Medicines

Fentanyl lozenges for pain

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Fentanyl can be dangerous if used incorrectly. Accidental use, particularly by young children, can result in death.

Name of medicine

Fentanyl

Brand name: Actiq

Why is it important for my child to take Fentanyl?

Fentanyl lozenges provide extra pain relief when needed. This leaflet is about the use of fentanyl lozenges for ‘breakthrough’ pain in children with severe long-lasting pain. This might be pain from an injury, after an operation or due to an illness. Fentanyl lozenges are also used to provide pain relief during a short surgical or medical procedure. 

What is Fentanyl available as?

  • Lozenges come on sticks and are sometimes called lollipops.
  • They come in doses of 200 micrograms, 400 micrograms, 600 micrograms and 800 micrograms, 1.2 mg and 1.6 mg; each lozenge contains 2 grams of glucose.

When should I give Fentanyl

  • Lozenges are usually used to treat ‘breakthrough’ pain in children who are already taking morphine or other strong medicines. They provide extra pain relief when it is needed. This may be during a short medical or surgical procedure, or because your child’s usual medicine is not providing enough pain relief.
  • Your child should have only one lozenge for any one episode of breakthrough pain. If this does not seem enough, contact your doctor for advice.
  • If the lozenge is being used to provide pain relief for a medical or surgical procedure, the person doing the procedure will say when your child should start using the lozenge.

Do not give your child more than four lozenges in 24 hours.

How much should I give?

Your doctor will work out the amount of fentanyl (the dose) that is right for your child and which dose lozenge provides this. This will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give Fentanyl?

Lozenges

A detailed information leaflet is provided with the lozenges. The following is a summary. If you are not sure what to do, ask your doctor for advice:

  • Unwrap the lozenge just before you give it to your child.
  • Your child needs to hold the lozenge in the mouth, between the gums and the inside of the cheek. The drug quickly gets from the cheek into the blood. It does not need to be swallowed. (It is not harmful if swallowed, but will not work as well.)
  • Your child should move the lozenge around to different areas of the cheek, and turn the lozenge on its stick so that all sides come into contact with the mouth. This should be done quite slowly – it should take about 15 minutes to dissolve the whole lozenge. If it is done too quickly, more of the drug will be swallowed and it will not work as well.
  • Your child should not bite or chew the lozenge. (Biting or chewing the lozenge does not make it work faster.)
  • Your child may want to have a small drink of water before having the lozenge, but should not eat or drink while the lozenge is in his or her mouth.

When should the medicine start working?

Your child should start to feel less pain 5–15 minutes after starting to use the lozenge.

What if my child is sick (vomits)?

If your child feels sick, or is sick (vomits), when they are using the lozenge, they should stop using it. (See advice below about disposal of an unfinished lozenge.)

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

Side effects you must do something about

If your child has difficulty breathing, stops breathing or seems very sleepy, they may have had too much Fentanyl. Take your child to hospital or telephone for an ambulance straight away.

Other side-effects you need to know about

  • Your child is likely to feel sick or be sick (vomit) for the first few days of taking Fentanyl. Your doctor may prescribe another medicine to help with this.

  • Most children get constipation (have difficulty doing a poo) when taking Fentanyl. You can help by encouraging them to drink plenty of fluid. Your doctor will probably suggest that your child also takes laxatives – medicines that will help them go to the toilet. It is important that your child doesn’t strain on the toilet.

  • Your child may get headaches, feel dizzy, have little energy, or get a rash. Contact your doctor if you are worried.

There may sometimes be other side effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side effects to a UK safety scheme at www.mhra.gov.uk/yellowcard

Can other medicines be given at the same time as Fentanyl?

  • The Fentanyl should not be taken with some common drugs that you get on prescription. It is important to tell your doctor and pharmacist that your child is taking Fentanyl.
  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal and complementary medicines.
  • Do not give your child any medicines that contain codeine or dihydrocodeine, as these will make the side effects of Fentanyl worse. Some painkillers and cough medicines contain codeine or dihydrocodeine (you can find this information on the label).

Is there anything else I need to know about this medicine?

Only give these lozenges to your child. Never give them to anyone else, even if they seem to have the same condition, as this is dangerous.

If you think someone else may have taken some Fentanyl by accident, take them to hospital straight away.

The Fentanyl is particularly dangerous for young children. Take extreme care to store lozenges where children cannot see or reach them. Ideally this should be in a locked container.

  • If your child does not finish a lozenge, run it under hot water until all the lozenge has dissolved. Dispose of lozenge sticks carefully, where young children cannot get them.
  • Each lozenge contains about 2 grams of glucose, which may cause a problem if your child has diabetes mellitus or is on a ketogenic diet. Check with your doctor or nurse.
  • Do not give your child grapefruit juice, as this affects the way fentanyl is broken down by the body.

General advice about medicines

  • If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses, as you may do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Keep all medicines where children cannot see or reach them. This is vital with Fentanyl, which is very dangerous for young children. If possible, keep Fentanyl in a locked container.

Where should I keep this medicine?

Keep the lozenges in the container they came in.

Keep the lozenges somewhere cool and dry, away from direct heat and light. They do not need to be kept in the fridge.

Who to contact for more information?

Your doctor or pharmacist will be able to give you more information about Fentanyl and other drugs or methods for pain relief.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Copyright disclaimer

Version [2]. © NPPG, RCPCH and WellChild, all rights reserved. Review by February 2017.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.