Fentanyl in palliative care: From pharmacology to clinical use

Fentanyl is a synthetic opioid analgesic with lipophilic, short-acting properties. In cancer-related pain, transdermic fentanyl is widely used for baseline pain. Injectable form was reserved to anaesthesia but is now available by intravenous or subcutaneous route in cases of refractory pain with failure or unmanageable adverse events after morphine or oxycodone. Buccal or intranasal transmucosal forms have shown efficacy for the management of breakthrough pain; titration period is necessary to determine the dose that produced satisfactory pain relief, which is not related to the baseline dose. This article reviews the pharmacokinetics, pharmacodynamics and clinical efficacy of these various forms of fentanyl. (C) 2010 Elsevier Masson SAS. All rights reserved.