Fentanyl Buccal
Loading...Fentanyl Buccal Recall
Get an alert when a recall is issued.
Questions & Answers
Side Effects & Adverse Reactions
See BOXED WARNING
When prescribing, DO NOT convert a patient from Actiq®‡ to fentanyl buccal tablets without following the instructions found in the prescribing information as Actiq®‡ and fentanyl buccal tablets are not equivalent on a microgram per microgram basis. Fentanyl buccal tablets are NOT a generic version of Actiq®‡.
When dispensing, DO NOT substitute a fentanyl buccal tablets prescription for an Actiq®‡ prescription under any circumstances. Fentanyl buccal tablets and Actiq®‡ are not equivalent. Substantial differences exist in the pharmacokinetic profile of fentanyl buccal tablets compared to other fentanyl products including Actiq®‡ that result in clinically important differences in the rate and extent of absorption of fentanyl. As a result of these differences, the substitution of the same dose of fentanyl buccal tablets for the same dose of Actiq®‡ or any other fentanyl product may result in a fatal overdose.
There are no safe conversion directions available for patients on any other fentanyl products. (Note: This includes oral, transdermal, or parenteral formulations of fentanyl.) Therefore, for opioid tolerant patients, the initial dose of fentanyl buccal tablets should be 100 mcg. Each patient should be individually titrated to provide adequate analgesia while minimizing side effects. (See DOSAGE AND ADMINISTRATION.)
The concomitant use of other CNS depressants, including other opioids, sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, sedating antihistamines, potent inhibitors of cytochrome P450 3A4 isoform (e.g., erythromycin, ketoconazole, and certain protease inhibitors), and alcoholic beverages may produce increased depressant effects. Hypoventilation, hypotension, and profound sedation may occur.
Fentanyl buccal tablets are not recommended for use in patients who have received MAO inhibitors within 14 days, because severe and unpredictable potentiation by MAO inhibitors has been reported with opioid analgesics.
Pediatric Use: The safety and efficacy of fentanyl buccal tablets have not been established in pediatric patients below the age of 18 years.
Patients and their caregivers must be instructed that fentanyl buccal tablets contain a medicine in an amount which can be fatal to a child. Patients and their caregivers must be instructed to keep tablets out of the reach of children. (See SAFETY AND HANDLING, PRECAUTIONS, and MEDICATION GUIDE for specific patient instructions.)
Fentanyl buccal tablets contain fentanyl, a mu-opioid agonist and a Schedule II controlled substance with high potential for abuse similar to hydromorphone, methadone, morphine, oxycodone, and oxymorphone. Fentanyl can be abused and is subject to misuse, and criminal diversion.
Concerns about abuse, addiction, and diversion should not prevent the proper management of pain. However, all patients treated with opioids require careful monitoring for signs of abuse and addiction, since use of opioid analgesic products carries the risk of addiction even under appropriate medical use.
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Drug addiction is a treatable disease, utilizing a multidisciplinary approach, but relapse is common.
“Drug-seeking” behavior is very common in addicts and drug abusers. Fentanyl buccal tablets should be prescribed with caution to patients who have a higher risk of substance abuse, including patients with bipolar disorder and/or schizophrenia.
Patients with chronic pain may be at a higher risk for suicide.
Abuse and addiction are separate and distinct from physical dependence and tolerance. Physicians should be aware that addiction may not be accompanied by concurrent tolerance and symptoms of physical dependence in all addicts. In addition, abuse of opioids can occur in the absence of addiction and is characterized by misuse for nonmedical purposes, often in combination with other psychoactive substances. Since fentanyl buccal tablets may be diverted for non-medical use, careful record keeping of prescribing information, including quantity, frequency, and renewal requests is strongly advised.
Proper assessment of patients, proper prescribing practices, periodic re-evaluation of therapy, and proper dispensing and storage are appropriate measures that help to limit abuse of opioid drugs.
Fentanyl buccal tablets should be handled appropriately to minimize the risk of diversion, including restriction of access and accounting procedures as appropriate to the clinical setting and as required by law.
Healthcare professionals should contact their State Professional Licensing Board, or State Controlled Substances Authority for information on how to prevent and detect abuse or diversion of this product.
The administration of fentanyl buccal tablets should be guided by the response of the patient. Physical dependence, per se, is not ordinarily a concern when one is treating a patient with cancer and chronic pain, and fear of tolerance and physical dependence should not deter using doses that adequately relieve the pain.
Opioid analgesics may cause physical dependence. Physical dependence results in withdrawal symptoms in patients who abruptly discontinue the drug. Withdrawal also may be precipitated through the administration of drugs with opioid antagonist activity, e.g., naloxone, nalmefene, or mixed agonist/antagonist analgesics (pentazocine, butorphanol, buprenorphine, nalbuphine).
Physical dependence usually does not occur to a clinically significant degree until after several weeks of continued opioid usage. Tolerance, in which increasingly larger doses are required in order to produce the same degree of analgesia, is initially manifested by a shortened duration of analgesic effect, and subsequently, by decreases in the intensity of analgesia.
Respiratory depression is the chief hazard of opioid agonists, including fentanyl, the active ingredient in fentanyl buccal tablets. Respiratory depression is more likely to occur in patients with underlying respiratory disorders and elderly or debilitated patients, usually following large initial doses in opioid non-tolerant patients, or when opioids are given in conjunction with other drugs that depress respiration.
Respiratory depression from opioids is manifested by a reduced urge to breathe and a decreased rate of respiration, often associated with the “sighing” pattern of breathing (deep breaths separated by abnormally long pauses). Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. This makes overdoses involving drugs with sedative properties and opioids especially dangerous.
Legal Issues
There is currently no legal information available for this drug.
FDA Safety Alerts
There are currently no FDA safety alerts available for this drug.
Manufacturer Warnings
There is currently no manufacturer warning information available for this drug.
FDA Labeling Changes
There are currently no FDA labeling changes available for this drug.
Uses
(See BOXED WARNING and CONTRAINDICATIONS.)
Fentanyl buccal tablets are indicated only for the management of breakthrough pain in patients with cancer who are already receiving and who are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. Patients considered opioid tolerant are those who are taking around-the-clock medicine consisting of at least 60 mg of oral morphine daily, at least 25 mcg of transdermal fentanyl/hour, at least 30 mg of oxycodone daily, at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid daily for a week or longer.
This product must not be used in opioid non-tolerant patients because life-threatening hypoventilation and death could occur at any dose in patients not on a chronic regimen of opioids. For this reason, fentanyl buccal tablets are contraindicated in the management of acute or postoperative pain.
Fentanyl buccal tablets are intended to be used only in the care of opioid tolerant cancer patients and only by healthcare professionals who are knowledgeable of and skilled in the use of Schedule II opioids to treat cancer pain.
History
There is currently no drug history available for this drug.
Other Information
Fentanyl buccal tablets are a potent opioid analgesic, intended for buccal mucosal administration. Fentanyl buccal tablets are formulated as a flat-faced, round, beveled-edge white to off-white tablet.
Fentanyl buccal tablets are designed to be placed and retained within the buccal cavity for a period sufficient to allow dissolution of the tablet and absorption of fentanyl across the oral mucosa.
Watson’s fentanyl buccal tablets employ immediate-release drug delivery technology which releases the drug substance upon dissolution.
Active Ingredient: Fentanyl citrate, USP is N-(1-Phenethyl-4-piperidyl) propionanilide citrate (1:1). Fentanyl is a highly lipophilic compound (octanol-water partition coefficient at pH 7.4 is 816:1) that is freely soluble in organic solvents and sparingly soluble in water (1:40). The molecular weight of the free base is 336.5 (the citrate salt is 528.6). The pKa of the tertiary nitrogens are 7.3 and 8.4. The compound has the following structural formula:
All tablet strengths are expressed as the amount of fentanyl free base, e.g., the 100 microgram strength tablet contains 100 micrograms of fentanyl free base.
Inactive Ingredients: Mannitol, sodium starch glycolate, potassium bicarbonate, and magnesium stearate.
Sources
Fentanyl Buccal Manufacturers
-
Watson Laboratories, Inc.
![Fentanyl Buccal Tablet [Watson Laboratories, Inc.]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Fentanyl Buccal | Watson Laboratories, Inc.
Physicians should individualize treatment using a progressive plan of pain management. Healthcare professionals should follow appropriate pain management principles of careful assessment and ongoing monitoring. (See BOXED WARNING and Dosing.)
It is important to minimize the number of strengths available to patients at any time to prevent confusion and possible overdose.
Dosing1. Initial Dose
For opioid-tolerant patients not being converted from Actiq®‡, the initial dose of fentanyl buccal tablets is always 100 mcg.
For patients being converted from Actiq®‡, prescribers must use the Initial Dosing Recommendations table below (Table 7). The doses of fentanyl buccal tablets in this table are starting doses and not intended to represent equianalgesic doses to Actiq®‡. Patients must be instructed to stop the use of Actiq®‡ and dispose of any remaining units.
Table 7. Initial Dosing Recommendations for Patients on Actiq®‡ Current Actiq®‡ Dose
(mcg) Initial Fentanyl Buccal Tablets Dose
(mcg) 200 100 mcg tablet 400 100 mcg tablet 600 200 mcg tablet 800 200 mcg tablet 1200 2 x 200 mcg tablets 1600 2 x 200 mcg tabletsFor patients converting from Actiq®‡ doses equal to or greater than 600 mcg, titration should be initiated with the 200 mcg fentanyl buccal tablet and should proceed using multiples of this tablet strength.
In cases where the breakthrough pain episode is not relieved after 30 minutes, patients may take ONLY ONE additional dose using the same strength for that episode. Thus patients should take a maximum of two doses of fentanyl buccal tablets for any episode of breakthrough pain.
Patients MUST wait at least 4 hours before treating another episode of breakthrough pain with fentanyl buccal tablets.
2. Titration
From an initial dose, patients should be closely followed by the prescriber and the dosage strength changed until the patient reaches a dose that provides adequate analgesia with tolerable side effects. Patients should record their use of fentanyl buccal tablets over several episodes of breakthrough pain and discuss their experience with their physician to determine if a dosage adjustment is warranted.
Patients whose initial dose is 100 mcg and who need to titrate to a higher dose, can be instructed to use two 100 mcg tablets (one on each side of the mouth in the buccal cavity) with their next breakthrough pain episode. If this dosage is not successful, the patient may be instructed to place two 100 mcg tablets on each side of the mouth in the buccal cavity (total of four 100 mcg tablets). Titrate using multiples of the 200 mcg fentanyl buccal tablet for doses above 400 mcg (600 mcg and 800 mcg). Note: Do not use more than 4 tablets simultaneously.
In cases where the breakthrough pain episode is not relieved after 30 minutes, patients may take ONLY ONE additional dose of the same strength for that episode. Thus patients should take a maximum of two doses of fentanyl buccal tablets for any breakthrough pain episode. During titration, one dose of fentanyl buccal tablets may include administration of 1 to 4 tablets of the same dosage strength (100 mcg or 200 mcg).
Patients MUST wait at least 4 hours before treating another episode of breakthrough pain with fentanyl buccal tablets. To reduce the risk of overdosing during titration, patients should have only one strength of fentanyl buccal tablets available at any one time.
Patients should be strongly encouraged to use all of their fentanyl buccal tablets of one strength prior to being prescribed the next strength. If this is not practical, unused fentanyl buccal tablets should be disposed of safely. (See DISPOSAL OF FENTANYL BUCCAL TABLETS.) Dispose of any unopened fentanyl buccal tablets remaining from a prescription as soon as they are no longer needed.
3. Maintenance Dosing
Once titrated to an effective dose, patients should generally use only ONE fentanyl buccal tablet of the appropriate strength per breakthrough pain episode.
On occasion when the breakthrough pain episode is not relieved after 30 minutes, patients may take ONLY ONE additional dose using the same strength for that episode.
Patients MUST wait at least 4 hours before treating another episode of breakthrough pain with fentanyl buccal tablets.
Dosage adjustment of fentanyl buccal tablets may be required in some patients in order to continue to provide adequate relief of breakthrough pain.
Generally, the fentanyl buccal tablets dose should be increased only when a single administration of the current dose fails to adequately treat the breakthrough pain episode for several consecutive episodes.
If the patient experiences greater than four breakthrough pain episodes per day, the dose of the maintenance (around-the-clock) opioid used for persistent pain should be reevaluated.
Patients with hepatic and/or renal impairmentCaution should be exercised for patients with hepatic and/or renal impairment, and the lowest possible dose should be used in these patients. (See PRECAUTIONS.)
Patients receiving CYP3A4 inhibitorsParticular caution should be exercised for patients receiving CYP3A4 inhibitors, and the lowest possible dose should be used in these patients. (See PRECAUTIONS.)
Patients with mucositisNo dose adjustment appears necessary in patients with Grade 1 mucositis. The safety and efficacy of fentanyl buccal tablets when used in patients with mucositis more severe than Grade 1 have not been studied.
Opening the Blister Package
Patients should be instructed not to open the blister until ready to administer fentanyl buccal tablets.
The pull tab should be lifted where indicated.
The tab should be pulled around the curve and the blister should be pressed against the other side to push the tablet through.
The tablet should not be stored once it has been removed from the blister package as the tablet integrity may be compromised, and more importantly, because this increases the risk of accidental exposure to the tablet.
Tablet Administration
Once the tablet is removed from the blister unit, the patient should immediately place the entire fentanyl buccal tablet in the buccal cavity (above a rear molar, between the upper cheek and gum). Patients should not split the tablet.
The fentanyl buccal tablet should not be sucked, chewed or swallowed, as this will result in lower plasma concentrations than when taken as directed.
The fentanyl buccal tablet should be left between the cheek and gum until it has disintegrated, which usually takes approximately 14 to 25 minutes.
After 30 minutes, if remnants from the fentanyl buccal tablet remain, they may be swallowed with a glass of water.
It is recommended that patients alternate sides of the mouth when administering subsequent doses of fentanyl buccal tablets.
SAFETY AND HANDLINGFentanyl buccal tablets are supplied in individually sealed, child-resistant blister packages. The amount of fentanyl contained in fentanyl buccal tablets can be fatal to a child. Patients and their caregivers must be instructed to keep fentanyl buccal tablets out of the reach of children. (See BOXED WARNING, WARNINGS, PRECAUTIONS, and MEDICATION GUIDE.)
Store at 20º to 25ºC (68º to 77ºF) until ready to use. [See USP Controlled Room Temperature].
Fentanyl buccal tablets should be protected from freezing and moisture. Do not use if the blister package has been tampered with.
DISPOSAL OF FENTANYL BUCCAL TABLETSPatients and members of their household must be advised to dispose of any tablets remaining from a prescription as soon as they are no longer needed. Information is available in the Information for Patients and Caregivers and in the Medication Guide. If additional assistance is required, referral to the Watson toll-free telephone number (1-866-510-7780) should be made.
To dispose of unused fentanyl buccal tablets, remove fentanyl buccal tablets from blister packages and flush down the toilet. Do not flush fentanyl buccal tablet blister packages or cartons down the toilet. If you need additional assistance with disposal of fentanyl buccal tablets, call Watson Laboratories, Inc., at 1-866-510-7780.
Login To Your Free Account