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Drug Evaluation

Oral transmucosal fentanyl citrate: a novel agent for breakthrough pain related to cancer

Erin McMenamin Department of Anesthesia and Neurology, Senior Research Fellow, Department of Epidemiology and Biostatistics, University of Pennsylvania, PA, USA. [email protected]
&
John T Farrar Department of Anesthesia and Neurology, Senior Research Fellow, Department of Epidemiology and Biostatistics, University of Pennsylvania, PA, USA. [email protected]
Pages 625-629 | Published online: 10 Jan 2014

References

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  • •• A thorough assessment of cancer pain.
  • Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain 41(3), 273–281 (1990).
  • •• Defined BTP and described common characteristics.
  • Portenoy RK, Payne R, Jacobsen P. Breakthrough cancer pain: Characteristics and impact in patients with cancer pain. Pain 81,129–134 (1999).
  • •• BTP further defined. Impact on daily life described.
  • Patt RB, Ellison NM. Breakthrough pain in cancer patients: characteristics, prevalence and treatment. Ontology (Thmtington)12 (7), 1035–1046, discussion 1049–1052 (1998).
  • •• Comprehensive review of cancer BTP.
  • Cleary JE Pharmacokinetic and pharmacodynamic issues in the treatment of breakthrough pain. Semin. Oncol 24(5 Suppl. 16), S16-13-9 (1997).
  • ••Various routes of opioids used for BTPdiscussed.
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  • ••Landmark guidelines for the treatment ofcancer pain.
  • Davis MP, Walsh D, LeGrand SB, Naughton M. Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions. Supportive Care Cancer 10(2), 117–138 (2002).
  • ••Comprehensive review of thepharmacology of rectal opioids.
  • Mercadante S, Radbruch L, Cherny Net al Episodic (breakthrough) pain. Concensus conference of an expert working group of the European Association for Palliative Care. Cancer 94(3), 832–839 (2002).
  • ••Brief mention of rectal absorption.
  • Coluzzi PH. Sublingual morphine: Efficacy reviewed.j Pain Sympt. Manage. 16 (3), 184–192 (1998).
  • •Sublingual morphine not absorbed well via buccal mucosa.
  • Simmonds MA. Pharmacotherapeutic management of cancer pain: current practice. Semin. 017C0i 24(5 Suppl. 16), S16-1-6 (1997).
  • •Appropriate use of opioids in cancer pain management discussed.
  • Streisand JB, Varvel JR, Stanski DR et al Absorption and bioavailability of oral transmucosal fentanyl citrate. Anesthesiology 75(2), 223–229 (1991).
  • ••Bioavailability for OTFC found to be50%.
  • Farrar JT, Cleary J, Rauck R, Busch M, Nordbrock E. Oral transmucosal fentanyl citrate: randomized, double-blinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients. Natl Cancer Inst. 90(8), 611–616 (1998).
  • ••OTFC more effective than placebo inrelieving cancer BTP.
  • Coluzzi PH, Schwartzberg L, Conroy JD et al Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR). Pain 91(1-4 123–130 (2001).
  • ••Compares OTFC to MS1R for cancer BTP
  • Egan TD, Sharma A, Ashburn MA, Kievit J, Pace NL, Streisand JB. Multiple dose pharmacokinetics of oral transmucosal fentanyl citrate in healthy volunteers. Anesthesiology 92 (3), 665–673 (2000) .
  • •Compared iv. to OTFC in healthy volunteers and demonstrated similar metabolism curves.
  • Christie JM, Simmonds M, Patt R et al. Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain. I Clin. Oncol 16(10), 3238–3245 (1998).
  • •Greater than 70% of patients able to titrate OTFC dose to relieve BTP.
  • Lichtor JL, Sevarino FB, Joshi GP, Busch MA, Nordbrock E, Ginsberg B. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth. Analg. 89(3), 732–738 (1999).
  • •OTFC produces pain relief similar to iv. morphine in severe post-op pain.
  • Chandler S. Oral transmucosal fentanyl citrate: a new treatment for breakthrough pain. Ainj Hospice Palliative Cam 16(2), 489–491 (1999).
  • ••Drug formulation, pharmacology andpatient selection for OTFC discussed.
  • Coluzzi P Cancer pain management: newer perspectives on opioids and episodic pain. Am.Hospice Palliative Med 15(1), 13–22(1998).
  • •Cancer pain assessment and management with opioids.

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