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Fentanyl - Fentanil
ℹ️ About
Always check the BNF link here for full prescribing details. ⚠️ Fentanyl is a highly potent opioid analgesic that can be misused or abused, often in combination with heroin or cocaine.
⚙️ Mode of Action
- Potent opioid analgesic, approximately 80–100× stronger than morphine.
- Acts primarily as a µ-opioid receptor agonist, producing analgesia and sedation.
- Very rapid onset; effects last ~2+ hours depending on route.
- High potency → increased risk of accidental overdose.
💊 Indications & Dose (check BNF for full guidance)
- Chronic pain / palliative care: Transdermal patch, usually 25–100 micrograms/hour, replaced every 72 hours.
- Peri-operative / RSI (Rapid Sequence Induction): IV bolus for analgesia, onset within ~3 minutes.
- Breakthrough cancer pain: Intranasal, buccal, or sublingual fentanyl preparations may be used.
🔄 Interactions
- Refer to BNF. ⚠️ Risk with other CNS depressants (benzodiazepines, alcohol, sedatives) → profound respiratory depression.
⚠️ Cautions
- Refer to BNF.
- Use with extreme care in opioid-naïve patients.
- Respiratory depression risk, particularly in elderly or those with COPD/respiratory compromise.
⛔ Contraindications
- Refer to BNF. Examples include acute severe respiratory depression, paralytic ileus, and hypersensitivity to fentanyl.
💥 Side Effects
- Euphoria, dizziness, nausea, vomiting.
- Respiratory depression → risk of death in overdose.
- Seizures, fainting, hypotension.
- Can be reversed with naloxone in overdose.
📚 References
- British National Formulary (BNF): Fentanyl entry
- NICE Palliative Care Guidelines
📝 Revisions
- Updated September 2025
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