Fentanyl is a very strong opium-like  painkiller that falls under the Narcotics Act in Germany. Due to its high analgesic and sedative effect, the opioid is used intravenously as an anesthetic, especially during operations. Because of its fast-acting effect, fentanyl is also used in emergency medicine. As a transdermal therapeutic system (TTS), the fentanyl patch is used as a pain patch in patients who regularly need painkillers.

Fentanyl Patch: Dosage and Side Effects

The fentanyl patch is characterized by fewer side effects than oral intake because the  active ingredient  is absorbed through the blood and not through the stomach. Fentanyl patches act directly on the affected area, such as  osteoarthritis . Heat exposure should be avoided during treatment with a fentanyl patch, and the pain patches should be changed every 72 hours. Nevertheless, according to the WHO, pain patches with fentanyl are among the strongest painkillers and should not be used lightly.

Fentanyl nasal spray for breakthrough pain

A newer dosage form is a nasal spray that came onto the market in 2009. Cancer patients in particular benefit from the fentanyl nasal spray. In contrast to fentanyl lozenges or lollipops, the analgesic effect is achieved more quickly with the nasal spray, since the active ingredient can be absorbed particularly well through the  nasal mucosa  – a disadvantage sometimes arises from dry air and the associated dry mucous membranes. The   dosage of fentanyl nasal spray also proves to be problematic in the case of a cold .

The drug reaches its high effect quickly, but does not last long, which corresponds to the property of the breakthrough pain that sets in quickly, but usually only lasts for a short time. Due to its easy handling, the fentanyl nasal spray received 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 the pain relief, many patients also appreciate the strong calming effect of fentanyl – a reason why it is also used in dentistry from time to time.

Fentanyl: dosage and effect

Fentanyl is about a hundred times more effective than morphine and its side effects are roughly the same as those of morphine. Any dosage form must be done under medical supervision. Particular attention should be paid to the dosage of fentanyl, since an increased dose can lead to respiratory depression and, in the worst case, death. Due to the effect of fentanyl on the respiratory center, therapy should be monitored regularly, especially at the beginning, for the purpose of correct adjustment.

Fentanyl: side effects

The most common side effects include  fatigueconstipation , sweating, anxiety or euphoria,  nausea ,  and vomiting. Decreased heart rate or muscle spasms can also occur as side effects of fentanyl. The most severe side effects are associated with overdosing or abuse.

If the fentanyl patch is used improperly, it can lead to serious side effects and even death, as the US Food and Drug Administration has been warning about this since 2005. In 2009 alone, 397 deaths are said to have occurred in the United States.

Fentanyl: Withdrawal and Dependence

Fentanyl is also known as “super heroin” in the USA. The calming effect can lead to altered perception and sleep-like states. There is a risk of rapid and severe dependence. Users risk their lives with each injection because the dosage of the drug is difficult to control. The already extremely strong effect of fentanyl is also difficult to predict after further development into a designer drug.

In addition to serious side effects, there are also severe symptoms during withdrawal. Caution: It is not only abuse that leads to dependence and may require withdrawal after cessation or sudden discontinuation of therapy; patients – for example with  cancer  – who used the fentanyl patch or the fentanyl nasal spray reported severe side effects and a variety of symptoms associated with withdrawal.

Typical symptoms such as anxiety, shivering,  diarrhea , nausea and vomiting occur during the so-called cold turkey, the seamless transition from a high dosage to complete abstinence. Similar to heroin, the substitute drug methadone is sometimes used in fentanyl withdrawal. Due to the extremely strong effect, side effects and risks, the use of fentanyl for medicinal purposes should be carefully considered.


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