fentanyl citrate at a glance
Medicine class
Potent opioid analgesic acting mainly at mu-opioid receptors.
Available forms
Hospital injection, sublingual tablet and nasal spray.
What is fentanyl citrate used for?
Licensed uses represented by selected products include:
Analgesia during surgery, including when assisted ventilation is used.
Treatment of severe pain with injectable fentanyl in an appropriately monitored clinical setting.
Use with a neuroleptic for neuroleptanalgesia and treatment of severe pain such as myocardial-infarction pain for Sublimaze.
Breakthrough pain in adults with chronic cancer pain who are already established on regular opioid therapy, using Abstral sublingual tablets or PecFent nasal spray.
How does fentanyl citrate work?
Fentanyl activates mu-opioid receptors in the brain and spinal cord, reducing pain transmission and perception. This action can also suppress breathing, slow gastrointestinal movement and cause sedation.
fentanyl citrate preparations and strengths
Nasal preparation
Route: Nasal
Strengths: 100 micrograms, 400 micrograms
Injection
Route: Parenteral
Strengths: 50 micrograms/mL
Sublingual tablet
Route: Sublingual
Strengths: 100 micrograms, 200 micrograms, 300 micrograms, 400 micrograms, 600 micrograms, 800 micrograms
How to take fentanyl citrate
Use only the prescribed formulation and follow its specific instructions. Injectable products must be administered by trained professionals where the airway can be controlled.
Place an Abstral tablet deep under the tongue and let it dissolve completely without chewing, sucking or swallowing it. Do not eat or drink until it has dissolved; water may be used beforehand to moisten a dry mouth.
Prime PecFent as directed. Hold the bottle upright, place the nozzle just inside the nostril and confirm delivery using the click and counter; the spray may not be felt. Do not blow the nose immediately afterwards.
Return PecFent to its child-resistant container after use. Keep all fentanyl securely away from children and other people, and return unwanted supplies to a pharmacy.
fentanyl citrate side effects
Common or expected effects
- Constipation
- Feeling or being sick
- Sleepiness or tiredness
- Dizziness or vertigo
- Headache
- Confusion
- Dry mouth
- Itching or rash
- Mouth irritation with sublingual products or nasal symptoms with nasal spray
Get urgent medical advice
- Slow, shallow or stopped breathing
- Extreme sedation, reduced consciousness or coma
- Seizure
- Severe allergic reaction
- Marked low blood pressure or fainting
- Severe muscle rigidity affecting breathing
- Serotonin syndrome, which may include agitation, fever, sweating, diarrhoea, muscle rigidity or overactive reflexes
fentanyl citrate in pregnancy
Evidence about fentanyl in pregnancy is limited, so specialist assessment is needed. Exposure near delivery can suppress the newborn's breathing, while repeated exposure during pregnancy may cause neonatal opioid withdrawal. Maternity and neonatal teams should be informed.
fentanyl citrate interactions
Fentanyl has important sedative and metabolic interactions. Check all prescribed, non-prescribed and herbal products.
Benzodiazepines and other sedatives
Additive sedation and respiratory depression can lead to coma or death; combined use requires clear clinical justification and close monitoring.
Alcohol
Increases drowsiness and the risk of serious central-nervous-system and breathing effects.
Common questions about fentanyl citrate
Answers are fully visible for fast scanning and source review.
Is fentanyl citrate the same as fentanyl?
Fentanyl citrate is the salt used in these products; fentanyl is the active opioid responsible for the clinical effects.
Who can use it for breakthrough cancer pain?
Abstral and PecFent are for adults with otherwise controlled chronic cancer pain who are already established on regular opioid therapy. They are contraindicated without maintenance opioid treatment.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.