Indications & Dose: ADJUNCT TO GENERAL ANAESTHESIA IV Adult Inj: In patients with spontaneous respiration, initially 50-200µg with supplements of 50µg, In ventilated assisted patients initially 300µg-3.5mg (up to 50µg/kg) with supplements of 100-200µg depending on the patient’s response Child Spontaneous respiration: 1 month-12 yr: Initially 1-3µg/kg over 30 sec, then 1µg/kg as required, 12-18 yr: initially 50-100µg over 30 sec then 25-50µg as required, In ventilated assisted neonate: Initially 1-5µg/kg over 30 sec, then 1-3µg/kg as required, 1 month-12 yr: Initially 1-5µg/kg, then 1-3 µg/kg as required, 12-18 yr: Initially 1-5µg/kg then 50-200µg as required | ADJUNCT TO REGIONAL ANAESTHESIA IV/IM Adult 50-100µg over 1-2 min | BREAK THROUGH CANCER PAIN Adult Transmucosal: Initially 1 lozenges (200µg) given over 15 min for an episode of breakthrough pain, may be repeated 15 min required. Based on response doses are subsequently titrated, max 1.6mg. Once the patient is stabilised with effective dose, no more than 4 lozenges/day should be taken | EMERGENCE DELIRIUM IM General 50-100µg 30-60min q1-2h | INTRACTABLE PAIN Chronic TD Adult Patches: Initially 25µg/h in opioid naive patients. Prior to initiation of fentanyl, patients are initially treated low doses of short-acting opioids. Patients already treated with strong opioid analgesic, the initial dose of fentanyl should be based on the previous 24h opioid requirement. Use of patch providing fentanyl 25µg/h is equivalent to 60-90mg/day of oral morphine sulfate. During transfer to treatment with fentanyl patches previous opioid analgesic therapy should be phased out gradually in order to allow for the gradual increase in plasma fentanyl levels. More than 1 patch may be applied if doses >100µg/h are required (applied at the same time to avoid confusion), additional or alternative analgesic therapy should be considered if doses >300µg/h are required. Patches should be replaced q3days with the new patch being applied to a different site | POST-OPERATIVE PAIN IM General 50-100µg 30-60min q1-2h | PREMEDICATION IV/IM Adult 50-100µg 30-60min before surgery | RESTLESSNESS IM General 50-100µg 30-60min q1-2h | TACHYPNEA IM General 50-100µg 30-60min q1-2h

Precautions: History of myasthenia gravis, bradycardia, COPD/other chronic respiratory conditions, renal/hepatic impairment, during withdrawal of drug, obesity, respiratory disease, elderly

ADR: Serious: Respiratory depression, muscle rigidity, hypotension, tachycardia, Others: CNS depression, confusion, abnormal dreams, agitation, amnesia, anxiety, dizziness, euphoria, fatigue, hallucinations, headache, insomnia, nervousness, erythema, pruritus, rash, abdominal pain, flatulence, diarrhea, dyspepsia, urinary retention, anorexia, diaphoresis

DDI: Serious Rifampicin decreases drug level, Ritonavir increases drug level, Voriconazole/Fluconazole inhibits drug metabolism, Propofol leads to grandmal seizures, Benzodiazepines leads to respiratory depression & hypotension, SSRIs leads to serotonin syndrome symptoms

Monitor: Respiratory and CV status, BP, HR, signs of misuse, abuse, or addiction