Transdermal Fentanyl Administration in Children and Adolescents with Sickle Cell Pain Crisis

Abstract

Improved understanding of the dose-effect relationship for TF in children and adolescents is necessary before adequate pain control can be achieved with this delivery system.

Transdermal Fentanyl in Childhood and Adolescence: A Comprehensive Literature Review

“…Children aged 7 to 16 years took longer to reach a steady-state serum concentration than adults. 2,4 In some patients, peak serum concentrations were not reached before 66 hours. 4 Cmax and Tmax are parameters confounded by the absorption rate constant, clearance, and volume and are inadequate to assess age-related differences in absorption.…”

“…Children may take longer to reach steady-state serum concentrations compared with adults, drug clearance appears to be higher than in adults when expressed as per kilogram, and younger children may require higher doses with respect to body weight compared with older children or adults. 1,2,4,10,16,27 Reported pharmacokinetic data are estimated from a very small number of children and derived from settings (eg, after surgery; sickle cell crisis) different from long-term pain therapy. The methodology used was poor.…”

Quantification of Analgesic Use in Children With Sickle Cell Disease

“…The MQS includes 10 classes of medications that are prescribed frequently for management of pain: (1) acetaminophen/aspirin, (2) nonsteroidal anti-inflammatory drugs, (3) antidepressants, (4) antihistamines, (5) anticonvulsants, (6) muscle relaxants, (7) weak opioids, (8) benzodiazepines, (9) barbiturates/sedatives/hypnotics, and (10) strong opioids. 20,21 For each pain-related medication, 2 components of the MQS were rated: a detriment weight, on the basis of the potential for producing adverse effects, and a dosage level based on the recommended daily dosage.…”

“…4 Other studies examined the dose-concentration relationship and clinical effects of transdermal fentanyl, 5 and continuous epidural infusions of fentanyl in children who were unresponsive to conventional analgesic therapy. 6 A study by Robieux and colleagues 2 compared the efficacy and safety of medications administered in different delivery modes.…”

Principles of Pediatric Pain Management during the End-of-Life Period

“…Transdermal fentanyl patches and transdermal buprenorphine patches are contraindicated for acute pain management due to a long onset time (it may take more than 60 h to reach peak concentrations in children) [20,21] , inability to rapidly titrate drug delivery and long The Actiq lozenge is a solid drug matrix with berry flavor providing oral transmucosal fentanyl citrate. Due to fentanyl's high lipophilicity, absorption across the oral mucosa directly into the systemic blood is rapid.…”