Intranasal Sufentanyl and Buccal Fentanyl for Breakthrough Cancer Pain

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)

2 nausea; 1 headache causing D/C med; one ineffective; one could not use inhaler because of hand OA. 

New Meds:
Abstral – not here yet but sublingual quick dissolve tablet  

  •  100 -200, 400, 600 800 mcg –
  • Must be able to tolerate 60 mg morphine  

    Onsolis – Fentanyl Buccal Soluble Film Efficacy using BioErodible MicroAdhesive =BEMA technology 

  • Be here in July 2010 – looks like a contact lense
  • adheres in < 5 seconds
  • bioerodes in 15-30 minutes
  • no way of knowing safe dose so start with 200 mcg
  • works in 15-30 minutes
      •  Absorption is slower than nasal spray and so is the drowsiness less.

          

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One Response to Intranasal Sufentanyl and Buccal Fentanyl for Breakthrough Cancer Pain

  1. admin says:

    Saw drug rep today -Onsolis drug was so popular in US, are only introducing it here now by March. Only usable in cases on equivalent of 60 mg Morphine a day already. Put pink side to cheek and white side to teeth – in gum – don’t press it in too hard as will increase salivation and then no stick – just press steady for 5 seconds. Will sell individual or in groups of 10 or box of 30. Comes in strengths 200, 400, 600, 800, and 1200 mcg Fentanyl. Takes 10-15 minutes for effect. For titration, they feel can increase every 4 hours by 200 mcg until get results.

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