Fentanyl sublingual spray for breakthrough cancer pain in patients receiving transdermal fentanyl.

Abstract

aim: To investigate the relationship between effective fentanyl sublingual spray (FSS) doses for breakthrough cancer pain (BTCP) and around-the-clock (ATC) transdermal fentanyl patch (TFP). Methods: Adults tolerating ATC opioids received open-label FSS for 26 days, followed by a 26-day double-blind phase for patients achieving an effective dose (100-1600 μg). Results: Out of 50 patients on ATC TFP at baseline, 32 (64%) achieved an effective dose. FSS effective dose moderately correlated with mean TFP dose (r = 0.4; p = 0.03). Patient satisfaction increased during the study. Common adverse events included nausea (9%) and peripheral edema (9%). conclusion: FSS can be safely titrated to an effective dose for BTCP in patients receiving ATC TFP as chronic cancer pain medication. clinicaltrials.gov identifier: NCT00538850 Keywords• breakthrough cancer pain • fentanyl sublingual spray • transmucosal immediate-release fentanyl David S Alberts, MD, and co-authorsPersistent underlying pain in patients with cancer is effectively managed by around-the-clock (ATC) opioid analgesics; however, transient exacerbations of pain that occur spontaneously over the underlying pain, commonly described as breakthrough cancer pain (BTCP), can occur [1,2]. BTCP is reported by 15-100% of patients with cancer depending on the clinical setting and patient population studied [3][4][5][6][7][8][9]. In a systematic review of 19 observational Practice points• Patients with cancer-related pain may require around-the clock (ATC) opioid analgesics.• Despite ATC opioids, breakthrough cancer pain (BTCP) may necessitate the use of additional analgesics.• Fentanyl products such as the transdermal fentanyl patch and fentanyl sublingual spray may be prescribed to manage BTCP.• Treatment of cancer-related pain is complex and requires thorough understanding of the relationship between doses of concomitant medications and their analgesic and adverse effects.• The current study indicates a weak-to-moderate correlation between the effective dose of fentanyl sublingual spray used to treat BTCP and the effective dose of ATC transdermal fentanyl patch.• Initiating treatment with a low dose of a fentanyl sublingual spray and titrating upward to identify an effective dose may be an efficacious strategy for patients receiving ATC transdermal fentanyl patch and fentanyl sublingual fentanyl spray.• Fentanyl sublingual spray is generally well tolerated in patients receiving ATC transdermal fentanyl patch for BTCP.Pain Manag. (Epub ahead of print)

The use of fentanyl in pain management in head and neck cancer patients: a narrative review

“…One of the advantages of fentanyl is that it is available in different ways of administration: transdermal patch, sublingual tablet, intranasal spray, pectin-based nasal spray and so on. 23–29 Each way of administration responds to the need for cover baseline pain or control BTcP.…”