Alfentanil buccal, sublingual or nasal
| Alfentanil buccal, sublingual or nasal | |
| What is it? | Strong opioid analgesic—CD schedule 2 drug |
| Mechanism of action | Opioid having central agonist effect |
| Dose | 10%–16% of the total CSCI dose hourly prn |
| Time to onset of effect | 5 min17 |
| Formulation | Nasal spray with attachment for buccal/SL use (5 mg/5 mL) bottle available as special order from Torbay Hospital Manufacturing Unit Tel: 01803 664 707. Each ‘spray’ delivers 0.14 mL=140 μg alfentanil OR Injection preparation given via buccal, sublingual or nasal route. Two strengths available, 500 μg/mL and 5 mg/mL |
| Indication | Moderate to severe pain for the management of breakthrough, incident or procedural pain when eGFR <20 |
| Common adverse effects | Apnoea; chills; fatigue; hypertension; movement disorders; muscle rigidity; procedural complications16 |
| Contraindications | Avoid or use a reduced dose in hepatic failure17 |
| Licencing | Nasal spray is an unlicensed product Injection is licensed but a transmucosal route is ‘off label’ |
| Benefits | Rapidity of onset of action Ease of nasal administration |
| Risks | Prescribing/administration error Lack of familiarity with drug Lay carer administration Lack of availability Cost Unrecognised hepatic failure |
| Cost | Special—price on application |
CD - Controlled Drug
CSCI - continuous subcutaneous infusion; SL - sublingual; eGFR - estimated Glomerular Filtration Rate