Oral transmucosal fentanyl citrate for the treatment of breakthrough pain

Zarth, R.; Ehmer, M.; Sittig, Hans-Bernd

doi:10.1007/s00482-007-0590-z

Schmerz

2007

DOI: 10.1007/s00482-007-0590-z

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Oral transmucosal fentanyl citrate for the treatment of breakthrough pain

R. Zarth¹,

M. Ehmer²,

Hans-Bernd Sittig³

Abstract: Oral transmucosal fentanyl citrate is a safe and effective treatment for breakthrough pain in chronic cancer-related pain.

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Cited by 6 publications

References 23 publications

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Schnell freisetzende Fentanylapplikationsformen

Wirz¹,

Wiese

Zimmermann

et al. 2013

Schmerz

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The spectrum of indications for rapid release fentanyl preparations is controversial. For this reason the Working Group on Tumor Pain will formulate comments on how to deal with these substances. Breakthrough pain should receive individualized therapy; therefore, the use of opioids of various galenic formulations seems to be advisable. New rapid release fentanyl preparations are suitable for alleviating spontaneous breakthrough pain in tumor patients due to a rapid but short-acting effect. However, a prior optimization of the analgesic basis medication is absolutely necessary. Uncontrolled prescription for non-cancer pain must be criticized due to the problem of addiction. The medical profession should be informed about the benefits of rapid release fentanyl preparations but must also be made aware of the risk of a rapid development of addiction and tolerance. A self-commitment of the pharmaceutical industry to waive advertising for the dangerous off-label use would be desirable. In the opinion of the Working Group on Tumor Pain the use of fentanyl should be openly discussed and further scientific investigations are imperative with the aim of formulating clear recommendations.

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Schnell freisetzende Fentanylapplikationsformen

Wirz¹,

Wiese

Zimmermann

et al. 2013

Schmerz

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Dosisfindung zur Behandlung mit transdermalem Fentanylpflaster

Mücke

Conrad

Marinova

et al. 2016

Schmerz

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To date, no studies investigating titration with oral transmucosal fentanyl for the dose-finding of transdermal fentanyl treatment have been published. In an open randomized study 60 patients with chronic malignant (n = 39) or nonmalignant pain (n = 21), who required opioid therapy according to step three of the guidelines of the World Health Organization (WHO), were investigated. In two groups of 30 patients each titration with immediate release morphine (IRM) or oral transmucosal fentanyl citrate (OTFC) was undertaken. For measurement purposes the Brief Pain Inventory (BPI) and Minimal Documentation System (MIDOS) were used. After a 24-h titration phase, in which patients documented the intensity of pain, nausea, and tiredness, treatment with transdermal fentanyl was evaluated over a 10-day period by means of the necessary dose adaptation (responder ≤ 1 dose adaptation; conversion formula 1:1 [OTFC group] vs 100:1 [IRM group]).The pain reduction over the first 24 h (titration phase) did not differ significantly between the groups. The number of responders (17 OTFC vs. 21 IRM) over the 10-day period did not show any difference either. In both groups there was a significant reduction in pain intensity (p < 0.001). Over the course of the study, there were significantly more drop-outs because of adverse effects in the OTFC group than in the IRM group (8 vs 1, p = 0.028).Oral transmucosal fentanyl citrate can be applied for the titration of transdermal fentanyl, but it does not show any clinically relevant advantage. For example, the risk of side effects-induced drop-outs was greater in the present study. Whether the unnecessary opioid switching to treat chronic pain and breakthrough pain is advantageous with regard to minimizing conversion errors cannot be definitively answered within the scope of this study.

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Notärztliche Behandlung akuter Schmerzexazerbationen bei ambulanten Palliativpatienten in Deutschland

Wiese

Strumpf

Löffler

et al. 2010

Notfall Rettungsmed

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Oral transmucosal fentanyl citrate for the treatment of breakthrough pain

Abstract: Oral transmucosal fentanyl citrate is a safe and effective treatment for breakthrough pain in chronic cancer-related pain.

Cited by 6 publications

References 23 publications

Schnell freisetzende Fentanylapplikationsformen

Schnell freisetzende Fentanylapplikationsformen

Dosisfindung zur Behandlung mit transdermalem Fentanylpflaster

Notärztliche Behandlung akuter Schmerzexazerbationen bei ambulanten Palliativpatienten in Deutschland

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