Table 11

Fentanyl nasal, buccal or sublingual

Fentanyl nasal, buccal or sublingual
What is it?Strong opioid (CD schedule 2)
Mechanism of actionMu agonist
Starting Dose50 (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 effect15–20 min17
FormulationPecfent nasal spray
Instanyl nasal spray
Abstral sublingual tablet
Effentora buccal tablet
IndicationModerate to severe pain for the management of breakthrough, incident or procedural pain
Common adverse effectsAcute respiratory depression, comatose, head injury, raised intracranial pressure
ContraindicationsThose at risk of aspiration
LicenceLicenced product
BenefitsRapidity of onset of action
Ease of nasal administration
RisksLack of familiarity with drug
Lay carer administration
Mucositis when using buccal or sublingual products
CostAbstral—£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