Fentanyl: a molecule and multiple dose formulations of clinical transcendence in the in the treatment of breakthrough cancer pain

Abstract

The breakthrough cancer pain management requires planned a "rescue" medication with quick-release opioids. However, despite the existence of media for their control, this is often inappropriate. Most of the authors point out that the onset and duration of action of oral opioids are not appropriate for the treatment of breakthrough pain. Fast-acting opioid, notably fentanyl, are the drugs of choice for the treatment of breakthrough pain. This paper reviews the characteristics of the different transmucosal formulations of fentanyl that, despite the same molecule, have differential degrees of importance. In fact, these presentations are not interchangeable. The choice of the most appropriate treatment for each patient should take into consideration the different Pharmacokinetic profiles, since they define when the effect starts, how long lasting analgesia and what is the level of the plasma peak (Cmax), often responsible for the adverse effects. General bibliography and various consensus of experts recommended to individualize the treatment after a carefully evaluation of the pain. Administered doses of different fentanyl formulations must take into account patient’s opioid tolerance, the pharmacokinetic profile of each products and conditions of each patient in relation to the routes of administration. In certain clinical circumstances, intranasal fentanyl appears to have a faster onset of action and be better tolerated at the gastrointestinal level that buccal presentations. The preference of the patient must also be taken into consideration.