Sufenta

stevierae · Dec 5, 2003

Originally posted by Jake
Thank you Tenesma.

The rest of you seem arrogant and judgmental. I'm a student and was up studying when I had the question. Not having anyone around to ask, I turned to this message board. I have looked in all of my books and there was no mention of a SQ or IM route. I even googled it and every link I could find never mentioned any pros or cons of IM. There were several on giving it to children through the nasal mucosa for anxiety/sedation in the ER.

So, again thanks Tenesma.

Jake

I'm sorry for my own catty remark, Jake. I have seen 3 anesthesiologists die from Fentanyl or Sufentanil overdoses--AFTER they went through rehab. It's a dangerous drug, and usually only used in OR settings--hence our wondering why anybody would use it any other way (I am an OR nurse.) I've also known of several thefts of Fentanyl, right off anesthesia carts, back when people used to leave pre-filled and labelled syringes on their anesthesia vcarts.

Here is a great article I found written by nurses; it's so good that i cut and pasted it in its entirety, rather than just giving the link. The IM route is mentioned here.

I also saw one for sublingual Sufentanil for intractable cancer pain, but I couldn't open the link, and can't help but wonder why a person in that situation wouldn't be on a continuous narcotic such as MSvia infusion pump, or even a Fentanyl (transdermal) patch..

For pediatric use, I have seen Fentanyl suckers, but not Sufentanil used. Fentanyl Oralet is mentioned in this article (below)

A Patient's Guide to using Fentanyl Citrate and Sufentanil Citrate

By Linda L. Halvorsen RN

Edited by Carissa Best RN

EVERY attempt has been made to ensure the accuracy of this material, however, medical science is constantly changing-if the information on this page differs from what you have been told by a nurse, pharmacist or physician, consult the person who told you differently or the manufacturer.

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Sublimaze, Duragesic-25, Duragesic-50, Duragesic-75, Duragesic-100

Fentanyl Oralet are all brand names of Fentanyl Citrate.

Sufenta is the brand name for Sufentanil Citrate.

All of these drugs are available by prescription only and many times will be given by specially trained persons such as an anesthesiologist (a doctor who specializes in giving anesthesia) or a Certified Nurse Anesthetist (a nurse who is specially trained to give anesthesia).

Use: Fentanyl and Sufenta are both used for moderate to severe pain. They can be used as an anesthetic to put you to sleep for surgery. They are given intravenously (IV) or by other ways such as intramuscular (IM) when the drug is injected into a muscle, or epidural, in which the anesthesiologist inserts a small tube between the bones of your spine to give medication. The medicine is absorbed through a membrane covering your spinal cord. A spinal is very similar except that the doctor inserts a needle through the membrane and gives the medicine there. This enables the doctor to give a smaller amount of drug to get the same effect and the drug takes effect faster. It also lessens the chance of side effects. These drugs could be given in a Patient Controlled Analgesia (PCA) pump after surgery as well. With a PCA pump you press a button and a machine gives you a small amount of drug in an IV or epidural tube. The amount is ordered by the doctor and the pump is set so you can't overdose yourself. Duragesic is used for chronic pain as a transdermal patch in which a measured dose of medication seeps through the skin slowly. Your doctor will prescribe these and you will be using them according to their instructions. Fentanyl Oralet is given by mouth but not swallowed. The medication is absorbed through the lining of the mouth, called transmucosal.

How they work: Both drugs work by scrambling pain messages the brain receives.

How you'll feel: When given IV especially, you'll feel drowsy and peaceful. Your pain will be relieved with smaller doses but with larger doses you will be unconscious. With an epidural or spinal you will still be awake but the lower part of your body will be affected. With the transdermal patch or the oralet you will have pain relief with minimal drowsiness.

When you will see effects: When given IV each drug takes effect in less than a minute and the effect lasts about an hour. An IM injection takes7 to 15 minutes to work and lasts 1 to 2 hours. In an epidural or spinal, it takes about 10 minutes to work but the effects last about 2 to 3 hours. The transdermal patch takes 12 to 24 hours to take effect and lasts 17 to 25 hours. The oralet takes 5 to 15 minutes to work and the length of time it works is variable.

When you will know if you need more: If the drug isn't working for you after 5 doses you need a higher dosage. Let your doctor or nurse know if you're not getting pain relief and they can adjust the dosage.

Side Effects: Both of these drugs affect your breathing. They can depress your ability to breathe. This is especially important in the IV route so a doctor or nurse will be watching you closely and if either drug is used to put you to sleep for surgery, the doctor will put a tube down your throat into your windpipe and help you breathe during surgery. If you have lung problems your dose should be reduced. These drugs can also change the way you view your surroundings and can give you hallucinations in which you see things that aren't there or feel anxious and afraid. This happens to older persons especially and you may need a smaller dose. Be sure to tell the nurse or doctor all of the medications you are taking and if you have medical problems (especially kidney or liver problems) so they can adjust your dosage accordingly. These drugs could harm you if the dose is too high so its important to get them adjusted properly. Do not use alcohol when using these drugs. Don't use more than the set dosage without talking to your doctor since this can increase the chance of side effects. There are special instructions you'll need to follow when using the transdermal patch or the oralet so be sure the doctor or nurse gives you this information.

When not to use: Don't use either of these drugs if you've had a problem taking them in the past.

Warning: It is important to tell your doctor if you are pregnant or think you may be pregnant because these drugs should not be taken during pregnancy unless the potential benefit to the mother outweighs the potential risk to the fetus. Fentanyl may be used during labor, but it is important for you to know that if your labor is too far along, the doctor may not give you this medication because if your baby is born soon after the fentanyl is given, the baby may have difficulty breathing for a short while after birth. Also, you must postpone breastfeeding for at least 4 to 6 hours after receiving fentanyl because this drug is excreted in human milk.

Sources:

Arky, R. 1997 PDR Guide to Injectable Medications. Medical Economics Co. Inc. 1997. pp. 244-245.

Arky, R. Physicians' Desk Reference. Medical Economics Co. Inc. 1998. p. 1319.

Barber, D. The Physiology and Pharmacology of Pain: A Review of Opioids. Journal of Perianesthesia Nursing. Vol. 12, No. 2, April 1997, pp.95-99.

Drain, C. The Post Anesthesia Care Unit: A Critical Approach to Anesthesia Nursing. W.B. Saunders Co. Philadelphia, PA. 1994. pp. 217-219.

Gahart, B.L. & Nazareno, A.R. (1999). Intravenous Medications. St. Louis: Mosby, Inc.

Kastrup, E. Drug Facts and Comparisons, Facts and Comparisons. St. Louis, MO. 1998. pp. 1388-1389.

Rose, M. Nursing 96 Drug Handbook. Springhouse Corp. Springhouse, PA. 1996. pp. 343-345, 357-358.