Drug Summary

Fentanyl (Sublimaze®)

Pharmacologic properties:

Fentanyl is a synthetic opioid analgesic that suppresses pain by agonizing opioid receptors in the central nervous system. Fentanyl has fewer vasoactive effects than morphine and does not induce significant histamine release. As a result, the drug does not cause significant hypotension in proper doses.

Indications:

  • Chest pain associated with suspected myocardial ischemia
  • Thermal burns
  • Frostbite
  • Isolated extremity injury
  • Pain from suspected kidney stone

Contraindications:

  • Pain due to multisystem trauma or suspected acute abdomen
  • Hypotension, (SBP <100 mmHg) or volume depletion
  • Head trauma
  • Acute alcohol intoxication
  • Acute respiratory distress
  • Known hypersensitivity

Precautions:

  • Use with caution in elderly patients
  • Fentanyl is metabolized by the liver, use caution in patients with known liver disease
  • Sedative effects are potentiated by alcohol, antihistamines, barbiturates, benzodiazepines, phenothiazines, and other sedatives

Adverse Reactions:

  • Euphoria
  • Drowsiness
  • Pupillary constriction
  • Respiratory arrest
  • Decreases gastric motility
  • Nausea and vomiting
  • Bradycardia
  • Chest wall rigidity

Dosage and administration:

  • Adult
    • Intravenous - 1-2 mcg/kg (maximum individual dose 50 mcg) slow IV push (maximum total dose 100 mcg)
    • Intranasal - via mucosal atomization device (MAD) – single 100 mcg dose (divide dose between nostrils) for all patients
  • Pediatric
    • Intravenous - 0.5 mcg/kg (maximum individual dose 25 mcg) slow IV push (maximum total dose 50 mcg)
    • Intranasal (via MAD) – single 1.5 mcg/kg dose (maximum 100 mcg, divide dose between nostrils)