Fentanyl Citrate - Verde Valley Emergency Medical Services
Narcotic agonist/narcotic analgesic
Mechanism of Action:
Alleviates pain by acting on the pain receptors in the brain; elevates pain threshold.
Depresses central nervous system; depresses brainstem respiratory centers; decreases responsiveness to changes in PaC02.
Increases venous capacitance (venous pooling) and vasodilates arterioles thereby reducing preload and afterload.
Indications and field use:
Analgesia, especially in patients with burns or other trauma, myocardial infarction, renal colic.
Adjunct to sedation in post-intubation state.
Adjunct to induction in Rapid Sequence Intubation
(RSI) or medication assisted intubation
Contraindications
Known allergy or intolerance to drug
(assess for medic alert bracelet)
Respiratory depression if airway and breathing can’t be supported
Known elevated intracranial pressure e.g. mass lesion
Head injury with ALOC (relative)
Asthma (relative)
Adverse Reactions:
MS:
CV:
Muscle rigidity, particularly involving muscles of respiration.
Bradydysrhythmias (common) or tachydysrhythmias, hypotension, orthostatic hypotension
Resp:
CNS:
GI:
Respiratory depression (common) or arrest.
Pupillary constriction. Sedation
Nausea and Vomiting
Derm: Histamine release may cause local or general urticaria
Special notes:
Although chest wall rigidity is uncommon and usually doesn’t result with small doses and slow
IV bolus (over > 2 minutes) the provider must have a heightened awareness this complication could result and be prepared to treat appropriately with benzodiazepines and other airway and mechanical ventilation techniques
Adult Dosage:
IV/IO Dose: 50 mcg slow push (over 2 minutes)
May repeat every 5 minutes at a range of
25-50 mcg IV/IO
Max dose of 200 mcg
IM Dose: 50 mcg
May repeat once in 5 minutes
Remember Fentanyl comes in 100mcg/2ml
Consider the lower dose in the elderly, debilitated, or those with chronic lung disease.
Pediatric Dosage
IV/IO Dose: 1-2 mcg/kg (over 2 minutes)
Max initial dose of 25 mcg
May repeat in 5 minutes
Max dose of 200 mcg
IM/IN Dose: 2 mcg/kg
Max initial dose of 50mcg
May repeat in 10 minutes
Fentanyl Citrate
Onset:
Peak:
1-2 minutes IV/IO
8 minutes IM
3-5 minutes IV route
Less predictable IM route
Duration: 30-60 minutes IV
1-2 hours IM
Duration of respiratory depressant effect of fentanyl may be longer than the analgesic effect
Onset of analgesic action; almost immediate, duration of analgesic action 30-60 minutes.
(0.5 – 1.0 mL of 50mcg/mL concentration) increments
