Breakthrough cancer pain occurs at least once in 2/3 of cancer patients. Either morphine sc injections, which require a needle, or fentanyl intranasal, which requires multiple sprays, has been used. Sufentanyl intranasal spray requires much less.
Palliative Medicine 2009; 23: 54–58
Intranasal sufentanil for cancer-associated breakthrough pain
P Good et al abstract here
- 30 cases 60% on sc. morphine for breakthrough
- used “GO Medical patient controlled IN analgesia device” which delivers 0.18ml – so for sufentanyl 50 mcg/ml, a spray gave 9 mcg. See here re sprayer:
Innovative Products To Improve Common Medical Procedures – Go Medical intranasal - Plan to achieve frequent drowsiness with easy to rouse
- Started with 1 spray (9 mcg) every 10 minutes up to the 30 minutes
- If required redosing doubled -2 sprays (18 mcg) every 10 minutes
- if this required the redosing, started with 4 sprays (36 mcg) and repeated twice at 10 minute intervals
Pain scores were 5.5 ,3,and 2 at 0, 15 and 30 min respectively (p<0.0001 at 15 and 30 min)
Average dose of 16 mcg = 2 puffs in 63 % cases – range 9-108 mcg (1-16 puffs)
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2 nausea; 1 headache causing D/C med; one ineffective; one could not use inhaler because of hand OA.
Comment – great innovation in which most are happy with 1-4 sprays. Some years ago, I tried to get the nursing staff to use it on one of my pateints – they refused as they were not comfortable with it. Either introduce a hospital protocol or you will have to sit and administer it yourself a couple time to make the staff confortable using it..
Coming soon:
Onsolis – Fentanyl Buccal Soluble Film Efficacy using BioErodible MicroAdhesive =BEMA technology
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Be here in July 2010 – looks like a contact lense
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adheres in < 5 seconds
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bioerodes in 15-30 minutes
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no way of knowing safe dose so start with 200 mcg
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works in 15-30 minutes
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Absorption is slower than nasal spray and so is the drowsiness less.
Any comments on its use?