Pro Pharma Talks5 Maalis 2019

Fentanyl

Episode Outline:

FENTANYL – USE VS. ABUSE

Bottomline – When used appropriately (surgery, cancer) it is very beneficial!

Approach: How to balance benefits vs. risks?

What it is?

• Synthetic narcotic painkiller and anesthetic – created 1960

• Pharmacology – binds to opiate receptors in brain – fast and in small doses 50-100x > morphine, 50x > heroin

• Dosage forms – injection, patch, sublingual, tablet, film, lozenges, lollipops

• Rx pain after surgery, severe cancer pain

o Rx requires enrollment in program to decrease risk of medication

o NMT 4x/day

• Drug Interactions –

o Heart: Amiodarone, Diltiazem

o Antibiotics: Clarithromycin, Erythromycin

o Antifungals: antifungals (fluconazole, itraconazole, ketoconazole)

o Heart burn: Cimetidine

o HIV drugs

o Depressants: Benzodiazepines, muscle relaxants, sedatives, tranquilizers

Risks?

• Narrow therapeutic index!

• Withdrawal – muscle pain, diarrhea, vomiting, nausea, sweating, abdominal pain, cramping, tachycardia, insomnia, tremors, anxiety

• NIH – 9580 deaths in 2015

• Illegal – cut heroin

• Addiction Treatment –

o Methadone, buprenorphine, naltrexone

o Recovery, professional therapy, group counseling

_______

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