# Fentanyl Lollipops



## rhan101277 (Jul 23, 2009)

I know these aren't use in the pre-hospital arena, but that the actual drug is.  I wondered why such a big dosage would be issued to a child as in this picture.

http://www.pharmer.org/files/images/fentanyl pop.jpg

If a child was to eat this whole thing seems like they would overdose.  Normal child dosage is 2-3mcg/kg, but this lollipop is 1200mcg, so a 50kg kid would have a 150mcg dose.  I don't see how they know they have eaten the proper amount of it.

Also why is the child dosage higher than the adult dosage of 1mcg/kg?  Most times children get lower doses than adults when it comes to meds.

I want to see if I am doing math right.  If you give a child 50mcg, they should weigh 32lbs right?


----------



## Aidey (Jul 23, 2009)

Why was the child prescribed it?


----------



## ResTech (Jul 23, 2009)

My guess the total dose of the lollipop is so high because its a PRN kinda thing. The child and also adults, suck on it when they need pain relief. They dont suck the whole thing down all at once and are instructed Im sure not to bite it and chew it.


----------



## rhan101277 (Jul 23, 2009)

In most cases, fentanyl lollipops are prescribed to:

    * patients with a tolerance to opioids or other pain medication (typically patients will already be taking at least 60 mg of morphine per day and/or 50 µg/h fentanyl)
    * treat breakthrough cancer pain
    * treat other non-malignant, severe chronic pain (which can be associated with bone injuries, severe migraines, etc.)

Some examples of this is prescribed to children.

bone marrow aspiration or lumbar puncture

I guess they suck on it through the day.


----------



## VentMedic (Jul 23, 2009)

You are looking at IV doses. PO or Lollipop can be 10 - 15 mcg/kg

IV for a single doee can be 0.5 - 5.0 mcg/kg.

Infusion is 1 - 3 mcg/kg/hr

There is also a transdermal dose.

We use the lollipop for a variety of painful procedures for kids. No, we do not allow them to suck on it all day. Usually within 15 - 30 minutes we have a good result.

They range in total dose from 200- 1400 mcg. 

Adults are usually the ones prescribed for them outside of the hospital for chronic pain and pallative care.


----------



## Shishkabob (Jul 23, 2009)

rhan101277 said:


> * patients with a tolerance to opioids or other pain medication (typically patients will already be taking at least 60 mg of morphine per day and/or 50 µg/h fentanyl)



Seems to be the answer right there.


----------



## rhan101277 (Jul 23, 2009)

VentMedic said:


> You are looking at IV doses. PO or Lollipop can be 10 - 15 mcg/kg
> 
> IV for a single doee can be 0.5 - 5.0 mcg/kg.
> 
> ...



Higher doses are given for PO to achieve same effect as IV or infusion?  Since route takes longer to absorb?


----------



## VentMedic (Jul 23, 2009)

Linuss said:


> Seems to be the answer right there.


 
Most of toddlers aren't drug seeking addicts. They are just frightened of the hospital and the really big needles we're about to use for some really painful procedures.


----------



## Shishkabob (Jul 23, 2009)

rhan101277 said:


> Higher doses are given for PO to achieve same effect as IV or infusion?  Since route takes longer to absorb?



When drugs are given PO, they go through the liver (hepatic first pass) before moving on to the rest of the body.  This greatly reduces the concentration of the drug.

When given by IV, IM, IO, and SubQ, they get to bypass the hepatic first pass and get directly into the bloodstream.


----------



## paccookie (Jul 23, 2009)

VentMedic said:


> Most of toddlers aren't drug seeking addicts. They are just frightened of the hospital and the really big needles we're about to use for some really painful procedures.



Or they are the cancer patients in pain.  :sad:


----------



## rmellish (Jul 24, 2009)

Anyone have the number to the candy shop that made that? I'd like to place an order.


----------



## thrilla82 (Jul 24, 2009)

works great for the infantry guys as well.  tape it to their finger and say "dont chew!"  once the desired amount hits them, their hand moves from their mouth.  and when they start complaining about the pain again, you remind them to look at their finger.


----------



## rhan101277 (Jul 24, 2009)

I just think it would be hard for some people to resist chewing it.


----------



## medicdan (Jul 24, 2009)

Was this the original form of PCA-- patient controlled analgesics?


----------



## timmy84 (Jul 24, 2009)

emt.dan said:


> Was this the original form of PCA-- patient controlled analgesics?



I think the original form of PCA was taking asa when your head hurt... better yet when the first person to discover the first analgesic used it the first time (perhaps an ancient Mesopotamian person who accidentally ate a poppy while he had a headache, then continued to do so for other types of pain??).   But the lollipop is really great for palliative uses.  I volunteer for a home hospice service, and they really make a difference when the pt cannot swallow anymore, and there is not a nurse to push anything (or often no IV access possible, and they usually do not want one anyway).


----------

