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Dose:

Acute pain

SC or IM injection, 5 mg repeated every 4 hours if necessary (up to 10 mg for heavier well-muscled patients)

by slow IV injection, quarter to half corresponding intramuscular dose

Myocardial infarction

by slow IV injection (1 mg/minute)

5 mg followed by a further 2.5–5 mg if necessary

elderly or frail patients, reduce dose by half

Acute pulmonary oedema

by slow IV injection (1 mg/minute) 2.5–5 mg

Chronic pain

Oral, SC or IM 5–10 mg regularly every 4 hours

dose may be increased according to needs

IM dose should be approx. half corresponding oral dose, and approx. one third corresponding oral morphine dose, by subcutaneous infusion (using syringe driver) in palliative care

Fentanyl by A. McLeod

Indications: breakthrough pain in patients already receiving opioid therapy for chronic cancer pain (lozenges); chronic intractable pain (patches).

Group: Opioid analgesics. Fentanyl is about 80x more potent than morphine

Duragesic: is a fentanyl transdermal patch used in chronic pain management. Duragesic patches work by releasing fentanyl into subcutaneous fats, which then slowly release the drug into the blood stream over 72 hours, allowing for long lasting relief from pain.

Duragesic is manufactured in five patch sizes: 12.5 µg/h, 25 µg/h, 50 µg/h, 75 µg/h, and 100 µg/h. Dosage is based on the size of the patch, since the transdermal absorption rate is generally constant at skin temperature. Dosages above 25 µg/h should not be prescribed unless the patient is opioid tolerant (seek senior advice).

Pethidine by A. McLeod

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