Fentanyl

Fentanyl is a type of opioid painkiller. It treats moderate to severe cancer pain. It can also help to control breakthrough cancer pain. Breakthrough pain is pain that occurs despite taking regular painkillers. 

Breakthrough pain can happen suddenly and can be very severe. It might be caused by movement or activities such as walking, changing position, or coughing. It can also be unexpected and happen for no apparent reason.

Fentanyl is not available over the counter. You can only get it with a prescription from your doctor.

Fentanyl is also called:

  • Abstral
  • Actiq
  • Durogesic DTrans
  • PecFent
  • Effentora
  • Matrifen

How fentanyl works

Fentanyl is a type of opioid. Opioids are strong drugs similar to natural pain killing substances made in our body called endorphins. They were originally made from opium poppies but are now man made in the laboratory. 

Opioids block pain messages from travelling along the nerves to the brain. 

How you have fentanyl

You can have fentanyl in different ways including:

  • patches 
  • lollies (lozenges)
  • tablets that dissolve under your tongue or between the gum and the cheek
  • nasal spray 

You should apply a fentanyl patch on a flat part of your upper body or arm. For example, the inner part of your upper arm, the top of your chest, or on your back. 

To make sure that you get the right dose of fentanyl, 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

The patches take a while to reach the correct dose at first. So you might need to have another type of painkiller when you put the first patch on. The drug is absorbed slowly into your body over a period of time. Each patch usually lasts 72 hours (3 days). 

Putting a patch on

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.

When you need to change the patch, first take off the old patch. Then put the new one on a different area of skin. Your skin can get sore or itchy if you keep putting the patches in the same place. 

The patches are usually waterproof, so you can shower and bathe while wearing them. But you shouldn't scrub them. The patch can loosen and might not work so well when it is hot or you are sweating a lot. You shouldn't put any direct heat on the patch, such as a hot water bottle. If it becomes loose, you may need to stick some tape over the patch.

Fentanyl lozenges give fast pain relief. You suck the lozenge and move it around your mouth so that it is in contact with the mouth lining. You might 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 bite, chew or swallow the lozenge. And always keep fentanyl lozenges out of sight and reach of children. 

You might have fentanyl as tablets that dissolve under your tongue (sublingual). Or as tablets that dissolve between your gum and cheek (buccal). 

Dissolvable tablets give fast relief of pain. So you might have them to relieve any pain that you get between doses of other painkillers (breakthrough pain). It usually starts to control pain within 5 minutes and works fully within 30 minutes.

Taking the tablets

If your mouth is dry, take a sip of water to moisten it. Spit out or swallow the water. Then place the tablet as far back under your tongue or between your gum and cheek. The tablet starts to dissolve straight away. 

You shouldn't chew or swallow the tablet as it won't work properly. You can eat and drink normally after the tablet has been completely absorbed. 

The nasal spray gives very fast pain relief. You might have it if you are feeling sick, have a sore month, or if you can't swallow.

Before you apply the spray, blow your nose if you feel the need to. You then spray the liquid up one nostril, while closing the other nostril with a finger. Then breathe in gently through your nose and out through your mouth.

When you have fentanyl

Your doctor or specialist nurse will help you choose the type and dose of fentanyl that best controls your pain. It depends on the pain you have and the amount of drug you need to control it.

You should always take fentanyl exactly as your doctor prescribes it. You shouldn't just stop taking fentanyl. You likely need to slowly reduce the amount you take. Always talk to your doctor or specialist nurse before you change your dose.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse
Early treatment can help manage side effects better.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

The side effects you have also depend on how you have fentanyl. 

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Headaches and dizziness 

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Constipation 

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Drowsiness 

Drowsiness may be a problem at first or when your dose is increased, but usually wears off after a few days.

 Do not operate machinery or drive if you are feeling drowsy.

Difficulty breathing 

You may have difficulty breathing with wheezing and coughing. Let your doctor or nurse know straight away if this happens. 

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

  • mouth problems such as a dry mouth and mouth ulcers
  • taste changes
  • loss of appetite and weight loss
  • watery or loose poo (diarrhoea)
  • sweating more than normal
  • confusion and seeing or hearing things that are not there (hallucinations)
  • mood changes such as low mood (depression)
  • difficultly coordinating your movement, feeling like the room is spinning (vertigo) and falling
  • fits (seizures) and loss of consciousness
  • muscle jerks or spasms
  • tingling or pricking in fingers and toes
  • problems with your eyes such as blurred and double vision
  • indigestion or heartburn
  • passing more wind than usual
  • difficulty passing urine and pain when passing urine
  • heart problems such as high blood pressure and a fast or irregular heartbeat
  • skin changes such as rash and redness
  • difficulty sleeping
  • an allergic reaction
  • feeling cold and generally unwell
  • shaking
  • nose bleeds and pain in your nose

Rare side effects

This side effects happens in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

  • flu like symptoms and high temperature (fever)
  • difficulty getting an erection
  • slow and shallow breathing
  • feelings of intense happiness or confidence and agitation
  • feeling thirsty
  • a build up of fluid in your body (oedema)
  • loss of memory and personality changes
  • tolerance and addiction to fentanyl which can cause withdrawal symptoms if the drug is stopped
  • pain in different parts of your body such as the throat, stomach, joints and muscles
  • bowel problems such as your bowel may stop working temporarily
  • low blood pressure and a slow heart rate
  • a drop in the number of white blood cells which can increase your risk of having infections
  • loss of fluid in your body (dehydration)
  • high blood sugar levels
  • nightmares and vivid dreams
  • hot flushes

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

You should not eat grapefruit or drink grapefruit juice when you are taking this drug because it can react with the drug.

Some fentanyl lozenges and tablets contain types of sugar called glucose or sucrose. If you have diabetes, you need to take this into account. The sugars can also harm your teeth. Make sure you clean your teeth regularly. 

Alcohol and fentanyl

Don't drink alcohol while using fentanyl because it can increase the drowsiness and other side effects.

Pregnancy and contraception 

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding 

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions 

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Tolerance and addition 

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.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
20 Aug 2019
  • Electronic Medicines Compendium

    Last accessed August 2019

  • Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines
    M Fallon and others
    Annals of Oncology, 2018. Vol 29, Supplement 4, Pages 166-191

  • Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis
    R Janknegt and others
    European Journal of Hospital Pharmacy, 2018. Vol 25, Issue 3

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