Fentanyl, also spelled 

fentanil, is an opioid used as a pain medication and together with other

medications for anesthesia.[3] It is also used as a recreational drug, often mixed
with heroin or cocaine.[5] It has a rapid onset and its effects generally last under two hours.
[3]
 Medically, it is used by injection, nasal spray, skin patch, or absorbed through the
cheek (transmucosal) as a lozenge or tablet. [3][6]
Common side effects include vomiting, constipation, sedation, confusion, hallucinations, nausea,
and injuries related to poor coordination. [3][7] Serious side effects may include decreased
breathing (respiratory depression), serotonin syndrome, low blood pressure, addiction, or coma.[3]
[7]
 Fentanyl works primarily by activating μ-opioid receptors.[3] It is around 100 times stronger
than morphine, about 50 times stronger than heroin, and some analogues such as carfentanil are
around 10,000 times stronger. [8]
Fentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States
in 1968.[3][9] In 2015, 1,600 kilograms (3,500 lb) were used in healthcare globally.[10] As of 2017,
fentanyl was the most widely used synthetic opioid in medicine.[11] Fentanyl patches for cancer pain
are on the World Health Organization's List of Essential Medicines.[12] In 2016, fentanyl and
analogues were the most common cause of overdose deaths in the United States at more than
20,000, about half of all opioid-related deaths. [13][14][15] Most of these overdose deaths were due to
illegally made fentanyl.[16]
In recent years fentanyl has disrupted the North American drug market, capitalizing on pre-existing
demand for opiates such as heroin and prescription pharmaceuticals. In 2017, it was the 250th most
commonly prescribed medication in the United States, with more than 1.7 million prescriptions. [17][18] At
the same time, there is concern that the growing demand may prove highly attractive to organized
crime and aspiring criminals, especially those operating in areas around the Golden Triangle
(Southeast Asia) and Shan State Myanmar where production of synthetic drugs has expanded
dramatically over the last decade. Compared to heroin, it is more potent, has higher profit margins
and, because it is compact, has simpler logistics. It can be cut into, or even replace entirely, the
supply of heroin and other opiates.[19]

Contents

 1Medical uses
o 1.1Anesthesia
o 1.2Obstetrics
o 1.3Pain management
 1.3.1Chronic pain
 1.3.2Breakthrough pain
 1.3.3Palliative care
 1.3.4Combat medicine
o 1.4Other
 2Adverse effects
o 2.1Respiratory depression
o 2.2Heart and blood vessels
o 2.3Muscle rigidity
 3Overdose
 4Pharmacology
o 4.1Classification
o 4.2Structure-activity
 o 4.3Mechanism of action
o 4.4Therapeutic effects
o 4.5Detection in biological fluids
 5History
 6Society and culture
o 6.1Legal status
o 6.2Recreational use
o 6.3Enforcement
o 6.4Recalls
o 6.5Brand names
o 6.6Cost
o 6.7Storage and disposal
o 6.8Notable deaths
o 6.9State use
 7Veterinary use
 8See also
 9References
 10External links

Medical uses[edit]
Anesthesia[edit]
Intravenous fentanyl is often used for anesthesia and to treat pain.[20] To induce anesthesia, it is
given with a sedative-hypnotic, like propofol or thiopental, and a muscle relaxant.[21] To maintain
anesthesia, inhaled anesthetics and additional fentanyl may be used. [21] These are often given in 15–
30 minute intervals throughout procedures such as endoscopy, surgeries, and in emergency rooms.
[22][23]

For pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for
emergence from anesthesia.[21] Balancing this medication and titrating the drug based on expected
stimuli and the person's responses can result in a stable blood pressure and heart rate throughout a
procedure and a faster emergence from anesthesia with minimal pain. [21]

Obstetrics[edit]
Fentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural
anaesthesia and analgesia. Because of fentanyl's high lipid solubility, its effects are more localized
than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia.
[24]
 However, it is widely used in obstetrical anesthesia because of its short time to action peak (about
5 min), the rapid termination of its effect after a single dose, and the occurrence of relative
cardiovascular stability.[25] In obstetrics, the dose must be closely regulated in order to prevent large
amounts of transfer from mother to fetus. At high doses, the drug may act on the fetus to cause
postnatal respiratory distress.[25] For this reason, shorter acting agents such as alfentanyl or
remifentanil may be more suitable in the context of inducing general anaesthesia. [26]
Pain management[edit]

A fentanyl nasal spray with a strength of 100 μg per use

The bioavailability of intranasal fentanyl is about 70–90%, but with some imprecision due to clotted
nostrils, pharyngeal swallow and incorrect administration. For both emergency and palliative use,
intranasal fentanyl is available in doses of 50, 100, and 200 µg. In emergency medicine, safe
administration of intranasal fentanyl with a low rate of side effects and a promising pain reducing
effect was demonstrated in a prospective observational study in about 900 out-of-hospital patients. [27]
In children, intranasal fentanyl is useful for the treatment of moderate and severe pain and is well
tolerated.[28]
Chronic pain[edit]
It is also used in the management of chronic pain including cancer pain.[29] Often, transdermal
patches are used.[30] The patches work by slowly releasing fentanyl through the skin into the
bloodstream over 48 to 72 hours, allowing for long-lasting pain management. [31] Dosage is based on
the size of the patch, since, in general, the transdermal absorption rate is constant at a constant skin
temperature.[31] Rate of absorption is dependent on a number of factors. Body temperature, skin type,
amount of body fat, and placement of the patch can have major effects. The different delivery
systems used by different makers will also affect individual rates of absorption. Under normal
circumstances, the patch will reach its full effect within 12 to 24 hours; thus, fentanyl patches are
often prescribed with a fast-acting opioid (such as morphine or oxycodone) to handle breakthrough
pain.[31] It is unclear if fentanyl gives long-term pain relief to people with neuropathic pain.[32]