Fentanyl (Abstral, Actiq, Durogesic, Effentora, Instanyl, PecFent)

Fentanyl is a type of opioid. It treats moderate to severe pain. Opioids work by mimicking the body’s natural painkillers, endorphins. They control pain by blocking pain messages to the brain. You can find out about cancer and pain control in our coping physically with cancer section.

You can only get fentanyl on prescription from a doctor. Your dose of fentanyl will be specific to you and depends on the amount you need to control your pain. Your doctor or nurse will give you instructions on how much to have and when to have it.

Because fentanyl is an opioid, some people worry about becoming addicted. When you take an opioid to control pain, you are very unlikely to become addicted. The body uses the drug to control pain, not to make you feel high. You can read about fear of addiction in our treating pain section.

You can have fentanyl in the following ways, as a

• Patch you stick on your skin
• Lolly or lozenge
• Fentanyl tablets
• Nasal spray

Fentanyl patch

The brand names of fentanyl patches include Durogesic DTrans and Tilofyl. There are other brand names. You stick a fentanyl patch on your skin and the drug is absorbed into your body over a period of time. Doctors call this a transdermal system.

The best areas to put the patches are on your upper arm, the top of your chest or on your back. To make sure that you get the dose of fentanyl that you need, find an area of skin that is

• Clean and dry
• Not too hairy – you can cut the hair but shouldn’t shave the area
• Not irritated or sore
• Not a previous radiotherapy site
• Flat and not likely to wrinkle when you move
• Has no creams, soap or lotions on it

All of these can change how you absorb the drug so you may absorb more or less.

You will need to have another type of painkiller when you put the first patch on. The patches take a while to reach the correct dose at first, and won’t work fully for 24 hours. They usually last for 72 hours. When you need to change a patch, put the new one on a different area of skin. Your skin can get sore or itchy if you keep putting them in the same place. Don't forget to remove your old patch.

When you open the packet you need to be careful not to damage the patch, so don’t use scissors. When you stick the patch onto your skin, press hard for about 30 seconds with the palm of your hand. Make sure that it has stuck, especially around the edges.

The patch can loosen and may not work so well when it is hot or you are sweating a lot. If it becomes loose, you may need to stick some tape over the patch. If it becomes a problem, talk to your nurse or doctor. Tell them if you have a high temperature (fever) because this can sometimes increase the amount of fentanyl you absorb. Don’t put any direct heat on the patch, such as a hot water bottle, because this can also increase the amount you absorb.

Remember that when you remove the patch it can take 24 hours for the effects of the drug to wear off.

Fentanyl lolly or lozenge

The brand name for this lozenge on a stick is Actiq. It gives fast relief of pain. You suck the lozenge and move it around your mouth so that it is in contact with the mouth lining. You may have it to relieve any pain that you get between doses of other painkillers. This is known as breakthrough pain. You usually suck the lolly for about 15 minutes. It should start to control pain within 5 minutes and work fully within 30 minutes. You must not chew or swallow the lozenge. 

Fentanyl tablets

The brand names are Abstral or Effentora. Fentanyl tablets give fast relief of pain. You may have them to relieve any pain that you get between doses of other painkillers (breakthrough pain). You put the tablet under your tongue and it dissolves. It usually starts to control pain within 5 minutes and works fully within 30 minutes.

Nasal spray

The brand names are Instanyl or PecFent. It gives very fast pain relief and works about 5 minutes more quickly than fentanyl lollies or tablets. It can be very helpful in giving quick pain relief to people who have nausea or vomiting, a very sore or dry mouth, or who can't swallow.

More than 10 in every 100 people have one or more of these.

• Constipation – to prevent this, try to drink at least 2 litres of fluid, eat at least 5 portions of fruit and vegetables a day, and ask your doctor if you should have a laxative. Contact your doctor or nurse if you have a change in your normal bowel movements for more than a few days
• Feeling or being sick – this usually wears off after a few days, but tell your doctor or nurse if it continues. You may need an anti sickness drug at first
• Drowsiness may be a problem at first or when you increase the dose, but usually wears off after a few days

Between 1 and 10 in every 100 people have one or more of these.

• Dizziness
• A dry mouth
• Headaches
• Mood changes – you may feel very happy or feel low in mood
• Confusion
• Narrowing of your pupils in your eyes
• Reduced sex drive (libido)
• Griping pain in your stomach – if you have this and haven’t opened your bowels for a few days tell your doctor or nurse
• Skin reaction – your skin may be red for a day or so after removing a patch

Fewer than 1 in 100 people have these.

• Difficulty passing urine
• Slowing of the heart beat or palpitations – tell your doctor or nurse because you may need a lower dose of fentanyl
• A drop in blood pressure
• Slowed breathing – tell your doctor or nurse as you may need a lower dose of fentanyl

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. You should have a contact number for your specialist nurse. You can ring them if you have any questions or problems. They can give advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements, and other over the counter remedies – some drugs can react together.