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Fentanyl is a strong opioid medicine that can be prescribed by your doctor as part of a broader strategy to help manage your pain. Fentanyl, also spelled fentanil, is a highly potent synthetic piperidine opioid drug primarily used as an analgesic. Because fentanyl is 50 to 100 times more potent than morphine, its primary clinical utility is in pain management for cancer patients and those recovering from painful surgical operations.^[6]Fentanyl is also used as a sedative.^[7] Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose.^[8] Fentanyl works by activating mu-opioid receptors.^[4] Fentanyl is also commonly known as fentanyl citrate, and is sold under the brand name Sublimaze among others.^[9]

Pharmaceutical fentanyl’s adverse effects resemble those of other narcotic opioids, including addiction, confusion, respiratory depression (which, if extensive and untreated, may lead to arrest), drowsiness, nausea, visual disturbances, dyskinesia, hallucinations, delirium, a subset of the latter known as “narcotic delirium”, analgesia, narcotic ileus, muscle rigidity, constipation, loss of consciousness, hypotension, coma, and death.^[7] Alcohol and other drugs (i.e., cocaine, heroin) can synergistically exacerbate fentanyl’s side effects. Naloxone (also known as Narcan) can reverse the effects of an opioid overdose; however, because fentanyl is so potent, multiple doses might be necessary.

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Fentanyl is used to treat acute (short term), severe pain caused by major trauma or surgery, as well as for chronic pain caused by cancer. How long you need to take fentanyl for will depend on why it has been prescribed. For example, fentanyl patches for cancer pain or in people receiving palliative care are approved for life-long use, while fentanyl used in acute pain or anaesthesia will be used only for a short time.

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Fentanyl reduces feelings of pain by interrupting the way nerves signal pain between the brain and the body. It works directly on the central nervous system.

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Fentanyl is available in several formulations in different strengths, including:

• patches to stick on your skin
• lozenges
• tablets that disintegrate in your mouth
• sublingual (under the tongue) tablets
• a spray applied inside your nose

Fentanyl is also given by injection for acute, severe pain or as part of anaesthesia before surgery.

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All opioids, including fentanyl, can have side effects, including life-threatening breathing problems. The risk of side effects is higher:

• when first taking fentanyl
• after a dosage increase
• if you are older
• if you have an existing lung problem

Fentanyl affects everyone differently. If you have any of these side effects while taking fentanyl, or if you notice anything that is making you feel unwell, speak with your pharmacist or doctor.

The side effects of fentanyl are similar to those of other opioids, and include:

• rash or skin reaction from a fentanyl patch
• constipation
• headache or dizziness
• fatigue or drowsiness (especially soon after a dose)
• loss of appetite, nausea and vomiting

It is important to follow the directions given to you by your doctor or pharmacist when taking this medicine.

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Opioids are strong pain medicines and can cause life-threatening or fatal breathing difficulties.Fentanyl may make it difficult for you to drive or operate heavy machinery. If you have recently started taking an opioid medicine or changed dosage, you may be at a higher risk of having an accident. If your kidney or liver function is impaired, your doctor may decide that fentanyl is not right for you. Fentanyl is not suitable for some people, for example, if you drink alcohol or take other medicines that can cause drowsiness. Never take an opioid medicine that was prescribed for someone else, or give another person an opioid that was prescribed for you. Your doctor is the best person to guide you on whether fentanyl is the right medicine for you, how much you need and how long to take it for.