Anyone take or try Actiq for breakthrough pain?

Discussion in 'Fibromyalgia Main Forum' started by garyandkim, Sep 11, 2002.

  1. garyandkim

    garyandkim New Member

    The doc gave Gary 200mcg sticks today and used 2 in a row and still not much relief. Gary takes Oxy and oxyirs and he is still always in major pain. The doc said he would give him 600mcg sticks if this didn't help.

    I am a bit confused why they don't give enough of the regular pain meds and give break through meds at such a strong dose and so often when you are always in pain. The doctor told us that Oxy can go to an infinate amount and he takes 400mgs per day now of the 12 hour but, every 8 hours. And an additional 45mgs in Irs. Now this. I guess I'll have to have a real hart to hart w/the doc. Do I make any sence or does the doc?

    Thanks for the help, Kim
  2. garyandkim

    garyandkim New Member

    The doc gave Gary 200mcg sticks today and used 2 in a row and still not much relief. Gary takes Oxy and oxyirs and he is still always in major pain. The doc said he would give him 600mcg sticks if this didn't help.

    I am a bit confused why they don't give enough of the regular pain meds and give break through meds at such a strong dose and so often when you are always in pain. The doctor told us that Oxy can go to an infinate amount and he takes 400mgs per day now of the 12 hour but, every 8 hours. And an additional 45mgs in Irs. Now this. I guess I'll have to have a real hart to hart w/the doc. Do I make any sence or does the doc?

    Thanks for the help, Kim
  3. Shirl

    Shirl New Member

    I am not sure this is exactly what you are looking for, but this is what I found with the name; ACTIQ. I got this from; www.medscape.com

    If you want additional information, there is a lot more there! You do need to join to have access, but it is free.

    Hope this helps.

    Let me thank you for all the help you are on the board, you are a tremendous help to so many people, and I just wanted to acknowledge this since I am posting to you. Thanks lady.


    Shalom, Shirl

    ____________________________________________________________
    New Search

    ACTIQ BUCCAL
    Drug Class
    Uses & Dosage
    • Uses
    • Dosage and Administration
    Adverse Effects
    Precautions
    Drug Interactions
    Overdose & Toxicity
    Pharmacology & Chemistry
    Preparations
    Patient Handout
    Opiate Agonists General Statement
    Use & Dosage
    Adverse Effects
    Precautions
    Drug Interactions
    Overdose & Toxicity
    Pharmacology & Chemistry



    ACTIQ BUCCAL
    Uses & Dosage
    Uses from First Databank





    Labeled Uses


    Breakthrough Cancer Pain
    Breakthrough Cancer Pain
    Conscious Sedation
    General Anesthesia
    General Anesthesia Adjunct
    Local Anesthesia

    Unlabeled Uses



    Uses from AHFS DI™
    Fentanyl citrate is a strong analgesic used preoperatively, during surgery, in the immediate postoperative period for its analgesic action. Fentanyl citrate also is used intrabuccally (transmucosally) in the management of breakthrough cancer pain.In addition, the drug may be used to prevent or relieve tachypnea and postoperative emergence delirium. Fentanyl citrate is used parenterally to provide preoperative anxiolysis and sedation and as a supplement to anesthesia. The drug may be especially useful preoperatively before surgery of short duration or minor surgery in outpatients and in diagnostic procedures or treatments that require the patient to be awake or very lightly anesthetized. Fentanyl citrate may be used as a supplement to general or regional anesthesia, including neuroleptanalgesia in which it is often used in combination with droperidol. When attenuation of the response to surgical stress is especially important, fentanyl citrate may be administered with oxygen and a skeletal muscle relaxant to provide anesthesia without the use of additional anesthetic agents. Fentanyl citrate intrabuccal (transmucosal) lozenges (Actiq®) are used for the management of breakthrough cancer pain in patients who are already being treated with, and are tolerant of, opiates used for chronic cancer pain.Patients are considered opiate tolerant if they have been receiving at least 60 mg of morphine sulfate daily, 50 mcg of transdermal fentanyl per hour, or an equianalgesic dosage of another opiate for at least 1 week. Because of the risk of life-threatening respiratory depression (e.g., hypoventilation), intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) are contraindicated in the management of acute or postoperative pain.In addition, intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) should not be used in patients who are not opiate tolerant.The manufacturer states that intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) should be administered only under the supervision of qualified clinicians who are experienced in the use of opiates for the management of cancer pain.|The efficacy of intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) for the management of breakthrough cancer pain has been studied in a double-blind, placebo-controlled, randomized study in cancer patients 18 years of age and older who were already receiving the equivalent dosage of at least 60 mg of oral morphine sulfate daily or at least 50 mcg of transdermal fentanyl per hour for the management of chronic cancer pain and who experienced at least one occurrence of breakthrough pain daily.Following titration to an effective dose of intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) (doses of fentanyl used were 200, 400, 600, 800, 1200, and 1600 mcg), patients received in a blind, randomized manner 7 lozenges of fentanyl citrate and 3 lozenges of placebo.Intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) were associated with substantially more pain relief than placebo.In addition, when intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) were used for breakthrough cancer pain, rescue drug therapy (e.g., administration of an analgesic agent previously used for breakthrough cancer pain) was required less frequently than when placebo was used for such breakthrough pain.|Fentanyl also previously was available for restricted use as an intrabuccal (transmucosal) premedicant prior to anesthesia or for inducing conscious sedation prior to diagnostic or therapeutic procedures in a monitored anesthesia setting (Fentanyl Oralet®). However, this preparation no longer is commercially available for such use in the US and the currently available intrabuccal preparation (Actiq®) is only labeled for use in opiate-tolerant patients with chronic cancer pain.Fentanyl is used transdermally for the management of chronic pain in patients requiring opiate analgesia.The transdermal system should only be used for the management of chronic pain (e..g., such as that associated with cancer) that cannot be managed adequately with less intensive analgesic therapy (e.g., acetaminophen/opiate combinations, nonsteroidal anti-inflammatory agents [NSAIAs], intermittent dosing with short-acting opiates) and only in patients who are already being treated with, and tolerant of, opiates and who require continuous opiate administration.Because of the risk of life-threatening respiratory depression, fentanyl transdermal system should not be used for the management of mild or intermittent chronic pain that can be managed with less potent analgesics or on an as needed (“prn”) basis. Although fentanyl also has been employed transdermally for the management of postoperative pain,such use, including that following outpatient surgery, is not recommended because of inadequate experience and the interindividual variations in absorption and disposition of the drug observed in controlled clinical trialsand because of the inability to properly titrate transdermal dosage in such pain and the risk of serious or life-threatening respiratory depression.The transdermal system also is not recommended for the management of acute pain because of these risks or for use in children (except under investigational research conditions) younger than 12 years of age nor in those younger that 18 years of age weighing less than 50 kg because of the risk of serious or life-threatening respiratory depression.|Dosage and Administration from AHFS DI™

    Administration
    Fentanyl citrate is administered by IM or IV injection or intrabuccally (transmucosally) as a lozenge. Fentanyl is administered percutaneously by topical application of a transdermal system. An opiate antagonist and facilities for administration of oxygen and controlled respiration should be available during and immediately following IV or buccal (transmucosal) administration of the drug. Intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) should be administered only under the supervision of qualified clinicians who are experienced in the use of opiates for the management of cancer pain.|Preservative-free injections of fentanyl citrate also have been injected or infused epidurally; specialized techniques are required for administration of the drug by this route, and such administration should be performed only by qualified individuals familiar with the techniques of administration, dosages, and special patient management problems associated with epidural fentanyl citrate administration. When buccal (transmucosal) fentanyl citrate lozenges are used, the overwrap should be removed just prior to administration.Once the plastic overcap is removed, the lozenge should be placed in the patient’s mouth (between the cheek and the lower gum) using the handle and the patient should be instructed to suck not chew the lozenge; the lozenge occasionally may be moved from one side to the other using the handle.|When intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) are used, lozenges usually should be consumed over a period of 15 minutes; longer or shorter consumption times may result in reduced efficacy compared with that reported in clinical trials.If signs of excessive opiate effects develop before the fentanyl citrate lozenge is consumed completely, the remaining portion should be removed from the patient’s mouth immediately, and future doses should be decreased.Because intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) contain sufficient amounts of fentanyl citrate to be fatal to a child,patients and/or their caregivers should be strongly warned to keep the intrabuccal (transmucosal) lozenges of fentanyl citrate (Actiq®) out of the reach of children.(See Chemistry and Stability: Stability.) In addition, patients and/or their caregiver should be instructed to dispose completely or partially used units of the drug.(See Chemistry and Stability: Stability.) Patients receiving transdermal fentanyl should be carefully instructed in the proper use and disposal of the transdermal system.To expose the adhesive surface of the system, the protective-liner covering should be peeled and discarded just prior to application.The transdermal system is applied to a dry, nonirritated, nonirradiated flat surface on the upper torso by firmly pressing the system by hand for 30 seconds with the adhesive side touching the skin of the torso and ensuring that contact is complete, particularly around the edges.Hair at the application site should be clipped, not shaved, prior to application;shaving may produce irritation, which could alter percutaneous absorption of the drug.If the site must be cleansed prior to application, only clear water should be used.Soaps, oils, lotions, alcohol, or any other agents that could irritate the skin or alter its characteristics should not be used.Patients should be advised to avoid exposing the application site to direct external heat sources (e.g., heating pads, electric blankets, heat lamps, saunas, hot tubs, heated water beds) while wearing the transdermal system since temperature-dependent increases in percutaneous absorption of fentanyl from the system are possible under such conditions.The transdermal system should not be altered (e.g., cut) in any way prior to application since controlled drug delivery cannot be ensured.If transdermal therapy is continued for longer than 72 hours, a new transdermal system should be placed at a different site on the upper torso.|Patients should be advised to keep both used and unused fentanyl transdermal systems out of reach of children.The manufacturer recommends that, immediately following removal, used systems be folded so that the adhesive side adheres to itself and then flushed down the toilet.In addition, following completion of a course of transdermal fentanyl therapy, any remaining transdermal systems should be discarded.The manufacturer recommends that any unused systems be removed from their packaging and flushed down the toilet. If the gel from the drug reservoir accidentally contacts the skin, the affected area should be washed with copious amounts of water; soap, alcohol, or other solvents should not be used to remove the gel since they actually may enhance percutaneous absorption of fentanyl from the gel.|
    Dosage
    Dosage of fentanyl and fentanyl citrate is expressed in terms of fentanyl. The drugs should be given in the smallest effective dose and as infrequently as possible to minimize the development of tolerance and physical dependence. Reduced dosage is indicated initially in poor-risk patients, in geriatric patients, and in patients receiving other CNS depressants. Doses as low as 25—33% of the usual parenteral dose and no higher than 50% of the usual transdermal dose should be employed when the drug is used in conjunction with other CNS depressants. Dosage adjustment for the concomitantly administered drug also may be necessary. If fentanyl is given concurrently with the commercially available combination of droperidol and fentanyl citrate, the dosage calculation must include the amount of fentanyl contained in the combination.
    Parenteral Dosage
    For use as a preoperative medication, 50—100 mcg of fentanyl is administered IM 30—60 minutes prior to surgery. As an adjunct to general anesthesia, fentanyl may be given in low-dose, moderate-dose, or high-dose regimens. In the low-dose regimen which is used for minor but painful surgical procedures, an IV dose of 2mcg/kg is administered; additional doses are usually not necessary. In the moderate-dose regimen which is used in more major surgical procedures, an initial IV dose of 2—20 mcg/kg is administered; additional doses of 25—100 mcg may be given IV or IM as necessary. In the high-dose regimen which may be used during open heart surgery or certain complicated neurosurgical or orthopedic procedures where surgery is more prolonged, an initial IV dose of 20—50 mcg/kg may be given; additional doses ranging from 25 mcg to one-half the initial dose may be administered as necessary. To provide general anesthesia without additional anesthetic agents when attenuation of the response to surgical stress is especially important, fentanyl doses of 50—100 mcg/kg may be administered IV in conjunction with oxygen and a skeletal muscle relaxant; in some cases, doses up to 150 mcg/kg may be required. As an adjunct to regional anesthesia, 50—100 mcg of fentanyl may be administered by IM injection or by slow IV injection over 1—2 minutes when additional analgesia is required. For the control of postoperative pain, restlessness, tachypnea, and emergence delirium, 50—100 mcg of the drug may be administered IM every 1—2 hours as needed. During the induction and maintenance phases of general anesthesia in children 2—12 years of age, a fentanyl dose of 1.7—3.3 mcg/kg is recommended.
    Buccal Transmucosal Dosage




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  4. dolsgirl

    dolsgirl New Member

    No Actiq for me!!! I tried for 5 weeks last year when I was going to a pain clinic and I was allergic to a gazillion analgesics, so they put me on Actic. During my first week, it was 400 mg. lozenges four times a day, I had a lucid moment and read the information on it....it's quickly addicting and I found that the relief of my pain was shortlived. I also found out that they usually, not always, but usually give Actiq to patients that can no longer take meds by mouth. So, that alone tells you alot. Also, it cost alot, since it wasn't 'formulary' with my insurance carrier. I got off all prescriptive pain meds (analgesics) at that point, because I find that they don't help in the long run. You have to be ready to be on meds that you'll be addicted to for the rest of your life. I have dealt with being IN pain for so many years, that I'm able to make that choice. It wasn't easy, but it was worth it. I simply don't find that precriptive meds do much better than over the counter (otc), meds in the long run. Sometimes they all work, and sometimes they simply don't. There's no rhyme or reason for fibromyalgia. Hope this helps. I hope Gary feels better. dolsgirl
  5. garyandkim

    garyandkim New Member

    kind and uplifting words. I called my Mom and Dad read what you wrote. You made them very happy to. It is amasing how one can make so many feel uplifted. You are a very kind.

    Thank you for the information. We have a new computer well 4 1/2 months and a new internet provider so I lost all my links and pass words. I use gator. Now to start all over.

    I am sorry to the other person who answered O forget so fast names and usually print out but, that's another thing not communicating with the computer right now. I guss I have to get someone in to get it up and running. I am so sorry you had such a horrible experiance. Were you already on opiods? From what the doc said and I have read you should only be given them if you are already taking opiods or else they can kill you. Well, thats what the site I read said. I wish Gary didn't need pain meds or any meds but, his spine is degenerating and he has one surgey and more ahead. Very debilitaing and progressing very quickly. He has been told that the morophine pump may help his spinnal pain but, the new PM doc doesn't want to go ther edue to complications that can arise. I to am allergic to many things and this Fentanyl is one of them (Acutiq) solid pop form. We are use to pain and have delt with it for 4 decades now. It wears at you and just have to take them. Gary started 11 years ago and I 3 for the meds. It just got to a point we were unable to do no more w/o them.
    Thank you so much for sharing and we are thinking about you. It is so scarry to have such experiances. We are so sorry you had to go through such an ordeal.

    Again, Thank you both, Kim and Gary
  6. BlueMoon

    BlueMoon New Member

    Lidoderm Patch. The Doc gave them to me & it has been the firstthing to give me relief! I too am on everything you had named Gary to be on. So Ask your Doc for the Lidoderm Patch. It does help!

    Robin
  7. garyandkim

    garyandkim New Member

    It just gets so frustrating some times. Take good care, Kim and Gary