Fentanyl
Acute pain management, Procedural sedation adjunct, RSI premedication, Post-intubation sedation
Indications
- Acute pain management
- Procedural sedation adjunct
- RSI premedication
- Post-intubation sedation
Adult dosing
- analgesia: dose: 1; unit: mcg/kg; route: IV; weightBased: true; maxDose: 200; maxDoseAbsolute: true; procedural: dose: 1; maxDose: 200; maxDoseAbsolute: true; unit: mcg/kg; route: IV; weightBased: true; drip: dose: 25; maxDose: 200; unit: mcg/hr; route: IV; fixed: true; intranasal: dose: 1.5; unit: mcg/kg; maxDose: 100; maxDoseAbsolute: true; route: IN; weightBased: true; im: dose: 1.5; unit: mcg/kg; maxDose: 150; maxDoseAbsolute: true; route: IM; weightBased: true
Pediatric dosing
- analgesia: dose: 1; unit: mcg/kg; maxDose: 100; maxDoseAbsolute: true; route: IV; weightBased: true; intranasal: dose: 1.5; unit: mcg/kg; maxDose: 100; maxDoseAbsolute: true; route: IN; weightBased: true; pedNote: Effective for pediatric pain — avoids IV start
Contraindications
- MAO inhibitor use within 14 days
Clinical pearls
- Preferred opioid in renal failure — no active metabolites unlike morphine
- Intranasal fentanyl effective for pediatric pain — avoids IV start
- Chest wall rigidity possible with rapid high-dose IV push — treat with naloxone or paralytic
- 80x more potent than morphine by weight
Source and review
- Tintinalli's Emergency Medicine, 9th ed.. Last reviewed: 2024-10-15