Sublimaze

Sublimaze - General Information

A potent narcotic analgesic, abuse of which leads to habituation or addiction. It is primarily a mu-opioid agonist. Sublimaze is also used as an adjunct to general anesthetics, and as an anesthetic for induction and maintenance. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1078)

 

Pharmacology of Sublimaze

Sublimaze is an opioid analgesic. Sublimaze interacts predominately with the opioid mu-receptor. These mu-binding sites are discretely distributed in the human brain, spinal cord, and other tissues. In clinical settings, Sublimaze exerts its principal pharmacologic effects on the central nervous system. Its primary actions of therapeutic value are analgesia and sedation. Sublimaze may increase the patient's tolerance for pain and decrease the perception of suffering, although the presence of the pain itself may still be recognized. In addition to analgesia, alterations in mood, euphoria and dysphoria, and drowsiness commonly occur. Sublimaze depresses the respiratory centers, depresses the cough reflex, and constricts the pupils.

 

Sublimaze for patients

A patient information sheet is included in the package of DURAGESIC® patches dispensed to the patient.

Patients receiving DURAGESIC® patches should be given the following instructions by the physician:

1. Patients should be advised that DURAGESIC® patches contain fentanyl, an opioid pain medicine similar to morphine, hydromorphone, methadone, oxycodone, and oxymorphone.

2. Patients should be advised that each DURAGESIC® patch may be worn continuously for 72 hours, and that each patch should be applied to a different skin site after removal of the previous transdermal patch.

3. Patients should be advised that DURAGESIC® patches should be applied to intact, non-irritated, and non-irradiated skin on a flat surface such as the chest, back, flank, or upper arm. Additionally, patients should be advised of the following:

· In young children or persons with cognitive impairment, the patch should be put on the upper back to lower the chances that the patch will be removed and placed in the mouth.

· Hair at the application site should be clipped (not shaved) prior to patch application.

· If the site of DURAGESIC® application must be cleansed prior to application of the patch, do so with clear water.

· Do not use soaps, oils, lotions, alcohol, or any other agents that might irritate the skin or alter its characteristics.

· Allow the skin to dry completely prior to patch application.

4. Patients should be advised that DURAGESIC® should be applied immediately upon removal from the sealed package and after removal of the protective liner. Additionally the patient should be advised of the following:

· The DURAGESIC® patch should not be used if the seal is broken, or if it is altered, cut, or damaged in any way prior to application. This could lead to the rapid release of the contents of the DURAGESIC® patch and absorption of a potentially fatal dose of fentanyl. The transdermal patch should be pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges.

· The patch should not be folded so that only part of the patch is exposed.

5. Patients should be advised that while wearing the patch, they should avoid exposing the DURAGESIC® application site to direct external heat sources, such as:

· heating pads,

· electric blankets,

· heat lamps,

· saunas,

· hot tubs, and

· heated water beds, etc.,

6. Patients should be advised that there is a potential for temperature-dependent increase in fentanyl release from the patch that could result in an overdose of fentanyl; therefore, if patients develop a high fever while wearing the patch they should contact their physician.

7. Patients should be advised to fold (so that the adhesive side adheres to itself) and immediately flush down the toilet used DURAGESIC® patches after removal from the skin.

8. Patients should be instructed that, if the gel from the drug reservoir accidentally contacts the skin, the area should be washed clean with clear water and not soap, alcohol, or other chemicals, because these products may increase the ability of fentanyl to go through the skin.

9. Patients should be advised that the dose of DURAGESIC® should NEVER be adjusted without the prescribing health care professional’s instruction.

10. Patients should be advised that DURAGESIC® may impair mental and/or physical ability required for the performance of potentially hazardous tasks (e.g., driving, operating machinery).

11. Patients should be advised to refrain from any potentially dangerous activity when starting on DURAGESIC® or when their dose is being adjusted, until it is established that they have not been adversely affected.

12. Patients should be advised that DURAGESIC® should not be combined with alcohol or other CNS depressants (e.g. sleep medications, tranquilizers) because dangerous additive effects may occur, resulting in serious injury or death.

13. Patients should be advised to consult their physician or pharmacist if other medications are being or will be used with DURAGESIC®.

14. Patients should be advised of the potential for severe constipation.

15. Patients should be advised that if they have been receiving treatment with DURAGESIC® and cessation of therapy is indicated, it may be appropriate to taper the DURAGESIC® dose, rather than abruptly discontinue it, due to the risk of precipitating withdrawal symptoms.

16. Patients should be advised that DURAGESIC® contains fentanyl, a drug with high potential for abuse.

17. Patients, family members and caregivers should be advised to protect DURAGESIC® from theft or misuse in the work or home environment.

18. Patients should be advised that DURAGESIC® should never be given to anyone other than the individual for whom it was prescribed because of the risk of death or other serious medical problems to that person for whom it was not intended.

19. Patients should be instructed to keep DURAGESIC® in a secure place out of the reach of children due to the high risk of fatal respiratory depression.

20. When DURAGESIC® is no longer needed, the unused patches should be removed from their pouches, folded so that the adhesive side of the patch adheres to itself, and flushed down the toilet.

21. Women of childbearing potential who become, or are planning to become pregnant, should be advised to consult a physician prior to initiating or continuing therapy with DURAGESIC®.

22. Patients should be informed that accidental exposure or misuse may lead to death or other serious medical problems.

23. Patients should be informed that, if the patch dislodges and accidentally sticks to skin of another person, they should immediately take the patch off, wash the exposed area with water and seek medical attention for the accidentally exposed individual.

DURAGESIC
(FENTANYL TRANSDERMAL SYSTEM)

This leaflet contains important information about DURAGESIC (Dur-ah- GEE-zik). Read this Patient Information carefully before you start using DURAGESIC. Read it each time you get a prescription. There may be new information. This information does not take the place of talking to your health care provider about your medical condition or your treatment. Only your health care provider can decide if DURAGESIC is the right treatment for you. If you do not understand some of this information or have questions, talk with your health care provider.

What is the most important information I should know about DURAGESIC?

· DURAGESIC contains fentanyl, a strong opioid narcotic pain medicine. DURAGESIC® can cause serious side effects, including trouble breathing, which can be fatal, especially if used the wrong way.

· DURAGESIC is only for patients with chronic (around the clock) pain that is moderate to severe and expected to last for weeks or longer. DURAGESIC should only be started if you are already using other opioid narcotic medicines.

· DURAGESIC is not for patients who need opioid pain medicines for only a short time.This includes the pain that happens with surgery (such as tonsillectomies), medical, or dental procedures (such as wisdom tooth removal).

· DURAGESIC is not for occasional ("as needed") use.

· You should NOT use DURAGESIC® unless you are opioid tolerant. You are opioid tolerant if you have been taking at least 60 milligrams (mg) of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equally strong dose of another opioid for a week or longer before starting DURAGESIC®. If you are unsure if you are opioid-tolerant, discuss this with your health care provider.

· DURAGESIC is only for adults and children 2 years of age or older who have already been using opioid narcotic pain medicines for a week or more. Children should ONLY use DURAGESIC® if they have been taking at least 60 milligrams (mg) of oral morphine daily or at least 30 mg of oral oxycodone daily or at least 8 mg oral hydromorphone daily or an equally strong dose of another opioid for a week or longer before starting DURAGESIC®.

· Do not use the DURAGESIC patch if the seal is broken or the patch is cut, damaged or changed in any way. Using a patch that is cut, damaged, or changed in any way can expose you to the contents of the patch, which contains a potentially fatal dose of medicine.

· Keep DURAGESIC in a safe place away from children. Accidental use by a child is a medical emergency and can result in death. If a child accidentally is exposed to a DURAGESIC patch, call your local Poison Control Center or the nearest emergency room right away.

· DURAGESIC is an opioid (narcotic) pain medicine. There is a chance you could get addicted to DURAGESIC. The chance is higher if you are or have been addicted to or abused other medicines, street drugs, or alcohol, or if you have a history of mental problems.

· Keep your DURAGESIC in a safe place to protect it from being stolen since it can be a target for people who abuse narcotic medicines or street drugs. Never give DURAGESIC to anyone else, even if they have the same symptoms you have. It may harm them and cause death. Selling or giving away this medicine is against the law.

· Some medicines may cause serious or life-threatening side effects when used with DURAGESIC. Talk to your health care provider about all the medicines you are taking.

What is DURAGESIC?

DURAGESIC is a prescription medicine that contains fentanyl. DURAGESIC is a federally controlled substance (CII) because it is a strong opioid narcotic pain medicine that can be abused by people who abuse prescription medicines or street drugs.

DURAGESIC® is only for patients with chronic (around the clock) pain that is moderate to severe and expected to last for weeks or longer.

You should ONLY use DURAGESIC® if you have been taking at least 60 milligrams (mg) of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equally strong dose of another opioid for a week or longer before starting DURAGESIC®.

DURAGESIC is not for patients who need opioid pain medicines for only a short time.This includes the pain that happens with surgery (such as tonsillectomies), medical, or dental procedures (such as wisdom tooth removal).

DURAGESIC is not for occasional ("as needed") use.

DURAGESIC should not be the first opioid (narcotic) pain medicine that is prescribed for your pain.

DURAGESIC is only for opioid tolerant children 2 years of age or older who are already using other opioid narcotic pain medicines. Pediatric patients 2 years of age or older are opioid tolerant if they are taking at least 60 milligrams (mg) of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equally strong dose of another opioid for a week or longer before starting DURAGESIC®.

Who should not use DURAGESIC?

Do not use DURAGESIC:

· If you are NOT already using other opioid narcotic medicines

· If you need opioid pain medicines for only a short time

· For pain from surgery, medical or dental procedures

· If your pain can be taken care of by occasional use of other pain medicines.

· In children who are less than 2 years of age

· In children 2 years of age or older who are not already using other opioid narcotic pain medicines (opioid tolerant).

· If you have acute (sudden) or severe asthma

· If you have a gastrointestinal problem called paralytic ileus

· If you are allergic to any of the ingredients in DURAGESIC®.

What should I tell my health care provider before starting DURAGESIC?

Tell your health care provider about all of your medical problems, especially if you have:

· trouble breathing or lung problems such as asthma, wheezing, or shortness of breath

· a head injury or brain problems

· a heart problem called bradycardia (slow heart beat)

· liver or kidney problems

· seizures (convulsions or fits)

· gallbladder problems

·low thyroid (hypothyroidism)

·low blood pressure

· problems urinating

·major depression

·hallucinations (seeing or hearing things that are not seen by other people)

·adrenal gland problems such as Addison’s disease

·a past or present drinking problem or alcoholism, or a family history of this problem

·a past or present drug abuse or addiction problem, or a family history of this problem

·Have skin reactions to the adhesives (glues) used inDURAGESIC. See the end of this leaflet for a complete list of all the ingredients in DURAGESIC.

Tell your health care provider if you:

·Are pregnant or planning to become pregnant. DURAGESIC may harm your unborn baby.

·Are breast feeding. The medicine in DURAGESIC passes into your milk and can harm your baby.

Some medicines may cause serious or life-threatening side effects when used with DURAGESIC. Tell your health care provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.Sometimes, the doses of certain medicines and DURAGESIC need to be changed when used together. Be especially careful about other medicines that make you sleepy such as other pain medicines, sleeping pills, anxiety medicines, antihistamines, or tranquilizers.

Do not start any new prescription medicine, non-prescription medicine, or herbal supplement while using DURAGESIC until you have talked to your healthcare provider. Your healthcare provider will tell you if it is safe to take other medicines while you are using DURAGESIC.

What should I know about using DURAGESIC in children?

DURAGESIC can be used in children 2 years of age or older only if they are already using other opioid narcotic pain medicines for a week or more. Children should ONLY use DURAGESIC® if they have been taking at least 60 milligrams (mg) of oral morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equally strong dose of another opioid for a week or longer before starting DURAGESIC®.

When DURAGESIC® is used in young children; put the patch on the child’s upper back. This will lower the chances that the child will remove the patch and put it in their mouth.

Keep DURAGESIC in a safe place. Keep DURAGESIC out of the reach of children. Accidental use in children is a medical emergency and can result in death. If a child accidentally takes DURAGESIC, call your local Poison Control Center or go to the nearest emergency room right away.

How do I use DURAGESIC?

· Follow your health care provider’s directions exactly. Your health care provider may change your dose after seeing how the medicine affects you.

· Do not use the DURAGESIC patch if the seal is broken or the patch is cut, damaged or changed in any way. Using a patch that is cut, damaged, or changed in any way can expose you to the contents of the patch, which contains a potentially fatal dose of medicine.

·Do not change your dose or stop using DURAGESIC unless your health care provider tells you to. Do not use DURAGESIC more often than prescribed.

· Do not wear more than one DURAGESIC patch at a time, unless your health care provider tells you to do so.

· Call your health care provider right away if you get a fever higher than 102°F. A fever may cause too much of the medicine in DURAGESIC to pass into your body. Your health care provider may tell you to use a lower dose while you have a fever.

· If you use more DURAGESIC® than your health care provider has prescribed or overdose, get emergency medical help right away.

· If you have concerns about abuse or addiction when using your pain medicine or if you have experienced drug or alcohol abuse or addiction in the past, or have a family history of these problems, talk to your health care provider.

· After you have stopped using a patch, be sure to fold the sticky sides of the patch together and flush it down the toilet. Do not put used DURAGESIC patches in a garbage can.

· If your health care provider tells you to stop using DURAGESIC, throw away the unused packages. Open the unused packages and fold the sticky sides of the patches together, and flush them down the toilet.

What should I avoid while using DURAGESIC?

· Do not use heat sources such as heating pads, electric blankets, heat lamps, saunas, hot tubs, or heated waterbeds. Do not take long hot baths or sun bathe.All of these can make your temperature rise and cause too much of the medicine in DURAGESIC to be released at once and this can be dangerous.

· Do not drink any alcohol while using DURAGESIC.It can increase your chances of having dangerous side effects.

·Do not drive, operate heavy machinery, or do other possibly dangerous activities until you know how DURAGESIC affects you. DURAGESIC can make you sleepy. Ask your health care provider to tell you when it is okay to do these activities.

· Do not stop using DURAGESIC suddenly. Your body can develop a physical dependence on DURAGESIC. If your healthcare provider decides you no longer need DURAGESIC, ask how to slowly reduce this medicine so you don’t have withdrawal symptoms.Do not stop taking DURAGESIC without talking to your healthcare provider. Stopping DURAGESICsuddenly can make you sick with withdrawal symptoms.

· Do not breast feed unless your health care provider tells you it is okay.DURAGESIC passes into your milk and can cause serious problems for your baby.

· Do not take other medicines without talking to your health care provider.Other medicines include prescription and non-prescription medicines, vitamins, and herbal supplements. Be especially careful about other medicines that make you sleepy.

What are the possible side effects of DURAGESIC?

· DURAGESIC can cause serious side effects, including trouble breathing, which can be fatal, especially if used the wrong way. See “What is the most important information I should know about DURAGESIC®?”

Call your healthcare provider right away or get emergency medical help if you:

·Have trouble breathing

·Have extreme drowsiness with slowed breathing

· Have shortness of breath (little chest movement with breathing)

· Feel faint, dizzy, confused, or have other unusual symptoms

These can be symptoms that you have taken too much (overdose) DURAGESIC or the dose is too high for you. These symptoms may lead to serious problems or death if not treated right away.

Some medicines may cause serious or life-threatening side effects when used with DURAGESIC.Talk to your health care provider about all the medicines you are taking.

You can develop physical dependence on DURAGESIC.Stopping DURAGESIC® suddenly can make you sick with withdrawal symptoms. Talk to your healthcare provider about slowly stopping DURAGESIC®.

There is a chance you could get addicted to DURAGESIC. The chance is higher if you are or have been addicted to or abused other medicines, street drugs, or alcohol, or if you have a history of mental problems.

DURAGESIC can cause your blood pressure to drop. This can make you feel dizzy if you get up too fast from sitting or lying down.

The common side effects with DURAGESIC are nausea, vomiting, constipation, dry mouth, sleepiness, confusion, weakness, and sweating. Although uncommon, trouble sleeping and seizures were reported in children. These are not all the possible side effects of DURAGESIC. For a complete list, ask your health care provider or pharmacist.

Constipation (less frequent than usual or hard bowel movements) is a very common side effect of opioids including DURAGESIC and is unlikely to go away without treatment. Talk to your healthcare provider about the use of laxatives (medicines to treat constipation) and stool softeners to prevent or treat constipation while taking DURAGESIC®.

· Talk to your health care provider about any side effect that concerns you.

How and where to apply DURAGESIC

In the hospital, your health care provider or other medical person will apply DURAGESIC for you. At home, you or a member of your family may apply DURAGESIC to your skin. You need to check the patches often to make sure that they are sticking well to the skin. In young children and people who have impaired thinking, put the patch on the upper back. This will lower the chances that the patch will be removed

1. Prepare: For adults, put the patch on the chest, back, flank (sides of the waist), or upper arm in a place where there is no hair. Put it on right away after you have removed it from the pouch and after you have removed the protective liner. Avoid sensitive areas or those that move around a lot. If there is hair, do not shave (shaving irritates the skin). Instead, clip hair as close to the skin as possible. Clean the skin area with clear water only. Pat skin completely dry. Do not use anything on the skin (soaps, lotions, oils, alcohol, etc.) before the patch is applied.

2. Peel: Peel the liner from the back of the patch and throw away. Touch the sticky side as little as possible.

3. Press: Press the patch onto the skin with the palm of your hand and hold there for a minimum of 30 seconds. Make sure it sticks well, especially at the edges.

· Each DURAGESIC patch is sealed in its own protective pouch. Do not remove the DURAGESIC® patch from the pouch until you are ready to use it. When you are ready to put on DURAGESIC, tear open the pouch along the dotted line, starting at the slit, and remove the DURAGESIC patch.

· Do not put the DURAGESIC patch on skin that is very oily, burned, broken out, cut, irritated, or damaged in any way.

· If you have any questions about where on your body you should or should not apply the patch, please ask your health care provider.

· DURAGESIC may not stick to all patients. If the patch does not stick well or comes lose after applying, tape the edges down with first aid tape. If the patch falls off, throw it away and put a new one on at a different skin site.

·Wash your hands when you have finished applying DURAGESIC.

·Remove DURAGESIC after wearing it for 3 days. Choose a different place on the skin to apply a new DURAGESIC patch and repeat Steps 1 through 3. Do not apply the new patch to the same place as the last one.

When to apply DURAGESIC

· You can apply DURAGESIC at any time of the day. Change it at about the same time of day 3 days later or as directed by your health care provider.

· Do not apply the new DURAGESIC patch to the same place where you removed the last DURAGESIC patch.

·Your health care provider may increase your DURAGESIC dose if your pain is not controlled well. If you continue to have pain, call your health care provider.

Water and DURAGESIC

You can bathe, swim or shower while you are wearing DURAGESIC. If the patch falls off, put a new DURAGESIC® patch on your skin. Make sure the new skin area you have chosen is dry before putting on a new DURAGESIC patch.

Disposing of DURAGESIC

· Before putting on a new DURAGESIC patch, remove the patch you have been wearing.

· Fold the used DURAGESIC patch in half so that the sticky side sticks to itself. Flush the used DURAGESIC down the toilet right away. A used DURAGESIC patch may be dangerous for or even lead to death in babies, children, pets, and adults who have not been prescribed DURAGESIC.

·Throw away any DURAGESIC patches that are left over from your prescription as soon as they are no longer needed. Remove the leftover patches from their protective pouch and remove the protective liner.Fold the patches in half with the sticky sides together, and flush the patches down the toilet.Do not flush the pouch or the protective liner down the toilet. These items can be thrown away in a garbage can.

Safety and handling of DURAGESIC

DURAGESIC is a patch with a drug-containing gel sealed inside. This design keeps the gel from getting on your hands or body. If the gel from the drug reservoir accidentally contacts the skin, the area should be washed with large amounts of water. Do not use soap, alcohol, or other solvents to remove the gel because they may increase the drug’s ability to go through the skin.

Do not use the DURAGESIC patch if the seal is broken or the patch is cut, damaged or changed in any way. Using a patch that is cut, damaged, or changed in any way can expose you to the contents of the patch, which contains potentially fatal dose of medicine.

The patch must be used only on the skin of the person for whom it was prescribed. If the patch comes off and accidentally sticks to the skin of another person, take the patch off of that person right away, wash the area with water, and seek immediate medical attention. Call a health care provider or poison control center.

Prevent theft and misuse. DURAGESIC contains an opioid narcotic pain medicine that can be a target for people who abuse prescription medicines. Keep your DURAGESIC in a safe place, to protect it from theft. Never give DURAGESIC to anyone else because it may be dangerous to them. Selling or giving away this medicine is against the law.

How should DURAGESIC be stored?

Store DURAGESIC below 77° F (25° C). Remember, the inside of your car can reach temperatures much higher than this in the summer.

Keep DURAGESIC in its protective pouch until you are ready to use it.

Keep DURAGESIC® in a safe place. Keep DURAGESIC out of the reach of children. Accidental use in children is a medical emergency and can result in death. If a child accidentally takes DURAGESIC®, call your local Poison Control Center or get emergency medical help right away.

General information about the safe and effective use of DURAGESIC

Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. Do not use DURAGESIC for a condition for which it was not prescribed. Do not give DURAGESIC to other people, even if they have the same symptoms you have. DURAGESIC can harm other people and even cause death. Sharing DURAGESIC is against the law.

Keep DURAGESIC out of the reach of children and pets. Accidental use in children and pets is a medical emergency and can result in death. If a child or pet accidentally takes DURAGESIC, call your local Poison Control Center or get emergency medical help right away.

This leaflet summarizes the most important information about DURAGESIC. If you would like more information, talk with your health care provider. You can ask your health care provider or pharmacist for information about DURAGESIC that is written for health professionals.

For questions about DURAGESIC call the JANSSEN Customer Action Center at 1-800-JANSSEN (1-800-526-7736) 9A.M. to 5 P.M. EST, Monday through Friday.

This patient information has been approved by the United States Food and Drug Administration.

What are the ingredients of DURAGESIC?

Active Ingredient: fentanyl

Inactive ingredients: alcohol*, ethylene-vinyl acetate copolymer membrane, hydroxyethyl cellulose, polyester film backing, silicone adhesive.

*Less than 0.2 mL of alcohol is released from the patch during use.

 

Sublimaze Interactions

Agents Affecting Cytochrome P450 3A4 Isoenzyme System

Fentanyl is metabolized mainly via the human cytochrome P450 3A4 isoenzyme system (CYP3A4), therefore potential interactions may occur when DURAGESIC® is given concurrently with agents that affect CYP3A4 activity. Coadminstration with agents that induce 3A4 activity may reduce the efficacy of DURAGESIC®. The concomitant use of transdermal fentanyl with ritonavir or other potent 3A4 inhibitors such as ketoconazole, itraconazole, troleandomycin, clarithromycin, nelfinavir, and nefazadone may result in an increase in fentanyl plasma concentrations. The concomitant use of other CYP3A4 inhibitors such as diltiazem and erythromycin with transdermal fentanyl may also result in an increase in fentanyl plasma concentrations, which could increase or prolong adverse drug effects and may cause serious respiratory depression. In this situation, special patient care and observation are appropriate.

Central Nervous System Depressants

The concomitant use of DURAGESIC® (fentanyl transdermal system) with other central nervous system depressants, including but not limited to other opioids, sedatives, hypnotics, tranquilizers (e.g., benzodiazepines), general anesthetics, phenothiazines, skeletal muscle relaxants, and alcohol, may cause respiratory depression, hypotension, and profound sedation, or potentially result in coma or death. When such combined therapy is contemplated, the dose of one or both agents should be significantly reduced.

MAO Inhibitors

DURAGESIC® is not recommended for use in patients who have received MAOI within 14 days because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.

 

Sublimaze Contraindications

Because serious or life-threatening hypoventilation could occur, DURAGESIC® (fentanyl transdermal system) is contraindicated:

· in patients who are not opioid-tolerant

· in the management of acute pain or in patients who require opioid analgesia for a short period of time

· in the management of post-operative pain, including use after out-patient or day surgeries, (e.g., tonsillectomies)

· in the management of mild pain

· in the management of intermittent pain (e.g., use on an as needed basis [prn])

· in situations of significant respiratory depression, especially in unmonitored settings where there is a lack of resuscitative equipment

· in patients who have acute or severe bronchial asthma

DURAGESIC® (fentanyl transdermal system) is contraindicated in patients who have or are suspected of having paralytic ileus.

DURAGESIC® (fentanyl transdermal system) is contraindicated in patients with known hypersensitivity to fentanyl or any components of this product.

 

Additional information about Sublimaze

Sublimaze Indication: For the treatment of cancer patients with severe pain that breaks through their regular narcotic therapy.
Mechanism Of Action: Opiate receptors are coupled with G-protein receptors and function as both positive and negative regulators of synaptic transmission via G-proteins that activate effector proteins. Binding of the opiate stimulates the exchange of GTP for GDP on the G-protein complex. As the effector system is adenylate cyclase and cAMP located at the inner surface of the plasma membrane, opioids decrease intracellular cAMP by inhibiting adenylate cyclase. Subsequently, the release of nociceptive neurotransmitters such as substance P, GABA, dopamine, acetylcholine and noradrenaline is inhibited. Opioids also inhibit the release of vasopressin, somatostatin, insulin and glucagon. Sublimaze's analgesic activity is, most likely, due to its conversion to morphine. Opioids close N-type voltage-operated calcium channels (OP2-receptor agonist) and open calcium-dependent inwardly rectifying potassium channels (OP3 and OP1 receptor agonist). This results in hyperpolarization and reduced neuronal excitability.
Drug Interactions: Amiodarone Possible bradycardia, hypotension
Amprenavir The protease inhibitor increases the effect and toxicity of fentanyl
Fosamprenavir The protease inhibitor increases the effect and toxicity of fentanyl
Nelfinavir The protease inhibitor increases the effect and toxicity of fentanyl
Indinavir The protease inhibitor increases the effect and toxicity of fentanyl
Saquinavir The protease inhibitor increases the effect and toxicity of fentanyl
Ritonavir Ritonavir increases the effect and toxicity of fentanyl/alfentanyl
Cimetidine Cimetidine increases the effect of the narcotic
Fluconazole The imidazole increases levels/toxicity of fentanyl
Itraconazole The imidazole increases levels/toxicity of fentanyl
Ketoconazole The imidazole increases levels/toxicity of fentanyl
Naltrexone Naltrexone may precipitate a withdrawal syndrome in opioid-dependent individuals
Voriconazole The imidazole increases levels/toxicity of fentanyl
Rifampin Rifampin reduces levels and efficacy of fentanyl/alfentanyl
Food Interactions: Avoid alcohol.
Generic Name: Fentanyl
Synonyms: Fentanila [Inn-Spanish]; Fentanyl citrate; Fentanylum [Inn-Latin]
Drug Category: Anesthetics; Narcotics; Adjuvants; Analgesics; Opiate Agonists
Drug Type: Small Molecule; Illicit; Approved; Investigational

Other Brand Names containing Fentanyl: Actiq; Duragesic; Duragesic-100; Durogesic; Fentanest; Fentanil; Pentanyl; Phentanyl; Sentonil; Sublimaze; Nasalfent;
Absorption: Bioavailability is 92% following transdermal administration and 50% following buccal administration.
Toxicity (Overdose): Fentanyl has an LD50 of 3.1 milligrams per kilogram in rats, and, 0.03 milligrams per kilogram in monkeys. The LD50 in humans is not known.
Protein Binding: 80-85%
Biotransformation: Fentanyl is metabolized primarily via human cytochrome P450 3A4 isoenzyme system.
Half Life: 7 (range 3-12) hours
Dosage Forms of Sublimaze: Liquid Epidural
Solution Epidural
Patch Transdermal
Solution Intramuscular
Chemical IUPAC Name: N-phenyl-N-[1-(2-phenylethyl)piperidin-4-yl]propanamide
Chemical Formula: C22H28N2O
Fentanyl on Wikipedia: https://en.wikipedia.org/wiki/Fentanyl
Organisms Affected: Humans and other mammals