Transdermal fentanyl: Pharmacology and toxicology

Nelson, Lewis S.; Schwaner, Robert

doi:10.1007/bf03178274

Cited by 169 publications

(144 citation statements)

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“…Fentanyl, a synthetic phenylpiperidine, is a prescription opioid that is used for management of marked pain and the induction of anesthesia [1][2][3]. It has agonist activity at the μ-opioid receptor that results in analgesia and euphoria and is a schedule II medication that has a high potential for abuse.…”

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Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death

2012

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Introduction Transdermal fentanyl, an opioid used for management of marked pain, also is abused and may cause death. Methods We reviewed medical examiner reports of 92 decedents who had one or more fentanyl transdermal patches on their body and had fentanyl detected in their postmortem toxicology analysis. Results The manners of death included 40 accidents, 36 natural, 8 suicides, 5 therapeutic complications, and 3 undetermined deaths. Among the accidental fentanyl intoxication deaths, 32 of 37 involved substance abuse. The majority (95 %) of the 37 accidental deaths involving fentanyl were multi-drug intoxications. The substance abuse deaths had a mean fentanyl blood concentration (26.4 ng/ml or μg/L) that was over twice that of the natural group (11.8 ng/ml). Our analysis suggests a relationship between total patch dosage and mean postmortem fentanyl concentration up to the 100-μg/h dose. Conclusions The very wide and overlapping ranges of postmortem fentanyl concentrations effectively nullify the utility of correlating the dose and expected postmortem concentration for any particular death. Based on the variable relationship between dose and blood concentration, the antemortem dose cannot be reliably predicted based on the postmortem concentration. This does not, however, render the medical examiner/coroner unable to determine the cause and manner of death because the toxicology results are only one datum point among several that are considered. Although there was a weakly positive relationship between body mass index and fentanyl concentration, further research is needed to determine whether adipose tissue represents a significant depot for postmortem release of fentanyl.Keywords Toxicology . Fentanyl . Fatality . Forensic pathology . Transdermal . Intoxication Fentanyl, a synthetic phenylpiperidine, is a prescription opioid that is used for management of marked pain and the induction of anesthesia [1][2][3]. It has agonist activity at the μ-opioid receptor that results in analgesia and euphoria and is a schedule II medication that has a high potential for abuse. It may be administered by intravenous, transdermal, epidural, transmucosal, and inhalational routes. Due to slow absorption, the transdermal route is prescribed only for treatment of chronic pain. Transdermal (TD) delivery occurs by passive diffusion of fentanyl through the epidermis and dermis into the systemic circulation. Due to fentanyl's lipophilicity, it rapidly diffuses through the epidermis but is delayed by the water-rich dermis. This results in a depot of fentanyl at the epidermis-dermal junction, which explains both the slow onset and prolonged effects of TD fentanyl that may continue even after removal of an unspent patch.We have reviewed 92 deaths in which the decedent was found to be using one or more fentanyl patches. The causes of death, indication for use, evidence of abuse, postmortem toxicologic results with concentrations, and the epidemiology are examined and discussed. Our goal is to examine the relationship between the...

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Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death

2012

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“…6 Constipation and drowsiness were the most common limiting adverse effects observed in our study. Constipation and drowsiness were found to be more prominent in morphine group then in fentanyl 6,7,8 group inspite of the fact that we used high dose of fentanyl which was equivalent to 225-314 mg of morphine. Except for the 6 illiterate patient compliance 6 was good in both the groups.…”

Section: Discussionmentioning

confidence: 83%

Compliance for Transdermal Fentanyl Patch versus Sustained Release Oral Morphine in Cancer Pain

Singh¹,

Raizada²,

Nigam³

et al. 2018

IJCMR

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Introduction: Cancer pain management is an art as it needs to be individualized according to the type and site of cancer and variability of response among patients to different pain medications and treatments. The emergence of the concept of 'total pain' alleviation emphasizes both on physical and psychological factors to improve the overall quality of life and decrease the work loss and disability. This study was done at a tertiary cancer care centre of North India.

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“…2,7 This delay to onset and peak is due to the need for the applied fentanyl to traverse multiple skin layers before being absorbed into the circulation. In addition, the apparent half-life of fentanyl is substantially longer after removal of the patch (17 h) than after discontinuation of other formulations owing to continued absorption from a fentanyl depot that develops in the lipophilic epidermal tissue.…”

Section: Consequences Of Unsafe Prescribing Of Transdermal Fentanylmentioning

confidence: 99%

“…In addition, the apparent half-life of fentanyl is substantially longer after removal of the patch (17 h) than after discontinuation of other formulations owing to continued absorption from a fentanyl depot that develops in the lipophilic epidermal tissue. 7 Perhaps most important, substantial variation between patients in serum fentanyl concentrations occurs during both the initiation phase immediately after application of the patch and after attaining steady-state concentrations. Wide variation in individual fentanyl pharmacodynamics has been implied by evidence that serum concentrations causing inadequate pain control in some patients will lead to hypoventilation in others.…”

Section: Consequences Of Unsafe Prescribing Of Transdermal Fentanylmentioning

confidence: 99%

Consequences of unsafe prescribing of transdermal fentanyl

Lucyk

Nelson

2016

CMAJ

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Transdermal fentanyl: Pharmacology and toxicology

Cited by 169 publications

References 93 publications

Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death

Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death

Compliance for Transdermal Fentanyl Patch versus Sustained Release Oral Morphine in Cancer Pain

Consequences of unsafe prescribing of transdermal fentanyl

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