UNCONTROLLED WHEN PRINTED
Introduction

A short acting synthetic narcotic analgesic

  • Fentanyl: 450mcg in 1.5ml (300mcg/ml); intra-nasal administration only
  • Fentanyl Citrate: 100mcg in 2ml ampoule (50mcg/ml); IV/IO only
  • Fentanyl Citrate: 500mcg in 10ml ampoule (50mcg/ml); IV/IO only

    Pharmacology Review 

    Indications
    • Moderate to severe pain.
    • Acute Coronary Syndromes where GTN has been ineffective
    Contraindications
    • Hypersensitivity to Fentanyl
    • Less than 1 year of age (IV / IO only)
    • Occluded nasal passages or epistaxis (intranasal only)
    Precautions / Notes
    • Elderly patients
    • Respiratory depression: especially those at risk e.g. patients with severe COPD
    • Patients on MAO inhibitors
    • Caution in larger doses of women in active labour
    • Use of IV Ketamine as analgesic prior to minimum (age dependant) dose of IV Fentanyl requires ASMA authorisation:
      • Paediatric: 100mcg
      • Adult < 70 years old: 200mcg
      • Adult > 70 (or frail): 100mcg
    • Administer slowly
    • Cease administration prior to calculated dose if desired effect is obtained.
    • Patients under extended care (e.g. 'ramped' patients) who have already been administered pain relief should have careful consideration with regards to the dosages of fentanyl administered, titrating only to effect.
    Management
    IV / IO Fentanyl Citrate
    • Ramped patients must not have loading doses administered - maintenance doses (max 25mcg IV) to effect as required.

    Adult < 70 years old:

    • Pre-hospital loading dose: Titrate 1mcg/kg slow IV push (maximum single dose: 100mcg)
    • Subsequent dose: 25mcg to effect every 5 minutes

    Adult > 70 years old or frail:

    • Pre-hospital loading dose: Titrate 0.5mcg/kg slow IV push (maximum single dose: 50mcg)
    • Subsequent dose: 25mcg to effect every 5 minutes

    Paediatric:

    • Pre-hospital loading dose: Titrate 1mcg/kg slow IV push (maximum single dose: 25mcg)
    • Subsequent dose: 1mcg/kg (up to 25mcg) to effect every 5 minutes.
    Intranasal Fentanyl
    AgeInitial DoseSubsequent at 5 minutesSubsequent IV Dose if required
    < 20 kg 1 x 0.05ml
    (15mcg)
    1 x 0.05ml
    (15mcg)
    Up to 1mcg/kg titrated to effect every 5 minutes
    (Maximum bolus dose 25mcg each time)
    21 - 30 kg 1 x 0.10ml
    (30mcg)
    1 x 0.10ml
    (30mcg)
    Up to 1mcg/kg titrated to effect every 5 minutes
    (Maximum bolus dose 25mcg each time).
    31 - 40 kg 1 x 0.15ml
    (45mcg)
    1 x 0.15ml
    (45mcg)
    Subsequent dose 25mcg titrated to effect every 5 minutes
    Small / elderly / frail 2 x 0.2ml
    (120mcg)
    1 x 0.2ml
    (60mcg)
    Subsequent dose 25mcg titrated to effect every 5 minutes
    Adult 3 x 0.2ml
    (180mcg)
    1 x 0.2ml
    (60mcg)
    Subsequent dose 25mcg titrated to effect every 5 minutes
    Critical Care Paramedic only
    Analgesia

    Adult:

    • Loading dose: Titrate 1mcg/kg slow IV push (maximum single dose - 100mcg)
    • Subsequent dose: 25-50mcg to affect every 5 minutes

    Infusion to maintain analgesia:

    Adult & Paediatric:

    • 1 to 2mcg/kg/hr, commencing at 1mcg/kg/hr.
    • Using 500mcg in 10ml and 40mL normal saline, dilute up to 500mcg in 50ml (10mcg/ml).

    Rate of infusion for syringe driver

    Dose20kg30kg40kg50kg60kg70kg80kg90kg100kg
    1mcg/kg/hr 2ml/hr3ml/hr4ml/hr5ml/hr6ml/hr7ml/hr8ml/hr9ml/hr10ml/hr
    2mcg/kg/hr 4ml/hr6ml/hr8ml/hr10ml/hr12ml/hr14ml/hr16ml/hr18ml/hr20ml/hr
    Rapid Sequence Induction

    Adult:

    • 1- 3mcg/kg

    Paediatric:

    • 1mcg/kg
    Special Considerations
    • Adopt a low threshold to engage with the ED team if pain remains difficult to control
    • Nausea/vomiting
    • Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
    • Cardiovascular effects:
      • Bradycardia
      • Hypotension (rare)

    References
    References
    Presentation

    Intranasal administration:

    • 450mcg in 1.5mL

    Intravenous/intraosseous administration:

    • 100mcg in 2mL
    • 500mcg in 10mL

    Intravenous Fentanyl

    fentanyl500-10

    INFentBottle

    label-fentanyl
    MUST BE LABELLED
    DILUTION

    Fentanyl Citrate for IV / IO Administration:

    • Dilute 100mcg in 2ml with 8ml NaCl 0/9% to produce10mcg/1ml
    Colour assist:

    Discarding unused medication must be witnessed and countersigned by attendant and credible witness.

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    Head of Clinical Services

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