フェンタニル

使用用途

• Perioperative pain
• Pain management
• Surgical analgesia
• Analgesia
• Induction
• MAC reduction during general anesthesia
• Severe to excruciating pain in the emergent patient
• Epidural for pain control
• Maintenance analgesia/heavy sedation in critically ill hypotensive animals
• Transdermal Analgesia
• Intraoperative analgesia
• Postoperative analgesia
• Postoperative or chronic pain
• Transdermal Analgesia (17-25 kg)

投与方法

考えられる副作用

• Dose-related respiratory depression
• CNS depression (sedation)
• Circulatory depression (bradycardia)
• Dysphoria or agitation (especially in cats)
• Urine retention
• Constipation
• Contact dermatitis/rash at patch site
• Altered thermoregulation (hypothermia or hyperthermia)
• Respiratory depression
• Severe bradycardia
• Asystole (with rapid IV injection)
• Reduction in heart rate

注意事項と禁忌

• Known hypersensitivity to fentanyl or patch adhesive
• Conditions where additional respiratory or CNS depression would be deleterious
• No specific contraindications available in the monograph (use with caution in patients with respiratory compromise)
• **Patient Selection:** Use with extreme caution in geriatric, severely ill, or debilitated patients, and those with preexisting respiratory compromise. **Transdermal Patch Warnings:** * **Heat Exposure:** Do NOT allow the applied patch to be exposed to exogenous heat sources (e.g., heating pads, heated cages, direct sunlight). Heat significantly increases drug release and absorption, which has resulted in fatal overdoses. * **Fever:** Febrile patients may have increased absorption of fentanyl and require intense monitoring. Consider removing the patch if a fever develops. * **Patch Integrity:** Do NOT cut patches unless specifically advised by a pharmacist (cutting alters the drug-releasing membrane of gel-reservoir patches, leading to rapid, uncontrolled drug release). * **Variable Absorption:** Absorption is highly variable. Always have injectable rescue analgesia available. **Feline Specifics:** Opioids may cause mydriasis (dilated pupils) in cats. Approach slowly to avoid startling them, and keep them out of bright light. **Laboratory Alterations:** Opiates can increase biliary tract pressure, potentially elevating plasma amylase and lipase values for up to 24 hours post-administration.

薬物相互作用

• Azole Antifungals (ketoconazole, itraconazole, fluconazole): May inhibit fentanyl metabolism, increasing risk of toxicity
• CNS Depressants (other): Additive CNS and respiratory depressant effects
• Diuretics: Opiates may decrease diuretic efficacy in congestive heart failure patients
• Macrolide Antibiotics (erythromycin, clarithromycin): May inhibit fentanyl metabolism
• Monoamine Oxidase Inhibitors (amitraz, selegiline): Severe and unpredictable opiate potentiation; generally not recommended within 14 days of MAOI use
• Skeletal Muscle Relaxants: Fentanyl may enhance neuromuscular blockade
• Nitrous Oxide: High fentanyl doses combined with nitrous oxide may cause cardiovascular depression
• Phenobarbital, Phenytoin: May increase the metabolism of fentanyl, reducing its efficacy
• Rifampin: May increase the metabolism of fentanyl
• Tricyclic Antidepressants (clomipramine, amitriptyline): Fentanyl may exacerbate the effects of tricyclic antidepressants

よくある質問