Fentanyl is a very strong analgesic similar to opium that is covered by the Narcotics Act in Germany. Because of its high analgesic and strong sedative effect, the opioid is used intravenously as an anesthetic, especially during surgery. Because of its rapid onset of action, fentanyl is also commonly used in emergency medicine. As a transdermal therapeutic system (TTS), the fentanyl patch is used as a pain patch in patients who require regular pain medication.
Fentanyl patch: dosage and side effects.
The fentanyl patch is characterized by fewer side effects compared to oral use, because the active ingredient is absorbed through the blood and not through the stomach. Fentanyl patches act directly on the affected area, such as in osteoarthritis. During treatment with a fentanyl patch, exposure to heat must be avoided, and the pain patches must also be changed every 72 hours. Nevertheless, according to the WHO, pain patches containing fentanyl are among the strongest painkillers and should not be used lightly. Painkillers: which one, when and for what?
Fentanyl nasal spray for breakthrough pain.
A newer dosage form is a nasal spray that came on the market in 2009. Cancer patients in particular benefit from fentanyl nasal spray. In contrast to fentanyl lozenges or lollipops, the pain-relieving effect is achieved more quickly with the nasal spray because the active ingredient can be absorbed particularly well through the nasal mucosa – a disadvantage sometimes arises from dry air and the accompanying dry mucous membranes. The dosage of Fentanyl nasal spray is also problematic in the case of rhinitis. The drug achieves its high effect quickly, but does not last long, which corresponds to the characteristic of fast-onset, but usually short-lasting breakthrough pain. Due to its ease of use, the fentanyl nasal spray achieved a positive response in oncology. Like the fentanyl patch, the fentanyl nasal spray and lozenges can be used on an outpatient basis. In addition to pain reduction, many patients additionally welcome the strong sedative effect of fentanyl – a reason why it occasionally finds use within dentistry.
Fentanyl: dosage and effect
Fentanyl has an effect about a hundred times greater than morphine, and its side effects are roughly equivalent to those of morphine. Any form of administration must be done under medical supervision. Special attention must be paid to the dosage of fentanyl, since an increased dose can lead to respiratory depression, in the worst case with fatal consequences. Because of the effect of fentanyl on the respiratory center, therapy must be monitored regularly, especially initially, for the purpose of proper adjustment.
Fentanyl: side effects
The most common side effects include fatigue, constipation, sweating, anxiety or euphoria, nausea, and vomiting. Slowed heart activity or muscle spasms may also occur as side effects of fentanyl. The most severe side effects occur in association with excessive dosing or abuse. If the fentanyl patch is used improperly, serious side effects, including death, can occur, as the U.S. Food and Drug Administration has warned in this regard since 2005. In 2009 alone, there were reportedly 397 deaths in the United States.
Fentanyl: withdrawal and dependence
Fentanyl is also known as “super-heroin” in the United States. Its sedative effects can lead to altered consciousness and even sleep-like states. There is a risk of rapid and severe dependence. Users risk their lives with each injection, as the dosage of the drug is almost impossible to control. Also, the already immensely powerful effects of fentanyl are difficult to predict after further development into a designer drug. In addition to severe side effects, there are also severe symptoms of withdrawal. Caution: Not only abuse leads to dependence and may require withdrawal after completion or sudden discontinuation of therapy; patients – for example, with cancer – who used the fentanyl patch or fentanyl nasal spray also reported severe side effects and a variety of symptoms associated with withdrawal.Especially in the so-called cold turkey withdrawal, the seamless transition from a high dosage to a complete renunciation, typical phenomena such as anxiety, cold tremors, diarrhea, nausea and vomiting occur. Similar to heroin, some people resort to the substitute drug methadone for fentanyl withdrawal. Because of its extremely potent effects, side effects, and risks, the use of fentanyl for medical purposes should be carefully considered.
