Fentanyl

Aliases: Sublimaze 

Indications: Pain management, ACS or STEMI, Constant Crush Injury > 4 hours, Procedural sedation      

Contraindications: Hypotension or Respiratory depression  

Concentrations: 

Injection: 50 mcg/mL

Dosing

Adult:

Indication	Dose	Route	Note
Analgesia (Moderate to Severe)  Procedural Sedation	1 mcg/kg	IV/IM/IN	-Round to nearest 25 mcg.   -Be sure to give IM/IN if 1st IV attempt fails or delayed.   -Repeat every 5 minutes PRN  -Avoid in headache

Pediatric:

Indication	Dose	Route	Note
Analgesia (Moderate to Severe)  Procedural Sedation	1 mcg/kg	IV/IM/IN	-Round to nearest 12.5 mcg.   -Consider diluting in syringe with NS -Be sure to give IM/IN if 1st IV attempt fails or delayed.

Precautions: Narcan should be available, Lower doses should be considered in elderly and frail patients. 

Adverse/Side Effects: Fentanyl may cause muscle rigidity, particularly involving the muscles of respiration. As with other narcotic analgesics, the most common serious adverse reactions reported to occur with fentanyl are respiratory depression, apnea, rigidity, and bradycardia. Other adverse reactions that have been reported are hypertension, hypotension, dizziness, blurred vision, nausea, emesis, laryngospasm, and diaphoresis. May cause Respiratory Depression.    

Class: Opioid, Schedule II controlled substance

Mechanism of Action: Competitive agonist that binds to opioid receptors which are found principally in the central and peripheral nervous system.

Onset of Action	Peak Effect	Duration of Action
Immediate (IV) 7-8 minutes (IN/IM)	Rapid (IV) 15-21 minutes (IN/IM)	30-60 minutes (IV) 1-2 hours (IM)