Lazanda, Fentanyl Citrate, Fentora, Actiq
Fentanyl Citrate Transmucosal
Fentanyl (FEN ta nil) is a generic medication prescribed for severe pain in certain people and pain relief with anesthesia. Fentanyl belongs to a group of drugs called opioid pain relievers.
Fentanyl (FEN ta nil) is a generic medication prescribed for severe pain in certain people and pain relief with anesthesia. Fentanyl belongs to a group of drugs called opioid pain relievers.
- Generic
- • Lozenge on a Handle
- • 200mcg
- • 30 Lozenges
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Intro
Introduction
Written by Sarah Lewis, PharmD
Medically reviewed by Amber Watson, PharmD
Updated on August 30, 2023
Fentanyl (FEN ta nil) is a generic medication prescribed for severe pain in certain people and pain relief with anesthesia. Fentanyl belongs to a group of drugs called opioid pain relievers.
The Food and Drug Administration (FDA) has approved fentanyl for:
- cancer pain in opioid-tolerant people (Tolerance means you’re already taking another opioid, but it isn’t working to manage your pain any longer.)
- pain relief before, during, or immediately after anesthesia
- severe chronic (long-term) pain that requires around-the-clock pain relief, in opioid-tolerant people
These approved uses differ based on the form of fentanyl your doctor prescribes.
This article doesn’t provide coupons for all forms of fentanyl. To find coupons for fentanyl transdermal patch, see this article.
Boxed warnings
Fentanyl has boxed warnings, which are the most serious warnings from the FDA. These include:
- risk of misuse and addiction with fentanyl transdermal patch, lozenge, and injection
- risk of serious or fatal respiratory depression with fentanyl transdermal patch, lozenge, and injection
- risk of fatal overdose due to accidental exposure, especially in children, with fentanyl transdermal patch and lozenge
- risk of neonatal opioid withdrawal syndrome with fentanyl transdermal patch and lozenge
- risk of fatal overdose due to drug interactions with fentanyl transdermal patch, lozenge, and injection
- risk of fatal overdose due to increased absorption from external heat sources with fentanyl transdermal patch
- risk of fatal overdose when switching from other forms of fentanyl with fentanyl lozenge
For details, see the “Interactions and warnings for fentanyl” section.
Uses
Uses of fentanyl
The Food and Drug Administration (FDA) approves prescription drugs such as fentanyl for certain conditions. Approved uses for fentanyl are described below. These uses differ based on the form of fentanyl prescribed.
Use for severe chronic pain
Doctors may prescribe fentanyl transdermal patch for treating severe chronic (long-term) pain that requires around-the-clock pain relief, in opioid-tolerant people. It’s used for this purpose in adults and children ages 2 years and older. It’s usually prescribed as a long-term treatment.
With opioid tolerance, people have already been taking another opioid pain reliever. But their bodies have adjusted to the effects of the other opioid, and it no longer works to relieve their pain. Applying fentanyl transdermal patch can help manage their pain.
Fentanyl transdermal patch can be prescribed along with other pain relievers, as needed.
Doctors may not prescribe fentanyl transdermal patch in certain situations, such as when:
- other pain relieving treatments are likely to work
- you aren’t tolerant to opioids or are new to opioid therapy
- you have mild pain, postoperative pain (pain after a surgical procedure), pain that isn’t chronic, or pain that comes and goes
- you have a higher risk of serious respiratory depression
- you have or may have a blockage in your digestive system
- you have severe asthma
Use for pain during cancer treatment
Doctors may prescribe fentanyl lozenge for treating breakthrough cancer pain in opioid-tolerant people. It’s used for this purpose in adults and children ages 16 years and older. It’s usually prescribed as a long-term treatment.
With breakthrough cancer pain, medication manages most of the pain people experience. But at certain times or with certain activities, the pain gets worse. Fentanyl lozenge can help with these periods of pain in people who are already taking opioids and are tolerant to them.
Fentanyl lozenge must be prescribed together with other around-the-clock opioid pain relievers.
Doctors may not prescribe fentanyl lozenge in certain situations, such as when you:
- aren’t tolerant to opioids
- aren’t on around-the-clock opioid pain relievers
- have mild pain, postoperative pain, or temporary pain, such as headache or dental pain
- have a higher risk of serious respiratory depression
- have or may have a blockage in the digestive system
- have severe asthma
Use for anesthesia
Doctors may prescribe fentanyl injection for helping with anesthesia. It’s used for this purpose in adults and children ages 2 years and older. It’s usually prescribed as a short-term treatment.
With anesthesia, doctors use a combination of drugs during surgery or procedures. The goals of anesthesia can include relieving pain, keeping you from remembering the surgery or procedure, and possibly putting you into a deep sleep. Fentanyl injection is a drug doctors can use for these goals.
Fentanyl injection is prescribed along with various other anesthesia drugs.
Side effects
Side effects of fentanyl
Fentanyl may cause mild or serious side effects. More common mild side effects of fentanyl and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.
To learn more about fentanyl’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for fentanyl listed in the “Resources” section.
Mild side effects
More common mild side effects reported with some forms of fentanyl are listed below. These side effects may differ based on the form of fentanyl you take.
This article doesn’t include all possible mild side effects of the drug. To learn more about fentanyl’s side effects based on the form, refer to the prescribing information for fentanyl listed in the “Resources” section.
With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.
Fentanyl lozenge’s mild side effects include:
- dizziness
- asthenia (body weakness)
- nausea or vomiting
- sleepiness
- mild allergic reaction*
Fentanyl transdermal patch’s mild side effects include:
- constipation
- dizziness
- nausea or vomiting
- sleepiness or sleep problems
- mild allergic reaction*
* For details about this side effect, see the “Interactions and warnings for fentanyl” section.
Serious side effects
Serious side effects of fentanyl are listed below. These side effects may differ based on the form of fentanyl you take.
This article doesn’t include all possible serious side effects of the drug. To learn more about fentanyl’s side effects based on the form, refer to the prescribing information for fentanyl listed in the “Resources” section.
With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.
In general, fentanyl’s serious side effects include:
- adrenal insufficiency (when the adrenal glands don’t make enough of the hormone cortisol)
- impaired mental or physical abilities
- serotonin syndrome (too much of the chemical serotonin in the body, which can be life threatening)
- severe low blood pressure leading to fainting
- slow heart rate
- boxed warnings:
- risk of misuse and addiction*
- risk of serious or fatal respiratory depression*
- risk of fatal overdose due to accidental exposure, especially in children*
- risk of neonatal opioid withdrawal syndrome*
- risk of fatal overdose due to drug interactions*
- risk of fatal overdose due to increased absorption from external heat sources*
- risk of fatal overdose when switching from other forms of fentanyl*
- severe allergic reaction*
* For details about this side effect, see the “Interactions and warnings for fentanyl” section.
Interactions and warnings
Interactions and warnings for fentanyl
Below, you’ll find information about fentanyl’s possible interactions and warnings.
Interactions of fentanyl
Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.
Before you take fentanyl, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:
- prescription or over-the-counter drugs
- vitamins, herbs, or supplements
To learn about drug-condition interactions, see the “Warnings for fentanyl” section below.
Warnings for fentanyl
Some people should not take fentanyl, and others should take it cautiously.
Boxed warnings
Fentanyl has boxed warnings, which are the most serious warnings from the Food and Drug Administration (FDA).
To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.
Risk of misuse and addiction with all forms of fentanyl. With misuse, a person uses fentanyl in a way other than how a doctor prescribes it. Misuse can lead to addiction, which is continuing to use a drug even though it may be causing harm.
Symptoms of addiction may include craving the drug and taking the drug to cope.
If you experience misuse or addiction, tell your doctor. They’ll likely recommend ways to get help.
Risk of serious breathing problems with all forms of fentanyl. With serious breathing problems, you have slowed or stopped breathing. Another name for this is respiratory depression. In some cases, it can be fatal.
The risk is highest when you first start fentanyl and after a dosage increase. Older adults (age 65 years and older) also have a higher risk.
If you experience serious breathing problems, seek immediate medical care or call 911.
Risk of fatal overdose due to accidental exposure with fentanyl patch and lozenge. With accidental exposure, you accidentally apply or ingest fentanyl. This can lead to an overdose, which can be fatal. Accidental exposure to fentanyl can be especially dangerous in children.
Symptoms may include slowed breathing, small pupils, cold and clammy skin, extreme sleepiness, and coma.
If you experience an accidental exposure, seek immediate medical care or call 911.
Risk of neonatal opioid withdrawal syndrome with fentanyl patch and lozenge. With neonatal opioid withdrawal syndrome, a newborn has side effects after they’re no longer exposed to the fentanyl their body became dependent on in the womb.
Symptoms may include a high-pitched cry, tremor, vomiting, and diarrhea in the newborn baby. Certain withdrawal symptoms can be fatal.
If you become pregnant during treatment with fentanyl, tell your doctor. They’ll help you decide if you should continue taking it.
Risk of fatal overdose due to drug interactions with all forms of fentanyl. With certain drug interactions, dangerously high levels of fentanyl can occur. This can lead to a fatal overdose. Examples of interacting drugs include other central nervous system (CNS) depressants and drugs that affect how your body processes and gets rid of fentanyl. CNS depressants slow brain activity. Benzodiazepines, alcohol, and many other drugs are CNS depressants.
Symptoms of CNS depression may include serious side effects, such as slowed breathing or seizures. It could also cause withdrawal symptoms, such as anxiety, nausea, vomiting, or diarrhea.
If you have concerns about drug interactions with fentanyl, talk with your doctor. They’ll likely recommend adjusting your treatment.
Risk of fatal overdose due to increased absorption from external heat sources with fentanyl patch. With increased absorption from external heat sources, your body absorbs more fentanyl from the patch. This can lead to high levels of fentanyl in your body, which can be fatal. Examples of external heat sources include heating pads, electric blankets, tanning lamps or beds, sunbathing, saunas, hot tubs, and hot baths.
Having a fever or overheating due to physical activity may also cause high levels of fentanyl.
Symptoms may include slowed breathing, small pupils, cold and clammy skin, extreme sleepiness, and coma.
If you experience any of these symptoms while taking fentanyl, seek immediate medical care or call 911.
Risk of fatal overdose when switching from other forms of fentanyl with fentanyl lozenge. With switching from one form of fentanyl to the lozenge, the dosage may be different from other fentanyl medications you may have been taking. This is because the lozenge contains a different amount of fentanyl than other dosage forms. Only take the dosage prescribed by your doctor. Taking other dosages can result in a fatal overdosage.
Symptoms may include slowed breathing, small pupils, cold and clammy skin, extreme sleepiness, and coma.
If you experience any of these symptoms, seek immediate medical care or call 911.
Other warnings
Fentanyl could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether fentanyl is a safe option for you. These warnings may differ based on the form of fentanyl you use.
Ask your doctor about specific warnings for fentanyl, and be sure to tell your doctor about your:
- current health, including any allergies to medications
- past health conditions or surgeries
Allergic reaction
Fentanyl can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.
If you’ve had an allergic reaction to fentanyl or any of its ingredients, your doctor will likely not prescribe fentanyl. They can tell you about medications that are safer options for you.
A mild allergic reaction may cause the following symptoms:
A severe allergic reaction may cause the following symptoms:
- swelling under your skin, usually in your hands, feet, eyelids, or lips
- swelling of your mouth, throat, or tongue, which can cause breathing problems
If you have an allergic reaction to fentanyl, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.
Overdose of fentanyl
If you use fentanyl, you should not use more fentanyl than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.
If you think you’ve used too much fentanyl, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.
Pregnancy or breastfeeding and fentanyl
Information about fentanyl and pregnancy and breastfeeding is described below.
Fentanyl and pregnancy
There are risks to using fentanyl during pregnancy. But there are also risks with having unmanaged pain while pregnant. (Keep in mind that fentanyl is prescribed for managing pain.)
If you’re planning a pregnancy or can become pregnant, talk with your doctor about pain treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether or not you should take fentanyl during pregnancy.
Boxed warning: risk of neonatal opioid withdrawal syndrome
With neonatal opioid withdrawal syndrome, a newborn has side effects after they’re no longer exposed to the fentanyl their body became dependent on in the womb.
Symptoms may include a high-pitched cry, tremor, vomiting, and diarrhea in the newborn baby. Certain withdrawal symptoms can be fatal.
If you become pregnant during treatment with fentanyl, tell your doctor. They’ll help you decide if you should continue taking it.
Fentanyl and breastfeeding
Fentanyl should not be used while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before using this medication. Your doctor may recommend other ways to feed your child during treatment with fentanyl.
FAQs
Common questions about fentanyl
Below you’ll find answers to a few commonly asked questions about fentanyl.
Is fentanyl safe for older adults?
Yes, fentanyl can be safe for older adults (age 65 years and older). But older adults may have a higher risk of side effects, including serious side effects, than younger adults. The main risk for older adults is respiratory problems or respiratory depression (slowed or stopped breathing). Due to this risk, doctors typically prescribe lower doses and increase dosages more slowly in older adults.
If you’re an older adult and you have concerns about using fentanyl, talk with your doctor.
How does fentanyl work? And how long does it take to start working?
Fentanyl works by binding to opioid receptors in the brain and spinal cord. (Receptors are sites on cells where drugs and proteins can attach.) This causes the pain relieving effects of fentanyl.
How long it takes fentanyl to start working depends on the dosage form. Fentanyl transdermal patch will start to work gradually. It usually reaches peak effects in about 12–24 hours. Fentanyl lozenge will begin to work very quickly, usually within 15–30 minutes. Fentanyl injection will start to work immediately.
If you’d like to know more about this, talk with your doctor or pharmacist.
Ask your doctor
What to ask your doctor
Let your doctor know if you have questions about fentanyl or would like more details about it.
Here’s a list of some possible questions you may want to ask your doctor:
- How should I take fentanyl?
- Am I at higher risk of side effects from fentanyl than other people?
- How does fentanyl compare to other pain relieving options?
Resources
Resources
- Fentanyl citrate injection, solution. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/a13ae145-5c5e-422b-d0a5-6cf34c1b8262/spl-doc
- Fentanyl citrate lozenge. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/552ba162-76ed-4bc9-8c2c-fac7a1804da0/spl-doc
- Fentanyl patch, extended release. (2022). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/529836fc-527c-45d8-a318-ab5513c053fe/spl-doc
- Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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