Excruciating and often unbearable pain is experienced by patients diagnosed with certain conditions. Individuals with cancer, or suffering from chronic pain due to other conditions may require powerful analgesics for pain management. Very often, opiates or other pain medications are of little or no use in offering relief from pain. In such instances, fentanyl is an opioid analgesic of choice to offer relief round the clock. Considered as one among the most effective and potent analgesics, the medication is in use for close to five decades. Following subsections offer an in-depth view of the medication and the possible side effects of Fentanyl.
Overview of the opioid analgesic
Belonging to the category of opioids such as morphine and oxycodone, Fentanyl is famous for its rapid action and long duration of effects. By virtue of its classification as an opioid and due to the pain-relieving effects, it has infamously become an ingredient used to adulterate illegal drugs. The medication works in the brain by altering the manner in which the body experiences pain and responds to the stimuli. Ideally, the medication is not intended to be used for offering relief from pain that may resolve in time. It is also not recommended as short-term treatment.
While it is considered as similar to morphine, its potency is almost a staggering 100 times greater than morphine. Just 100 micrograms of fentanyl are regarded as equal to 10 mg of morphine in terms of efficacy. It is also used as a sedative for patients who have been intubated, apart from patients with pain from renal conditions. As outlined earlier, it is known to work when other opiates have not delivered desirable outcomes. The medication is also used in treating patients diagnosed with epilepsy.
Mechanism of action of fentanyl
The medication is known to bind to opioid receptors, and the sequence of actions results in the inhibition of activity in nerves. This inhibition brings about a reduction in pain experienced from various conditions. The medication is known for its quick onset of action, and extended duration of action, which helps patients experience relief for a longer period.
Precautions that need to be taken when on Fentanyl
Due to the potency of the medication and the possible undesirable effects, patients are advised to follow certain precautions to prevent undesirable effects. This includes the need for close monitoring by the specialist, to determine if any effects are experienced or if the medication is triggering any allergic reaction, especially the dreaded anaphylaxis. This is a potentially life-threatening condition, and patients experiencing any tell-tale symptoms are to seek urgent medical intervention. For instance, symptoms such as outbreak of rashes, abnormal itching, hoarse voice, and difficulty in breathing are al regarded as possible indications of allergies. Other symptoms include difficulty in swallowing liquid or solids, and unusual swelling in the limb extremities.
Patients are also cautioned to diligently follow dosage instructions, as overdose can bring about dangerous outcomes. Commonly occurring symptoms that could indicate overdose include dizziness or feelings of weakness, and sudden reduction in heartbeat rate. Patients may also experience abnormal seizures, may find it difficult to breathe easily and the skin may also be cold to the touch. Possible side effects of Fentanyl are explained in detail in following sections; however, as precautionary measures, patients are to rise from resting positions slowly, to avoid falling from dizzy feelings. Similarly, consumption of alcohol when on fentanyl may amplify the effects of alcohol and this could result in possible untoward incidents or accidents. This effect may also be experienced when fentanyl is taken alongside medications belonging to the category of central nervous system depressants. Medicines that belong to this category may also be known as antihistamines, or treatment options for allergic conditions and hay fever. These medications are also used for treating cold, seizures, and as sedatives. CNS drugs are also used during dental procedures, apart from being used as muscle relaxants.
Commonly reported undesirable effects of fentanyl
All drugs come with the possibility of side effects and fentanyl is no exception. Undesirable effects are broadly classified into mild or moderate effects, and adverse or serious effects. Typically, mild effects are common in occurrence, while serious effects are known to occur rarely. Moderate effects may not generally require any medical intervention, as the effects either wear away after a few days or resolve naturally with time. Serious effects may require some kind of medical intervention, and in some instances, there may be a need for emergency treatment, depending on the intensity and type of effects. It is necessary to add that effects may not be experienced by all patients, with a significant percentage of users, known to be fully free from any or all side effects.
The type and duration of effects depend on various factors such as the age of the patient, the dosage of the drug, the intake schedule/frequency, the condition being treated, overall health of the patient, and other existing conditions. Here is a compilation of commonly occurring side effects of Fentanyl. This is not a complete or exhaustive compilation, and is intended to serve as a broad reference of the types of effects that may be experienced.
Frequently reported undesirable outcomes
By virtue of the strong effects of the medication in offering relief from pain, the dosage is likely to end up as a habit. Patients may find it difficult to discontinue use of the medication, due to the effects, including the sedative effects. There is a possibility of the drug triggering sleep apnea, a sleep-related breathing complication. In the event of the medication causing sleep apnea, it may be necessary to alter the dosage so as to eliminate the possibility of disruption in breathing while asleep.
Other effects that need to be carefully monitored and handled is the possibility of dizzy or drowsy feelings. The patient is likely to be disoriented or could be confused when on the medication. It is absolutely necessary for patients to stay away from driving or operation of heavy machinery. Similarly, any task or responsibilities that require the individual to be alert with fast reflexes will be unsuitable for patients on fentanyl.
In addition to the above, the patient may end up with constipation when the drug is used for a long stretch. Patients prescribed the medication for lengthier periods are often recommended suitable dietary modifications and formulations to ease the constipation. For instance, the individual will typically be asked to increase intake of fluids, and consume more fiber as part of regular diet. Additionally, the use of laxatives may be recommended to tackle constipation. It is necessary to ensure that constipation is managed effectively, as it could in turn lead to other complications, if left untreated.
Dosage related instructions
Patients on the medication are to stick to the prescribed dosage diligently and should not take decisions regarding the dosage without medical advice. For instance, tapering dosages are only with the recommendation of a specialist, and complete discontinuation is also to be under medical advise and supervision. Gradual tapering of dosage will help to prevent any aggravation of the condition, and also help pre-empt any possible withdrawal effects. For instance, patients are known to experience withdrawal effects such as pain in the stomach, cramps, feelings of anxiety and possible low- or high-grade fever. Other withdrawal symptoms include nausea, profuse sweating, and possible tremors.
Impact on muscles and movement
The medication is known to have an impact on movements and cause some form of muscle rigidity. This may have a direct impact on mobility and ability to perform routine actions. In the event of patients experiencing any effect on the muscles, the same is to be reported to the treating specialist. Individuals experiencing any such effect are to immediately stop driving or performing tasks that require flexibility and control of limbs.
Possibility of serotonin syndrome
Among side effects, certain effects are a cause for concern. For instance, serotonin syndrome is a condition caused when the intake of medications or other illicit drugs result in an increase in serotonin. Excessive serotonin causes various complications, including serious conditions that can turn out to be emergencies. Individuals are to constantly monitor and report symptoms that are indicative of the condition. For instance, feelings of anxiety, or restlessness, or a racy heartbeat are all indications of a possible increase in serotonin levels. Similarly, patients on Fentanyl who experience profuse sweating, or low/high grade fever, and muscle spasms are also to seek evaluation. The risk of this condition increases when the medication is combined with other drugs of certain categories.
Impact on pregnant women and babies in the womb
Pregnant women and women planning a pregnancy are advised to stay off the drug to avoid possible undesirable effects. For instance, the drug may cause possible neonatal withdrawal syndrome in the child, and mothers are to seek urgent medical attention in the event of observing certain tell-tale symptoms. For instance, new born babies with abnormal sleep patterns, or babies that have bouts of diarrhea are reasons for concern. Other possible symptoms include cries that are high-pitched in nature, and babies that get irritated all the time. Sudden loss of weight, or the failure to increase weight like other normal babies, and vomiting are all possible symptoms of the syndrome.
Other possible undesirable effects
In addition to the above, there is also the possibility of individuals experiencing certain conditions. For instance, discoloration of the lips and skin, wherein the color appears bluish is a possible undesirable outcome. Fatigue and overall weakness are another possible outcome, apart from an impact on vision. Abnormal cough, with no apparent reason may also be experienced, while some patients may find it difficult to move the eyes.
Others are known to blink more frequently, or the eyelids may start twitching without any other attributable reason. A pounding sensation in the ears may also be experienced, while some are known to end up with puffed up eyelids. The patient may appear to be behaving abnormally, by sticking his/her tongue out, without consciously or intentionally attempting to do it. Individuals may also find themselves performing certain uncontrolled or unintentional movements, such as twisting the trunk, the arms or the legs.
Education: Master’s in Nursing (MSN) from Johns Hopkins University. Experience: 7 years writing for online health portals and nursing journals, specializing in patient education and chronic illness management.
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