# Fentanyl Effectiveness (Intranasal Administration)



## High Speed Chaser (Apr 14, 2010)

So I have heard from a few sources that Fentanyl (specifically Intranasal Administration which can be given to what is equivalent to an EMT-I with our EMT-P equivalents being allowed to give it IV) is very ineffective and that most are reluctant to use it. I have also heard from other sources that Fentanyl can be better than Morphine in certain situations but I'm assuming that this is not the case for Intranasal Administration.

Is this a specific problem with the Fentanyl (itself), the intranasal administration of Fentanyl via or intranasal administration of any drug?

Anyone have experiences with the use of Fentanyl via different routes of administration?


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## MrBrown (Apr 14, 2010)

IN meds are bloody marvelous; we have IN naloxone and IN midaz however with fent replacing morphine I wager a bet we'll get IN fent too .... wow a lot of IN going on? 

Yes the dosage is slightly higher and onset minimally delayed but it is a great option for when IV admin is difficult or not required/posslbe.


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## boingo (Apr 14, 2010)

Huge fan of IN, assuming you don't have bleeding, snots, etc...IN fentanyl and midaz work very fast and are very effective.


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## dmiracco (Apr 14, 2010)

Not a huge fan of IN admin, if thats your only option at the time then ok but there are better routes. There are a few variables with IN so its dependant upon each patient as the onset and effectiveness of that med. Its just something new so I have seen some medics do it becuase they can type of mentality.


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## Shishkabob (Apr 14, 2010)

Might just be me, but I don't want to fumble around with a sharp trying to get benzos on board for a seizure.



Yes, fumble.  What can I say, I'm new.


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## Epi-do (Apr 14, 2010)

I have given fentanyl IN a few times, and have had it work well every time I have used it.  The biggest complaint I have gotten from anyone is that it tastes horrible, and one person said they felt like they were drowning and asked for an IV.


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## Smash (Apr 14, 2010)

My personal experience with no data to back it up, is that IN fentanyl is extremely effective in children, but less so in adults. 

Great option to have.


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## dmiracco (Apr 14, 2010)

You also have to watch the amount of fluid (cc) that you can admin per nare, just another drawback of this route.
But you can always can tell them to open there mouth and squirt it in. LOL


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## Melclin (Apr 14, 2010)

Some of the people who dislike IN fent don't necessarily dislike it because it isn't effective. The fact that many in ambulance don't like change also comes into it. I don't want to spread aspersions about all older medics but the reality is, as you will have picked up at uni, that _some_ joined up when the service didn't do much more than your average Johno in terms of scope and every time they have some new medical thingy to learn it pisses them off. 

Others have a legitimate beef with trying it and it not working. I think it probably has a lot to do with technique and preparation, nose blowing, patient snorts or doesn't etc. I've seen it used twice, and it worked well both times. We could probably stand to learn a lot from our American cousins who seem to have a bit more experience with the IN route.

Also the IN fent calcs are a pain in the arse for kids, so many just don't feel you need to use it. Granted I've no experience, but I think its unfair to leave a person in pain because you can't be bothered doing your job.

ADULTS: The IN fent comes in 900mcg/3ml amps, its 200mcg for <60kg and/or <60yrs old, 100mcg for older and thinner, 50mcg maintenance doses 2 if the initial dose is 100 and four if the initial dose is 200.

KIDS: For kids its 2mcg/kg, 2x 1mcg/kg maintenance doses, <25 kg uses the 100mcg in 2ml amps.

All doses add .1ml for the atomizer's dead space.

It is a _bit_ of a pain in the arse. But then, you have drug cards and you have 5-15 minutes driving to the scene to figure out your calcs for predicted drugs needs...


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## MrBrown (Apr 14, 2010)

Melclin said:


> ADULTS: The IN fent comes in 900mcg/3ml amps, its 200mcg for <60kg and/or <60yrs old, 100mcg for older and thinner, 50mcg maintenance doses 2 if the initial dose is 100 and four if the initial dose is 200.
> 
> KIDS: For kids its 2mcg/kg, 2x 1mcg/kg maintenance doses, <25 kg uses the 100mcg in 2ml amps.
> 
> ...



Yuck what a pain in the arse 

If 300mg is 1ml then 200mcg is what, about 0.66ml ... yeah I can see where that's a bit of a bugger right there and that's w/o even counting the 50/100mcg doses.

Ick thats just nasty.


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## Melclin (Apr 14, 2010)

MrBrown said:


> Yuck what a pain in the arse
> 
> If 300mg is 1ml then 200mcg is what, about 0.66ml ... yeah I can see where that's a bit of a bugger right there and that's w/o even counting the 50/100mcg doses.
> 
> Ick thats just nasty.



There are memory shortcuts. 75, 45, 25 for example is the .75, .45, and .25 mls for the adult 200, 100 and 50mcg doses plus dead space. 

I think the problem lies in the two different amps and their calcs. In paeds if you did the calc for the 100mcg/2ml concentration and messed up the vials for some reason and used the 900/3, you can easily OD a kiddy. But still, its just the same as any other drug. If you pick the wrong vial, its bad juju.


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## mycrofft (Apr 14, 2010)

*The mfger will pack it in convenient doses.*

But, what an abuse potential!

Here in Allergy Central of the West Coast, intranasal admin might be mechancally iffy.

I remember IN was the coming thing about five years ago, and twenty years ago it was trans tracheal.
If medical MJ is so great, the next route mnight be to SMOKE everything? ("Laerdahl Non-Rebreathing Powerhitter 7000"?).<_<


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## BBFDMedic28 (Apr 15, 2010)

I am personally a big fan of IN


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## Melclin (Apr 15, 2010)

mycrofft said:


> But, what an abuse potential!
> 
> Here in Allergy Central of the West Coast, intranasal admin might be mechancally iffy.
> 
> ...



I reckon if you want to abuse fentanyl Victoria is the place to do it right now. 400mcg max total dose from single use 900mcg vial. They warned people in the PDP day on fentanyl when it came in to watch their colleagues with it :wacko:

Not a bad idea. Whats that Mrs Magoo? You've NOF'd yourself. Now worries, here's a pipe, now.. chase the dragon. I'll have Lien-Hua bring you some herbal tea in about an hour.


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## MrBrown (Apr 15, 2010)

Melclin said:


> I reckon if you want to abuse fentanyl Victoria is the place to do it right now. 400mcg max total dose from single use 900mcg vial. They warned people in the PDP day on fentanyl when it came in to watch their colleagues with it :wacko:
> 
> Not a bad idea. Whats that Mrs Magoo? You've NOF'd yourself. Now worries, here's a pipe, now.. chase the dragon. I'll have Lien-Hua bring you some herbal tea in about an hour.



You make no sense mate .... you been dipping into the magic MAD spray again?


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## Melclin (Apr 15, 2010)

MrBrown said:


> You make no sense mate .... you been dipping into the magic MAD spray again?



Haha nah just all that penthrane floating around  (I was referencing opium dens, BTW).


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## MrBrown (Apr 15, 2010)

Melclin said:


> Haha nah just all that penthrane floating around  (I was referencing opium dens, BTW).



Yeah I figured ... put the green whistle down mate


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