A short acting synthetic narcotic analgesic
- Fentanyl: 450 microg/1.5 mL (300 microg/mL); intra-nasal administration only
- Fentanyl Citrate: 100 microg/2 mL ampoule (50 microg/mL); IV/IO only
- Fentanyl Citrate: 500 microg/10 mL ampoule (50 microg/mL); IV/IO only
- Moderate to severe pain.
- Acute Coronary Syndromes where GTN has been ineffective
- Hypersensitivity to fentanyl
- Child <1 year of age (for IV / IO only)
- Occluded nasal passages or epistaxis (for IN only)
- Elderly patients
- Respiratory depression: especially those at risk e.g. patients with severe COPD
- Patients currently on MAO inhibitors or MAO inhibitor use within previous 14 days
- 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: 100 microg
- Adult < 70 years old: 200 microg
- Adult > 70 (or frail): 100 microg
- 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.
Fentanyl Citrate for IV / IO Administration:
- Dilute 100microg in 2mL with 8mL NaCl 0.9% to produce 10microg/1mL
| kg | ||
| Mode: | ||
| Weight: | ||
IN Fentanyl
Presentation: 450mcg:1.5mLSubsequent dose: in
IV Fentanyl Citrate
Presentation: 100mcg:10mLIV Fentanyl for Rapid Sequence Induction
Presentation: /mLCalculated dose: in to in
IV Fentanyl infusion to maintain analgesia
Presentation: /mLCalculated dose: to per hour ( to )
- Ramped patients must not have loading doses administered - maintenance doses (maximum 25 microg) to effect as required.
Adult < 70 years old:
- Pre-hospital loading dose: titrate 1 microg/kg, slow push over 3-5 minutes (maximum single dose: 100 microg)
- Subsequent dose: 25 microg to effect every 5 minutes, titrated to effect
Adult > 70 years old or frail:
- Pre-hospital loading dose: titrate 0.5 microg/kg slow push over 3-5 minutes (maximum single dose: 50 microg)
- Subsequent dose: 25 microg to effect every 5 minutes, titrated to effect
Paediatric:
- Pre-hospital loading dose: titrate 0.5-1 microg/kg, slow push over 3-5 minutes (maximum single dose: 25 microg)
- Subsequent dose: 1 microg/kg (up to 25 microg) every 5 minutes, titrated to effect
| Weight | Initial Dose | Subsequent at 5-10 minutes | Subsequent IV Dose if required |
|---|---|---|---|
| < 20 kg | 1 x 0.05 mL (15 microg) | 1 x 0.05 mL (15 microg) | Up to 1 microg/kg titrated to effect every 5 minutes (Maximum bolus dose 25 microg each time) |
| 21 - 30 kg | 1 x 0.10 mL (30 microg) | 1 x 0.10 mL (30 microg) | Up to 1 microg/kg titrated to effect every 5 minutes (Maximum bolus dose 25 microg each time). |
| 31 - 40 kg | 1 x 0.15 mL (45 microg) | 1 x 0.15 mL (45 microg) | Subsequent dose 25 microg titrated to effect every 5 minutes |
| Small / elderly / frail | 2 x 0.2 mL (120 microg) | 1 x 0.2 mL (60 microg) | Subsequent dose 25 microg titrated to effect every 5 minutes |
| Adult | 3 x 0.2 mL (180 microg) | 1 x 0.2 mL (60 microg) | Subsequent dose 25 microg titrated to effect every 5 minutes |
Subsequent IN dosages can be administered every 5-10minutes, titrated to effect.
Adult:
- Loading dose: titrate 1 microg/kg, slow push over 3-5 minutes (maximum single dose - 100 microg)
- Subsequent dose: 25-50 microg every 5 minutes, titrated to effect
Infusion to maintain analgesia:
Adult & Paediatric:
- 1 to 2 microg/kg/hr, commencing at 1 microg/kg/hr
- Use 500 microg in 10 mL ampoule and 40 mL sodium chloride 0.9% to create a solution with a concentration of 500 microg in 50 mL (10 microg/mL)
Rate of infusion for syringe driver
| Dose | 20 kg | 30 kg | 40 kg | 50 kg | 60 kg | 70 kg | 80 kg | 90 kg | 100 kg |
|---|---|---|---|---|---|---|---|---|---|
| 1 microg/kg/hr | 2 mL/hr | 3 mL/hr | 4 mL/hr | 5 mL/hr | 6 mL/hr | 7 mL/hr | 8 mL/hr | 9 mL/hr | 10 mL/hr |
| 2 microg/kg/hr | 4 mL/hr | 6 mL/hr | 8 mL/hr | 10 mL/hr | 12 mL/hr | 14 mL/hr | 16 mL/hr | 18 mL/hr | 20 mL/hr |
Adult:
- 1- 3 microg/kg IV, slow push over 3-5 minutes
Paediatric:
- 1 microg/kg IV, slow push over 3-5 minutes
- Adopt a low threshold to engage with the ED team if pain remains difficult to control
- Drowsiness
- Nausea/vomiting
- Respiratory depression; monitor pulse oximetry for all patients having IV / IN Fentanyl
- Cardiovascular effects:
- Bradycardia
- Hypotension (rare)
Intranasal administration:
- 450 microg/1.5mL
Intravenous/intraosseous administration:
- 100 microg/2 mL
- 500 microg/10 mL
| MUST BE LABELLED |
| Settings | |
|---|---|
| Current mode: | |
| Extended Care: | |
| Colour assist: | |
Discarding unused medication must be witnessed and countersigned by attendant and credible witness.
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