Actiq
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TheLocalMedic
Grumpy Badger
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Actiq may be a good option for chronic pain patients, but we try to keep most patients NPO here until we get to the ER.
Aidey
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TransportJockey
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Out here there's not much use for it. Our intermediates can give dilaudid, fentanyl, and morphine with online orders. I would love to add intranasal fentanyl to our protocols our here though at both levels.
Ive used IN fentanyl and dont really care for it. Patients didnt like it and more ran back out than seemed to stay. Id rather go IM as the alternative to IV. The few patients I tried IN on said theyd rather have had it IM
TransportJockey
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Really? I'd seen some good study results at least from the pediatric side for IN... I have been trying to find more studies to justify it for presentation to our medical director... I've primarily thought of using it for peds, cause they tend to freak out more from the needle than from the bone sticking out of their leg.
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I only have IV or IN routes available for Fentanyl, but I'd much prefer to have the IM option as well. As mentioned, adults would be fine with that for the most part. I've had okay results with IN, but at least getting all of the medication into the body seems like a better plan to me. This is pretty useless as I'm only using anecdotes, but that's all I have at the moment.
In an attempt at avoiding complete and shameless thread jacking, no we do not use Actiq nor have I seen it pre-hospitally. What's the onset time with that route/how well does it control acute pain? I imagine the difficulty would be with the gradual absorption and the fact that you're telling patients it needs to absorb through the oral mucosa rather than be chewed up and swallowed.
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I've had the same experience as shfd with IN Fentanyl. About the only people I give it to now are peds, and that's usually just for the initial dose. I'm quickly losing my fondness of administering drugs intranasally.
Just to at least hit on the topic of the thread, I have no experience at all with Actiq, but would love to hear other people's opinions who have used it.
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It looks like Actiq is only used for cancer patients in the US in a specific research study- are you using it outside the US, or under a special projects waiver?
Aidey
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If only there was some way a doctor could get authorization to use a medication for something other than what it was originally approved for by the FDA... Oh wait...
If only they had a magic pen and could write for whatever the heck they wanted...
I looked a little further, but at the time, it seemed it was only being distributed to hospitals and physicians actively involved in cancer analgesia, and like other study medications under review, could not be used for anything else...
Aidey
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At what time? Actiq isn't even on patent anymore. It's been around for a while. And has been used off label for a while. Fentanyl in general has been used off label for ages.
WARNING: RISK OF RESPIRATORY DEPRESSION, MEDICATION
ERRORS, ABUSE POTENTIAL
Fatal respiratory depression has occurred in patients treated with ACTIQ,
including following use in opioid non-tolerant patients and improper
dosing. The substitution of ACTIQ for any other fentanyl product may
result in fatal overdose.
RESPIRATORY DEPRESSION
Due to the risk of respiratory depression, ACTIQ is contraindicated in the
management of acute or postoperative pain including headache/migraine
and in opioid non-tolerant patients.[see Contraindications[/B]
Actiq is a 200mcg dose of fentanyl, not an insignificant dose. Granted, onset is slower and of course you're not getting a 200mcg dose all at once.
There's a limit to off-label use that I would follow from a cowboy medical director - that applies to a lot of drugs including droperidol and propofol. Using anything outside it's intended/approved purposes carries a medico-legal risk that should be considered. Saying "my medical director said give it" or "it's in our protocols" provides absolutely zero protection to you.
IN fentanyl is great for kids without IV access, less so for adults, and I think in general that's it's only indication.
ERRORS, ABUSE POTENTIAL
Fatal respiratory depression has occurred in patients treated with ACTIQ,
including following use in opioid non-tolerant patients and improper
dosing. The substitution of ACTIQ for any other fentanyl product may
result in fatal overdose.
RESPIRATORY DEPRESSION
Due to the risk of respiratory depression, ACTIQ is contraindicated in the
management of acute or postoperative pain including headache/migraine
and in opioid non-tolerant patients.[see Contraindications[/B]
Actiq is a 200mcg dose of fentanyl, not an insignificant dose. Granted, onset is slower and of course you're not getting a 200mcg dose all at once.
There's a limit to off-label use that I would follow from a cowboy medical director - that applies to a lot of drugs including droperidol and propofol. Using anything outside it's intended/approved purposes carries a medico-legal risk that should be considered. Saying "my medical director said give it" or "it's in our protocols" provides absolutely zero protection to you.
IN fentanyl is great for kids without IV access, less so for adults, and I think in general that's it's only indication.
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