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Drug Therapy Protocols: Fentanyl
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Date
April, 2017
Purpose
Scope
Author
To ensure a consistent procedural approach to Fentanyl administration.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
April, 2020
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security
This document has been security classified using the Queensland Government
Information Security Classification Framework (QGISCF) as UNCLASSIFIED and will
be managed according to the requirements of the QGISF.
URL
https://ambulance.qld.gov.au/clinical.html
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Fentanyl
April, 2017
Drug class
Narcotic analgesic
Precautions
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Pharmacology
• Elderly patients
Fentanyl is a synthetic narcotic analgesic that acts on the central
nervous system by binding with the opioid receptors.[1-3]
• Hypotension
Metabolism
• Respiratory depression and/or failure
Hepatic metabolism and renal excretion.[1]
• Respiratory tract burns
• Known addiction to narcotics
• Current MAOI therapy
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Indications
• Significant pain
Side effects
• Sedation (for the maintenance of an established ETT)
• Bradycardia
• Autonomic dysreflexia (with systolic BP > 160 mmHg)
• Hypotension
• Drowsiness
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• Nausea and/or vomiting
• Pin point pupils
• Respiratory depression
Contraindications
• Muscular rigidity (particularly muscles of respiration)
• KSAR or hypersensitivity to fentanyl
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Figure 4.12
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Fentanyl
April, 2017
Presentation
Special notes[4-6]
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• Fentanyl is the preferred narcotic for patients presenting with ACS.
• Ampoule, 100 microg/2 mL fentanyl
Onset (NAS/IV)
Duration (NAS/IV)
Half-life
< 3 minutes
30–60 minutes
2–3 hours
• Fentanyl is a rapid onset synthetic narcotic that may potentiate respiratory depression and haemodynamic instability, particularly when administered intravenously in the setting of CNS depression or hypovolaemia.
• Fentanyl administration should be considered for patients where a morphine allergy exists.
UNCONTROLLED WHEN PRINTED
• When fentanyl is administered to a hypotensive patient, ACPs must call for CCP backup where available.
Schedule
• In the setting of hypotensive adult patients (SBP ≤ 90 mmHg) all incremental fentanyl doses are to be ≤ 25 microg for IV and ≤ 50 microg for IM.
• S8 (Controlled drug).
Routes of administration
• There is no significant difference in the effectiveness of IV morphine to NAS fentanyl. The true benefit of paediatric NAS fentanyl administration is that it avoids painful IM or IV administration. ACP2
CCP
ACP1
ACP2
CCP
Intramuscular injection (IM)
CCP
ACP1
Subcutaneous injection (SUBCUT)
ACP2
Intranasal (NAS)
ACP1
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• When administering fentanyl and midazolam to maintain sedation in the intubated patient, appropriate management is to be instituted to address any adverse side effects such as
hypotension. The addition of fentanyl in this setting will reduce
midazolam requirements, provide analgesia and ultimately
decrease the risk of hypotension. Under no circumstances are fentanyl and midazolam to be mixed in the one syringe.
Intraosseous injection (IO)
CCP
CCP
Intravenous injection (IV)
ACP2
UNCONTROLLED WHEN PRINTED
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Fentanyl
Adult dosages
Adult dosages (cont.)
CCP
ACP2
ACP1
Significant pain
SUBCUT
QAS Clinical Consultation and Advice Line
approval required in all situations.
• Significant pain
• Autonomic dysreflexia (with a significant BP > 160 mmHg)
IV
≥ 70 yrs – 25 microg
Repeated at up to 25 microg every 5 minutes. Total maximum dose 100 microg.
≥ 70 yrs – 25–50 microg
Repeated at up to 50 microg every 10 minutes. Total maximum dose 100 microg.
< 70 yrs – 25–100 microg
Repeated at up to 50 microg every 10 minutes.
Total maximum dose 200 microg.
ACP2
IM
< 70 yrs – 25–50 microg
Repeated at up to 50 microg every 5 minutes.
Total maximum dose 200 microg.
CCP
ACP1
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IV
25–50 microg
Repeated at up to 50 microg every 5 minutes. No maximum dose.
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≥ 70 yrs – 25–50 microg.
Repeated at up to 50 microg every 10 minutes.
Total maximum dose 100 microg.
< 70 yrs – 50–100 microg.
Repeated at up to 100 microg every 10 minutes.
Total maximum dose 200 microg.
CCP
NAS
Sedation (for the maintenance of an established ETT)
IV
25 microg. Consider administration with midazolam.
Repeated PRN. No maximum dose.
CCP
ACP2
ACP1
• Significant pain
• Autonomic dysreflexia (with a significant BP > 160 mmHg)
IO
25 microg. Consider administration with midazolam.
Repeated PRN. No maximum dose.
ACP2
CCP
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NAS
IM
25 – 100 microg
Repeated every 10 minutes.
No maximum dose.
≥ 70 yrs – 25–50 microg
Repeated at up to 50 microg every 10 minutes. Total maximum dose 100 microg.
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CCP
< 70 yrs – 25–100 microg
Repeated at up to 50 microg every 10 minutes.
Total maximum dose 200 microg.
IM
25 – 100 microg
Repeated at up to 50 microg every 10 minutes. No maximum dose.
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Fentanyl
Paediatric dosages (cont.)
Paediatric dosages
Significant pain
NAS
Initial dose of fentanyl is to be administered using the following scale.
ACP2
ACP1
Significant pain
NAS
≥ 1 year – 1.5 microg/kg
Repeated once at 1 microg/kg at 10 minutes.
Total maximum dose 100 microg.
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Dose
Volume
10 kg
15 microg
0.3 mL
10 – < 15 kg
20 microg
0.4 mL
15 – < 20 kg
25 microg
0.5 mL
20 – < 25 kg
30 microg
0.6 mL
25 – 30 kg
40 microg
0.8 mL
< 1 year – QAS Clinical Consultation and Advice
Line approval required in all situations.
CCP
Weight
NAS
≥ 6 months – 1.5 microg/kg
Repeated once at 1 microg/kg at 10 minutes. Total maximum dose 100 microg
< 6 months – QAS Clinical Consultation and Advice Line approval required in all situations.
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> 30 kg
45 microg
0.9 mL
10 kg
10 microg
0.2 mL
10 – < 15 kg
10 microg
0.2 mL
15 – < 20 kg
15 microg
0.3 mL
20 – < 25 kg
20 microg
0.4 mL
25 – 30 kg
25 microg
0.5 mL
> 30 kg
30 microg
0.6 mL
CCP
Volume
ACP2
Dose
ACP2
Weight
ACP1
Repeated once at 1 microg/kg at 10 minutes.
SUBCUT
IM
QAS Clinical Consultation and Advice Line approval required in all situations.
≥ 1 year – 1–2 microg/kg
Single maximum dose 50 microg.
Total maximum dose 2 microg/kg.
UNCONTROLLED WHEN PRINTED
CCP
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
IM
≥ 1 year – 1–2 microg/kg
Single maximum dose 50 microg.
Repeated at 1 microg/kg (maximum 25 microg) at 10 minute intervals.
No maximum dose.
UNCONTROLLED WHEN PRINTED
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
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Fentanyl
ACP2
Significant pain (cont.)
IV
≥ 1 year – 1 microg/kg
Single maximum dose 25 microg.
Repeated at 0.5 microg/kg (maximum 25 microg) at 5 minute intervals.
Total maximum dose 2 microg/kg.
Paediatric dosages (cont.)
Sedation (for the maintenance of an established ETT)
CCP
Paediatric dosages (cont.)
IV
≥ 1 year – 1 microg/kg
Single maximum dose 25 microg.
Consider administration with midazolam.
No maximum dose.
UNCONTROLLED WHEN PRINTED
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
IV
≥ 1 year – 1 microg/kg
Single maximum dose 25 microg.
Repeated at 0.5 microg/kg (maximum 25 microg) at 5 minute intervals. No maximum dose.
CCP
CCP
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
IO
≥ 1 year – 1 microg/kg
Single maximum dose 25 microg.
Consider administration with midazolam.
No maximum dose.
UNCONTROLLED WHEN PRINTED
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
< 1 year – QAS Clinical Consultation and Advice Line approval required in all situations.
Note: QAS officers are NOT authorised to administer fentanyl to paediatric patients presenting with cardiogenic
chest pain.
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UNCONTROLLED WHEN PRINTED
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