Buccal - Breakthrough cancer pain - Patients already receiving and tolerant to opioid treatment.
As loz - Initial: 200 mcg over 15 min per episode; may repeat once after 15 min if needed. Max: 1.6 mg/dose. No more than 4 unit doses should be taken daily.
As tab - Initial: 100 mcg episode; may repeat once after 30 min if needed; wait for at least 2 or 4 hr before treating another episode.
As film - Initial: 200 mcg per episode; thereafter, at least 2 hr must elapsed before treating another episode.
Sublingual - Breakthrough cancer pain
As tab - Initial: 100 mcg per episode; may repeat once after 30 min if needed; wait for at least 2 or 4 hr before treating another episode.
As spray - Initially, 100 mcg per episode; may repeat once after 30 min if needed; wait for at least 4 hr before treating another episode.
Nasal - Breakthrough cancer pain. Initial: Spray 50 or 100 mcg into 1 nostril per episode; may repeat once after 10 min; wait for at least 2 or 4 hr before treating another episode. Max: 4 episodes treated daily.
Adjunct to general anaesthesia
Patients w/ spontaneous respiration: Initial: 50-200 mcg followed by supplements of 50 mcg. Max: 200 mcg. Admin lower infusion rates of 0.05-0.08 mcg /kg/min.
Patients w/ assisted ventilation. Initial: 300-3,500 mcg (up to 50 mcg/kg) followed by supplements of 100-200 mcg depending on response. Loading dose (alternatively via bolus): Approx 1 mcg/kg/min given for the 1st 10 min followed by infusion of approx 100 ng/kg/min.
Premedication before anaesthesia: 50-100 mcg to be given 30-60 min prior to induction.
Transdermal. Intractable chronic pain.
Opioid-naive patients. Initial: Apply patch that delivers ≤25 mcg/hr. Adjust dose according to response.
Patients receiving a strong opioid analgesic: Initial dose should be based on the previous 24-hr opioid requirements. Replace patch every 72 hr and apply the new patch to a different site; avoid using the same area of skin for a few days.
Adverse drug reactions: reduce pulmonary compliance and/or apnoea, bronchoconstriction, laryngospasm; nausea, vomiting; bradycardia, oedema, CNS depression, confusion, dizziness, drowsiness, headache, sedation, hypotension, peripheral vasodilation, increased intracranial pressure, itching, rash, erythema, pruritus, coughing, urinary retention.
CIMS Drug Information System. Internet. Accessed on January 10, 2016.