#建議持續輸注 (IV pump) 之高警訊藥品

鴉片類止痛 Severe pain, surgical analgesia & Anesthesia

Fentanyl citrate is a narcotic analgesic. A dose of 100 mcg (0.1 mg) is approximately equivalent in analgesic activity to 10 mg of morphine or 75 mg of meperidine. The principal actions of therapeutic value are analgesia and sedation.

Absorption:
1.Onset of action: (IM) 7 to 8 minutes; (IV) Almost immediate
2. Duration: (IM) 1 to 2 hours; (IV) 0.5 to 1 hour
Distribution:
1. Highly lipophilic, redistributes into muscle and fat
2. Vdss: (Children) ~15 L/kg; (Adults) 4 to 6 L/kg
3. Protein binding: 79% to 87%, primarily to alpha-1 acid glycoprotein; also binds to albumin and erythrocytes
Metabolism:
Hepatic, primarily via CYP3A4 by N-dealkylation (to norfentanyl) and hydroxylation to other inactive metabolites
Excretion:
Urine 75% (primarily as metabolites, <7% to 10% as unchanged drug); feces ~9%

1. Hypersensitivity to fentanyl or any component of the formulation
2. Known or suspected mechanical GI obstruction (eg, bowel obstruction, strictures) or any diseases/conditions that affect bowel transit (eg, ileus of any type)
3. Severe CNS depression, hemorrhage or shock
4. Concurrent use or use within 14 days of a monoamine oxidase inhibitor (MAOI)

C

Avoided.

Hypertension, hypotension, dizziness, blurred vision,emesis, laryngospasm, diaphoresis, muscular rigidity, bradycardia, laryngospasm, nausea & vomiting, chills, restlessness, post-op hallucinations, extrapyramidal symptoms

Acute postoperative pain:
1. IV: 25 to 50 mcg every 5 minutes (moderate pain) or 50 to 100 mcg every 2 to 5 minutes (severe pain)
2. IM: 50 to 100 mcg every 1 to 2 hours as needed Note: IM route should only be used if IV administration is not available.
Acute nonoperative severe pain:
IV, IM: 25 to 50 mcg or 0.35 to 0.5 mcg/kg every 30 to 60 minutes as needed
Procedural sedation and analgesia:
Usual initial dose range: 0.5 to 2 mcg/kg, administered in incremental boluses of 25 to 50 mcg, titrated to effect. When used in combination with a sedative (eg, midazolam), consider dosage reduction.
General anesthesia:
1. Induction: IV 25 to 100 mcg (or 0.5 to 1 mcg/kg)
2. Maintenance: 25 to 50 mcg bolus as needed OR Continuous infusion 1 to 2 mcg/kg/hour

1. CrCl <50 mL/minute: No dosage adjustment necessary when single or infrequent bolus doses are used for short interventional procedures
2. Dialysis, Peritoneal dialysis, CRRT: Use lowest effective dose with gradual titration and close monitoring of response and adverse effects

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Compatible with NS or D5W