 mg oral oxymorphone daily, or an equivalent dose of another opioid for a week or longer. Learn More About Fentanyl Citrate Uses

Other, off label uses for this medicine

Physicians sometimes prescribe fentanyl citrate "off-label" to treat pain from medical conditions other than cancer, such as for back pain or injuries. Fentanyl citrate may be used pre-operatively, during surgery and post-operatively in patients who have used opioids before surgery and are therefore already opioid tolerant.

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Administration/Dosage

Fentanyl citrate is available under the brand names of Actiq, Duragesic, Fentora and Sublimaze. This medication is available in pill form, as an intramuscular injection, as a transdermal patch or as part of a patient controlled analgesia system, commonly known as a PCA pump. It is also offered intrabuccaly, as a lozenge or tablet that dissolves slowly when placed on or beneath the tongue.

Do not expose the fentanyl citrate patch or the surrounding area to excessive heat, as this may cause the patch to release an excessive or dangerous amount of medicine. Medical personnel should monitor for signs of opioid toxicity in those patients with a fever or whose body temperature rises following strenuous exercise.

Medical scientists have not yet established safety and efficacy in children under the age of 2 years. Use of fentanyl citrate is only indicated in children over the age of 2 years who are already tolerant to opioids.

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Action

When illness or trauma injures the cells of your body, the cells release chemicals that bind to pain receptors in your central nervous system and send a message of pain to your brain. Fentanyl citrate works by binding to these pain receptors to replace pain messages with ones of pleasure and euphoria. This changes the way your brain perceives and reacts to the pain.

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Precautions

Do not take fentanyl citrate if you are allergic to it or any other opioids, such as codeine or morphine. An allergic reaction is a serious medical emergency. An allergic reaction is a serious event that could deteriorate rapidly into a medical emergency. Discontinue fentanyl citrate and seek qualified medical assistance as soon as you notice symptoms of an allergic reaction, including rash, hives or itching. Other symptoms include shortness of breath, wheezing, cough and swelling of face, lips, tongue or throat.

Anaphylaxis is a severe, life-threatening form of allergic reaction. You can die within 15 minutes after exposure to a drug allergen. Emergency room physicians treat approximately 82,000 people suffering from anaphylaxis each year.

Symptoms of a moderate or severe reaction include:

  • Abdominal Pain
  • Chest Discomfort or Tightness.
  • Difficulty Breathing or Wheezing.
  • Difficulty Swallowing.
  • Dizziness or Light-Headedness.
  • Fear or Feeling of Apprehension or Anxiety.
  • Flushing or Redness of the Face.
  • Nausea, Vomiting or Diarrhea.
  • Palpitations.
  • Stomach Cramps.
  • Swelling of the Face, Eyes or Tongue.
  • Unconsciousness.
  • Weakness.

Talk with your doctor about your medical history. She may change your dosage or recommend a different drug if you have a history of or are currently under a doctor's care for certain illnesses. This medication may worsen your disease or interfere with treatment. Your ailment may change the way fentanyl citrate works in your body. Tell your doctor if you or if any member of your family drinks large amounts of alcohol or used street drugs. Inform your physician about any head injuries, strokes or other illnesses that causes increase cranial pressure. Be sure your doctor knows about any seizures, cardiovascular problems, respiratory, liver and kidney disease or mental problems.

Fentanyl citrate may make you dizzy, drowsy or interfere with your ability to make decisions. Do not drive a motor vehicle, operate heavy machinery or participate in potentially unsafe activities until you know how fentanyl citrate affects you.

Fentanyl citrate is habit forming like other opioids. To avoid developing a drug habit, do not take higher doses or use this medication more frequently than prescribed. Do not share this medication with others, especially individuals with a history of drug or alcohol abuse, even if they complain of symptoms similar to your own.

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Warnings

Medical scientists have not yet established whether taking fentanyl citrate during pregnancy will harm an unborn child. If you are pregnant, discuss the benefits and risks of taking fentanyl citrate during pregnancy. Fentanyl citrate easily passes across the placenta to the fetus; therefore, medical professionals should not administer this medication to women during labor and delivery. Fentanyl citrate passes into breast milk and can cause depressive effects in a nursing baby. Nursing babies may also develop dependence on fentanyl and experience withdrawal symptoms when they stop nursing.

Do not stop taking fentanyl citrate abruptly, unless directed to do so by a physician. Sudden cessation may result in withdrawal symptoms. To avoid symptoms of withdrawal, take successively smaller doses at greater intervals. Talk with your doctor or rehabilitation specialist if withdrawal symptoms prevent you from discontinuing fentanyl citrate as directed.

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Drug Interactions

Some medications interact with fentanyl citrate in unsafe or unwanted ways. Give the prescribing doctor and druggist filling the order a complete list of all your medications, including prescriptions, over-the-counter medications, herbal remedies and vitamin supplements. Do not start, stop or change the way you take any medicine while you are taking fentanyl citrate without first consulting with a doctor.

Do not take fentanyl citrate if you already take aprepitant, diltiazem or verapamil. Tell the prescribing physician if you take antibiotics such as clarithromycin or erythromycin. Certain antifungal medications such as fluconazole, ketoconazole, itraconazole or HIV medicines such as indinavir, fosamprenavir, nelfinavir or ritonavir can interact with fentanyl citrate.

Avoid drinking alcohol and consuming grapefruit products while taking fentanyl citrate. Both may interact with fentanyl citrate and lead to potentially serious side effects. Talk with your doctor before increasing or decreasing the amount of grapefruit in your diet. Do not take fentanyl citrate with cold or allergy medicine, sleeping pills, muscle relaxers and medicine for seizures, depression or anxiety as these drugs can add to sleepiness associated with fentanyl citrate use.

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Side effects

Patients have reported side effects associated with using fentanyl citrate. Most of the commonly reported side effects are not serious and disappear on their own. Continue taking fentanyl citrate but contact the prescribing physician if these commonly reported side effects become intolerable or if they do not go away on their own.

Common side effects include:

  • Anxiety
  • Dizziness.
  • Dry Mouth.
  • Headache.
  • Weakness.

Discontinue fentanyl citrate and contact a medical professional immediately if you experience any serious side effects. Serious side effects include:

  • Extreme Sleepiness.
  • Fainting.
  • Feeling Light-Headed.
  • Shallow Breathing.
  • Slow Heart Rate.

The concentration of fentanyl citrate reaches its peak 24 to 72 hours after application of the patch. Serious or life-threatening breathing problems can occur at any time, even in patients who are already tolerant to opioids, particularly after the initial dose or after a change in dosage strength. Fentanyl citrate has a lengthy elimination half-life of 17 hours, which means this drug remains in your system for a long time after you apply the patch. Healthcare professionals should observe patients experiencing adverse reactions, side effects and overdose for more than 24 hours.

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Overdose

Overdose is a potentially fatal medical crisis that requires the immediate attention of qualified health professionals. More Americans are dying from drug overdose than ever before. According to the Centers for Disease Control and Prevention, or CDC, more than 36,000 Americans died from drug overdoses in 2008, more than triple the number of drug overdose deaths in 1990. An increasing number of these deaths are from prescription drugs, rather than from illegal drugs. In 2008, more people died in the United States from prescription drug overdose than from overdosing on cocaine and heroin combined.

If you suspect that you or someone you know has taken too much fentanyl citrate or any other drug, contact poison control center at 1-800-222-1222 or go to the emergency room. If it is faster, call for an ambulance.

Overdose symptoms include:

  • Breathing That Stops.
  • Fainting.
  • Shallow Breathing.
  • Weak Pulse.

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Abuse

Abuse of fentanyl citrate is similar to other opioids but the patches may be favorable over other forms of medication because these patches contain a high dose of fentanyl citrate. Americans constitute less than 5 percent of the world's population but they consume more than 80 percent of the world's supply of opioids, including fentanyl citrate. American physicians prescribe these opioids to prevent their patients from experiencing significant pain. Unfortunately, this widespread use of medically necessary prescription painkillers has created a significant opioid abuse problem in the United States. The CDC states that, in 2010, more than 12 million people reported using prescription drugs for non-medical reasons, which means the people used the drugs without a prescription to relieve symptoms or simply to get high. About 55 percent of drug abusers get their drugs free from family members or friends. The DEA calls this diversion - when abusers divert drugs from a medical purpose to a recreational one.

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Withdrawal

Medical professionals recognize withdrawal as a normal, predictable result of using high doses of fentanyl citrate or using this medication for a long time. Experiencing withdrawal symptoms is not necessarily an indication of criminal drug use; a patient may suffer withdrawal symptoms after using a medication as prescribed by her physician to treat an acute or chronic condition. Withdrawal symptoms are unpleasant and uncomfortable. Potent withdrawal symptoms may prevent you from discontinuing fentanyl citrate when recommended by your doctor. If your withdrawal symptoms prevent you from quitting fentanyl citrate, contact your doctor or a qualified rehabilitation clinic.

Symptoms from fentanyl citrate withdrawal include:

  • Aches in the Bones and Muscles.
  • Anxiety.
  • Cramps.
  • Depression.
  • Diarrhea.
  • Fever.
  • Goosebumps.
  • Leg Kicking.
  • Malaise.
  • Muscle Cramps.
  • Nausea or Vomiting.
  • Severe and Chronic Insomnia.
  • Sweating.
  • Yawning.

Detox

Dependence on opioids such as fentanyl citrate is a complex medical and social condition that requires expert rehabilitative care. The first phase of rehabilitation always includes overcoming potent and uncomfortable symptoms of withdrawal and detoxification from the effects of fentanyl citrate. During standard rehabilitation, your doctor will administer medication to ease withdrawal symptoms and drugs to detoxify your body. This stage may last five days or longer. After doctors have stabilized and cleansed your body, you can participate in counseling or other social services to help you deal with any family, social or legal issues that may have contributed to or been the result of your dependence on opioids such as fentanyl citrate.

Rapid detox is a new, humane approach to overcoming potent withdrawal symptoms and detoxification. During rapid detox, physicians administer anesthesia and sedatives along with the usual detoxification drugs and medications to ease withdrawal symptoms. You sleep through the worst parts of treatment, blissfully unaware of the uncomfortable withdrawal symptoms that prevent you from quitting fentanyl citrate on your own. Learn More About Fentanyl Citrate Detoxification Programs

Storage

Keep fentanyl citrate at room temperature, away from excessive heat, light and moisture. Put fentanyl citrate out of the reach of children, pets and adults who might take this medication by accident or on purpose. Do not use fentanyl citrate if the foil pouch containing the patch is damage, cut or altered, as this could result in accidental exposure to caregivers, patients and others.

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