Select a medication above to begin.
fentanyl
generic
Black Box Warnings .
Appropriate Use
should only be administered by healthcare professionals trained in use of IV anesthetics and management of respiratory effects of potent opioids; ensure opioid antagonist, resuscitative and intubation equipment, and oxygen readily available
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
CYP450 3A4 Interaction
concomitant use with CYP450 3A4 inhibitors or D/C of concomitant CYP450 3A4 inducers may incr. fentanyl concentration which may incr. or prolong adverse effects including potentially fatal respiratory depression; monitor patients receiving any concomitant CYP450 3A4 inhibitor or inducer
Adult Dosing .
Dosage forms: INJ (pre-filled syringe): 50 mcg per mL, 100 mcg per 2 mL; INJ (vial): 50 mcg per mL
analgesia, preop
- [50-100 mcg IV/IM x1]
- Start: 30-60min prior to surgery; Info: consider low dose in patients 65 yo and older
anesthesia adjunct
- [2-50 mcg/kg/dose IV x1]
- Info: 2 mcg/kg/dose for low dose, 2-20 mcg/kg/dose for moderate dose, 20-50 mcg/kg/dose for high dose; consider doses at lower end of desired range in patients 65 yo and older
regional anesthesia adjunct
- [50-100 mcg IV/IM x1]
- Info: consider low dose in patients 65 yo and older
general anesthesia
- [50-100 mcg/kg/dose IV x1]
- Info: for high-risk patients undergoing major or complicated surgical procedures; use with oxygen and muscle relaxant; doses up to 150 mcg/kg/dose may be needed; consider low dose in patients 65 yo and older
pain, postop
- [IV/IM route]
- Dose: 50-100 mcg IV/IM q1-2h prn; Alt: 0.5-1.5 mcg/kg/h IV prn; Info: use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in patients 65 yo and older
- [PCA route (off-label)]
- Dose: 10-20 mcg IV q6-20min prn; Start: 10-50 mcg IV x1; Info: basal rate for opioid-experienced patients is up to 50 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in patients 65 yo and older
pain, moderate-severe acute (off-label)
- [1-2 mcg/kg/dose intranasally q1h prn]
- Max: 100 mcg/dose; Info: use injectable form with mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration; consider low start dose, titrate slowly in patients 65 yo and older
rapid sequence intubation adjunct (off-label)
- [1-3 mcg/kg/dose IV x1]
- Start: 3min before induction agent; Info: see Rapid Sequence Intubation (RSI), Adult table
renal dosing
- [anesthesia]
- renal impairment: no adjustment
- HD/PD: not defined
- [pain]
- CrCl 10-50: decr. usual dose by 25%; CrCl <10: decr. usual dose by 50%
- HD: decr. usual dose by 50%; supplement after dialysis not defined; PD: decr. usual dose by 50%; supplement not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ (pre-filled syringe): 50 mcg per mL, 100 mcg per 2 mL; INJ (vial): 50 mcg per mL
sedation/analgesia
- [1-3 yo]
- Dose: 2-3 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
- [3-12 yo]
- Dose: 1-2 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
- [>12 yo]
- Dose: 0.5-1 mcg/kg/dose IV q1-4h prn; Alt: 1-2 mcg/kg/dose IV x1, then 0.5-1 mcg/kg/h, may titrate upward
sedation during ECMO
- [1-5 mcg/kg/h IV]
- Start: 5-10 mcg/kg/dose IV x1; Info: may titrate infusion upward
pain, post-op (off-label)
- [PCA route, <50 kg]
- Dose: 0.5-1 mcg/kg/dose IV q6-20min prn; Start: 0.5-1.5 mcg/kg/dose IV x1; Max: 4 mcg/kg/h; Info: basal rate for opioid-experienced patients is up to 0.5 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration
- [PCA route, >50 kg]
- Dose: 10-20 mcg IV q6-20min prn; Start: 10-50 mcg IV x1; Info: basal rate for opioid-experienced patients is up to 50 mcg/h; dosing varies, refer to institution protocol; use lowest effective dose, shortest effective tx duration
pain, moderate-severe acute (off-label)
- [1-16 yo]
- Dose: 1-2 mcg/kg/dose intranasally q1h prn; Max: 50 mcg/dose up to 3 mcg/kg/24h; Info: use injectable form with mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration
- [>16 yo]
- Dose: 1-2 mcg/kg/dose intranasally q1h prn; Max: 100 mcg/dose; Info: use injectable form with mucosal atomization device; divide dose and give as 1 spray in each nostril; use lowest effective dose, shortest effective tx duration
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised