Index of drugs

In small doses to relieve pain during short surgical procedures. In high doses as an analgesic / breathing suppressant in patients requiring respiratory support. In order to induce surgical analgesia during general anesthesia. In combination with neuroleptics for neuroleptoanalgesia. As a single medicine or in combination with other medicines (eg benzodiazepines) for analgosedation. For the treatment of severe pain, i.e. post-traumatic, pain associated with myocardial infarction.

1 ml of solution contains 50 μg of fentanyl in the form of citrate.

An analgesic medicine from the group of pure opioid receptor agonists. After administration, the effect is immediate and short-lived - it lasts about 30 minutes. It exhibits all the central opioid activities, including reducing the sensitivity of the respiratory center, inducing vomiting, constipation and physical dependence. It may cause a slight reduction in blood pressure. It is 80% bound to plasma proteins. Excavated in about 8% with urine.

Hypersensitivity to fentanyl or compounds with a similar chemical structure. Respiration depression. Diseases of the lungs. Concomitant use of MAO inhibitors or use within 14 days of discontinuation of MAO inhibitors. Clinical conditions that may be a contraindication for epidural and subarachnoid route of administration.

The drug can only be used by people who are experienced in the use of anesthetics, in conditions that allow monitoring and supporting breathing and circulation. Fentanyl given over a long period of time may cause addiction and symptoms of tolerance. Caution should be exercised in patients with: hypovolaemia and a tendency to hypotension, respiratory depression, myasthenia gravis, debilitated or elderly, hypothyroidism, with a tendency to bradyarrhythmias, lung diseases, alcoholism, and liver and kidney disorders. The concentration of fentanyl in the blood serum decreases gradually, therefore, due to the persistent inhibition of the respiratory center, it is recommended to observe the patient. Opioid analgesics are not recommended for rapid intravenous injection in patients with impaired brain function.

The safety of fentanyl during pregnancy has not been established - the medicine can only be used during pregnancy if the benefits of treatment outweigh the risks to the fetus. Due to the possibility of penetration through the placenta, fentanyl may cause depression of the respiratory center in the newborn - do not use during labor (including caesarean section). If fentanyl is used, an antidote should be given to the newborn immediately in the form of naloxone. The drug is excreted in breast milk, breastfeeding can be started 24 hours after the use of fentanyl.

Very common: muscle stiffness (which may also include intercostal muscles), nausea, vomiting. Common: agitation, dyskinesia, sedation, dizziness, blurred vision, bradycardia, tachycardia, arrhythmia, hypotension, hypertension, venous pain, laryngeal spasm, bronchospasm, apnea, allergic dermatitis, post-operative confusion. Uncommon: Euphoric mood, headache, phlebitis, blood pressure fluctuations, hyperventilation, hiccups, chills, hypothermia, respiratory complications resulting from anesthesia. Not known: hypersensitivity (such as anaphylactic shock, anaphylactic reactions, urticaria), convulsions, loss of consciousness, myoclonus, cardiac arrest, depression of breathing, pruritus. During the simultaneous use of serotoninergic drugs, and drugs that reduce serotonin metabolism, a potentially life-threatening serotonin syndrome may develop with such symptoms as: changes in mental state (eg agitation, hallucinations, coma), autonomic nervous system disorders (eg tachycardia, fluctuations in blood pressure, hyperthermia), neuromuscular disorders (e.g.hyperreflexia, lack of coordination, stiffness) and / or gastrointestinal disorders (e.g., nausea, vomiting, diarrhea). Some patients may experience anxiety, especially movement, feeling cold or chills, after surgery - hallucinations, extrapyramidal syndromes. After administration of fentanyl either epidural or subarachnoid, early or late (up to 24 h) depression of the respiratory center may occur.

The dose should be individually adjusted to the intensity of pain; age, the patient's clinical condition and the type of anesthesia planned.Adults and children from 12 to 17 years intravenously: with a spontaneous breath: 0.05-0.2 mg as the starting dose, 0.05 mg additional dose; with assisted breath: 0.3-3.5 mg as the starting dose, 0.1-0.2 mg additional dose. Premedication: 0.05-0.1 mg intramuscularly 45 minutes before the planned anesthesia, similarly intravenously 5-10 minutes before the induction of general anesthesia. As an analgesic: 0.1 mg eliminates pain for 10-20 minutes during the procedure causing minor pain; 0.2-0.5 mg in a quick intravenous injection gives relief of pain for about 1 hour during the procedure causing moderate pain; 50 μg / kg It gives relief of pain for 4-6 h during surgery that causes great pain. Intravenous fractionated doses of 0.05-0.1 mg are recommended, adequate for pain stimulation. Intravenous infusion: with controlled breath 1 μg / kg / min in a rapid infusion for the first 10 min, then 0.1 μg / kg / min in infusion; the loading dose can be administered in the form of a bolus. Sustained spontaneous breathing: 0.05-0.08 μg / kg bw / min; cardiac surgery: up to 3 μg / kg bw / min.subcutaneous: by injection or continuous infusion, the dose adjusts to the patient's condition.epidural: 50-100 μg once; 25-100 μg / h in a continuous infusion; PCA method: saturation - 75-100 μg; basic infusion of 30-75 μg / h; dose on demand 10-15 μg; pump blocking time 6 min.subarachnoidally: 5-25 μg / dose once; 0.8 μg / kg / h in continuous infusion.Children from 2 to 11 years intravenously: with spontaneous and assisted breath: 1-3 μg / kg as an initial dose, 1-1.25 μg / kg additional dose. Subcutaneous: children about the month of <50 kg: initially 0.5-2 μg / kg / h by injection or continuous infusion; children under 6 months: initially 1 / 4-1 / 3 doses 0.5-2 μg / kg / h, Next modified depending on the effect; children> 50 kg: initial 25-75 μg every 1 hour. Reduced doses are recommended in elderly or debilitated patients.