From: Cancer Pain (PDQ®)
PDQ Cancer Information Summaries [Internet].
Bethesda (MD): National Cancer Institute (US); 2002-.
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Table 4. Routes of Fentanyl Administration
| Drug | Starting Dose (µg) | Tmax (median, minutes) | Comments | Evidence |
|---|---|---|---|---|
| Transmucosal fentanyl lozenges (Actiq, generic) | 200 | 20–40 | Lozenge on stick, rubbed against cheek. Sugar content may increase dental caries. | Multiple RCTs showing benefit over placebo and oral morphine. |
| Fentanyl buccal tablet (Fentora) | 100, 200, or 400 | 35–45 | Absorption may be affected by mucositis. Before use, wet mouth if dry. | RCT showing benefit over placebo, and open-label study showing benefit for pain rescue; more rapid than oxycodone. |
| Fentanyl buccal film (Onsolis) | 200 | 60 | Before use, wet mouth if dry. | DB, PC, RCT showing benefit. |
| Fentanyl nasal spray (Lazanda) | 100 | 15–21 | Vial contains residual fentanyl when empty, requiring special disposal. Do not use with decongestant sprays. | DB, PC, RCT showed benefit. Open-label RCT showed benefit over transmucosal fentanyl and oral morphine. |
| Fentanyl sublingual spray (Subsys) | 100 | 40–75 | Contains residual fentanyl when empty, requiring special disposal. | Open-label and PC RCT showing benefit. |
| Fentanyl sublingual tablet (Abstral) | 100 | 30–60 | Absorption may be affected by mucositis. Before use, wet mouth if dry. | Multiple PC RCTs showing benefit. |
DB = double blinded; PC = placebo controlled; RCT = randomized controlled trial; Tmax = time to maximum blood concentration.