Fentanyl nasal, buccal or sublingual
| Fentanyl nasal, buccal or sublingual | |
| What is it? | Strong opioid (CD schedule 2) |
| Mechanism of action | Mu agonist |
| Starting Dose | 50 (instanyl) to 100 mg (pecfent, abstral and efentora) A further 50 or 100 mg after 15–30 min if required Maximum two doses per pain episode Dose titration as per manufacturer’s guidance |
| Time to onset of effect | 15–20 min17 |
| Formulation | Pecfent nasal spray Instanyl nasal spray Abstral sublingual tablet Effentora buccal tablet |
| Indication | Moderate to severe pain for the management of breakthrough, incident or procedural pain |
| Common adverse effects | Acute respiratory depression, comatose, head injury, raised intracranial pressure |
| Contraindications | Those at risk of aspiration |
| Licence | Licenced product |
| Benefits | Rapidity of onset of action Ease of nasal administration |
| Risks | Lack of familiarity with drug Lay carer administration Mucositis when using buccal or sublingual products |
| Cost | Abstral—£49.99 for 10×100 mg sublingual tablets; Effentora—£139.72 for 28×100 mg buccal tablets; Instanyl—£35.70 for 6× doses nasal spray 100 mg/dose; Pecfent—£36.48 for 8× doses nasal spray 100 mg/dose. |
CD - Controlled Drug