Oral fentanyl AKA lollipop

[Doczilla]

Originally Posted by 82ndtrooper

I understand that composition of the opiod and other elements to the medication are measured differently, but is 1600mg equivalent to say 100mg of Demerol, or 10mg of Morphine, 4mg of Stadol ?

What is the anesthetic effect of this drug ? It seems like a whopper of a dosage if it's purely an synthetic opiod with phenagan for nausea.

Equianalgesic dosing is roughly:
100mcg of IV Fentanyl = 10mg of IV morphine = 75mg of IV demerol

Fentanyl provides analgesia in the same manner of all opiods, but can be used in higher doses to produce coma.

The 1600mcg fentanyl lollipop is roughly equivalent to carrying 160mg of morphine. To be honest it may not be as effectively absorbed by mouth as it is when given IV, so the effective dosage the patient gets may be less. It comes in dosages ranging from 400mcg to 1600mcg.

That said, the patient doesn't get it all in one dose. It's designed to be titrated as needed, and has a much shorter duration of action than morphine. The 1600mcg lollipop means that the patient will be able to get repeat doses for some significant period of time without breaking out more ampules of medicine. This is key in the austere environment, where the medic can carry this one little lollipop that will sustain the patient's pain control needs over a long period of time, as evacuation may be prolonged.

Fentanyl is a terrific prehospital drug to use for pain control. In most EMS settings and even in many military ones (downtown Baghdad), the lollipop is too much drug for a short transport time, and most of it would be wasted (these things aren't cheap). IV fentanyl is a very good choice here. It can be used like anything else for acute pain control. I often add it to my RSI regimen, and it can be used as a continuous infusion in the ICU for patients on the ventilator.

As Crip said, reductions aren't frequently done in the prehospital setting. A paramedic may use procedural sedation for cardioversion or transcutaneous pacing. For intubation, the doses of meds are higher, and it's technically not "procedural sedation" since you don't usually care if they keep breathing or not.

'zilla

[52bravo]

some good points doczilla

i here in Denmark it is meant to replaces the 10 mg morphine IM. and it is not meant to replaces IV pain medicine.

it work fast in ped's, but you say it dont fast in adults? your ref. to bagdad.

on the dosis:Normally 25% of the drug is absorbed via the buccal mucosa directly into the bloodstream while the remaining 75% is swallowed and then slowly absorbed in the gastrointestinal tract. Two-thirds of the swallowed (or 50% of the total dose) is metabolized by the liver and becomes unavailable for any pain relief function. This is why the drug is far less potent if consumed orally compared to transmucosally.

[ernesto]

manufacturer told me Fentanyl Lollipops will be good for about 9 month under conditions like in Iraq and Afghanistan. This is an off the record info though.
And no they dont melt in the sandbox.

approximately:
600 mcg Fentanyl transmucodermal : 60 mcg Fentanyl iv : 6 mg Morphine iv : 18 mg Morphine oral

Id carry 600 or 800 mcg lozenges


ernesto

[The Reaper]

ernesto, have you followed the instructions in your registration message before posting?

TR