Open Access(215) Experience with Oral Transmucosal Fentanyl Citrate Opioid‐Tolerant Patients at a Large Cancer Institution
Author(s) -
Kornick Craig A.,
Kesselman Donna R.,
SantiagoPalma Juan,
Khojainova Natalia,
Yim Jeremiah,
Gonzales Gilbert R.
Publication year - 2001
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2001.pme01039-15.x
Subject(s) - medicine , odynophagia , cancer pain , anesthesia , opioid , fentanyl , cancer , surgery , receptor , dysphagia
Background: Oral transmucosal fentanyl citrate (OTFC) is approved for the control of cancer breakthrough pain. Patients at our institution were noted to be using OTFC for around‐the‐clock dosing, (2) IV opioid supplementation, (3) “when water was unavailable to swallow pills”, (4) wound care (5) anxiety and insomnia, and (6) gastrointestinal obstruction. Objective: To evaluate the use and barriers for OTFC. Methods: We attempted to contact 67 consecutive cancer patients by telephone 5 months after they were prescribed OTFC at our institution and asked the following: (a) Are you still using OTFC?; (b) If “yes”, for what reasons?; and (c) If “no”, why not? Results: 22 now deceased, 14 not available, 3 with no recollection of OTFC use, 1 never filled the prescription due to concern regarding potential hazards to children and pets. Thirteen patients were using OTFC for cancer breakthrough pain. 14 discontinued OTFC for the following reasons: 5 due to resolution of pain (post‐operative pain and radiation‐induced odynophagia); 7 due to suboptimal pain relief; 1 due to conversion to a continuous IV opioid infusion; 2 due to excessive sedation; and 1 due to self‐consciousness during public use. Discussion: Although OTFC is approved for cancer breakthrough pain, we have identified other uses in our patients, including the following: around‐the‐clock dosing; as a “more convenient” substitute for pills; as an anxiolytic or hypnotic; for procedure‐related pain; for radiation‐induced odynophagia; and in patients with gastrointestinal obstruction. Reasons given for discontinuing OTFC include: ineffective pain relief; side effects; stigmata associated with public use; conversion to continuous parenteral opioids; and concern of accidental intoxication by others. Closer monitoring of compliance and appropriate dose titration may improve the therapeutic use of OTFC.