Duragesic, Actiq Oralet, Sublimaze, Ionsys
Classifications: analgesic; narcotic (opiate) agonist;
Therapeutic: narcotic analgesic
; opiate agonist
Prototype: Morphine
Pregnancy Category: C (B for fentanyl injection)
Controlled Substance: Schedule II


0.05 mg/mL injection; 100 mcg, 200 mcg, 300 mcg, 400 mcg lozenges; 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg, 1600 mcg lozenges on a stick; 12 mcg/h, 25 mcg/h, 50 mcg/h, 75 mcg/h, 100 mcg/h transdermal patch


Synthetic, potent narcotic agonist analgesic with pharmacologic actions qualitatively similar to those of morphine, but action is more prompt and less prolonged. Principal actions: analgesia and sedation. Drug-induced alterations in respiratory rate and alveolar ventilation may persist beyond the analgesic effect.

Therapeutic Effect

Provides analgesia for moderate to severe pain as well as sedation.


Short-acting analgesic during operative and perioperative periods, as a narcotic analgesic supplement in general and regional anesthesia, and with droperidol or with diazepam to produce neuroleptanalgesia. Also given with oxygen and a skeletal muscle relaxant (neuroleptoanesthesia) to selected high-risk patients (e.g., those undergoing open heart surgery) when attenuation of the response to surgical stress without use of additional anesthesia agents is important.


Patients who have received MAO INHIBITORS within 14 d; substance abuse; myasthenia gravis; labor and delivery; pregnancy (category C, and category B for fentanyl injection).

Cautious Use

Head injuries, increased intracranial pressure; older adults, debilitated, poor-risk patients; cardiac diseases, angina, hypotension, or cardiac arrhythmias; COPD, other respiratory problems; liver and kidney dysfunction; bradyarrhythmias; children.

Route & Dosage

Adult: IM 50–100 mcg 30–60 min before surgery PO Suck on 400 mcg lozenge until sedated
Child: PO Suck on lozenge until sedated, 10–25 kg, 200 mcg lozenge; 25–35 kg, 300 mcg lozenge; 35–40 kg, 400 mcg lozenge

Adjunct for Regional Anesthesia
Adult: IM/IV 50–100 mcg

General Anesthesia
Adult: IV 2–20 mcg/kg, additional doses of 25–100 mcg as required
Child: IV 1–2 mcg/kg as needed

Postoperative Pain
Adult: IM/IV 50–100 mcg q1–2h prn
Child: IM 1.7–3.3 mcg/kg q1–2h prn

Chronic Pain
Adult: Transdermal Individualize and regularly reassess doses of transdermal fentanyl; for patient not already receiving an opioid, the initial dose is 25 mcg/h patch q3d; for patients already on opioids, see package insert for conversions Stick lozenge (Actiq) Place in mouth between cheek and lower gum and suck on lozenge; should be consumed over 15-min period



PREPARE: Direct: Give parenteral doses undiluted or diluted in 5 mL sterile water or NS.  

ADMINISTER: Direct: Infuse over 3–5 min.  

INCOMPATIBILITIES Solution/additive: Fluorouracil, lidocaine. Y-site: Azithromycin, phenytoin.

  • Store at 15°–30° C (59°–86° F) unless otherwise directed. Protect drug from light.

Adverse Effects (≥1%)

CNS: Sedation, euphoria, dizziness, diaphoresis, delirium, convulsions with high doses. CV: Hypotension, bradycardia, circulatory depression, cardiac arrest. Special Senses: Miosis, blurred vision. GI: Nausea, vomiting, constipation, ileus. Respiratory: Laryngospasm, bronchoconstriction, respiratory depression or arrest. Body as a Whole: Muscle rigidity, especially muscles of respiration after rapid IV infusion, urinary retention. Skin: Rash, contact dermatitis from patch.


Drug: Alcohol and other cns depressants potentiate effects; mao inhibitors may precipitate hypertensive crisis.


Absorption: Absorbed through the skin, leveling off between 12–24 h. Onset: Immediate IV; 7–15 min IM; 12–24 h transdermal. Peak: 3–5 min IV; 24–72 h transdermal. Duration: 30–60 min IV; 1–2 h IM; 72 h transdermal. Metabolism: In liver by CYP3A4. Elimination: In urine. Half-Life: 17 h transdermal.

Nursing Implications

Assessment & Drug Effects

  • Monitor vital signs and observe patient for signs of skeletal and thoracic muscle (depressed respirations) rigidity and weakness.
  • Watch carefully for respiratory depression and for movements of various groups of skeletal muscle in extremities, external eye, and neck during postoperative period. These movements may present patient management problems; report promptly.
  • Note: Duration of respiratory depressant effect may be considerably longer than narcotic analgesic effect. Have immediately available oxygen, resuscitative and intubation equipment, and an opioid antagonist such as naloxone.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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