What is fentanyl?

Fentanyl is a strong opioid medicine that can be prescribed by your doctor as part of a broader strategy to help manage your pain.

How does fentanyl work?

Fentanyl reduces feelings of pain by interrupting the way nerves signal pain between the brain and the body. It works directly on the central nervous system.

What is fentanyl used for?

Fentanyl is used to treat acute (short-term), severe pain caused by major trauma or surgery. It may also be used for severe chronic pain and pain caused by cancer.

The duration and dose of fentanyl recommended will depend on why you are taking it. For example, fentanyl patches for cancer pain or in people receiving palliative care are approved for life-long use, while fentanyl used for acute pain or anaesthesia will be used only for a short time.

What forms of fentanyl are available?

Fentanyl is available in several formulations in different strengths, including:

• transdermal patches (patches to stick on your skin)
• lozenges (Actiq®)
• buccal (next to the cheek) tablets (Fentora®), that dissolve inside your mouth
• sublingual (under the tongue) tablets (Abstral®)

Fentanyl can also be given via a nasal spray or injection (into a muscle or vein) for acute, severe pain or before surgery.

What are the possible side effects of taking fentanyl?

All opioids, including fentanyl, can have side effects, including life-threatening breathing problems. The chance of side effects is higher:

• when first taking fentanyl
• after a dosage increase
• if you are older
• if you have an existing lung problem

The side effects of fentanyl are similar to those of other opioids, and include:

• rash or skin reaction from a fentanyl patch
• constipation
• headache or dizziness
• fatigue or drowsiness (especially soon after a dose)
• loss of appetite, nausea and vomiting

Fentanyl affects everyone differently. If you have any of these side effects while taking fentanyl, or if you notice anything that is making you feel unwell, speak with your doctor or pharmacist.

What are the risks associated with fentanyl?

Opioids are strong pain relief medicines that can cause life-threatening or fatal breathing difficulties.

Fentanyl may make it difficult for you to drive or operate heavy machinery. If you have recently started taking an opioid medicine, or changed the dosage, you may be more likely to have an accident. Ask your doctor if it is legal for you to drive while taking fentanyl. Also contact your car insurer, as you may not be covered for accidents that occur while you are taking fentanyl.

Fentanyl is not suitable for some people, for example, if:

• you drink alcohol
• take other medicines that can cause drowsiness, such as benzodiazepines
• your lung or liver function is impaired

Opioid tolerance and dependence

If you use opioid medicines, you may also develop tolerance. This means that you may need to take larger amounts of the opioid to get the same effect. The chance of side effects also increases with a higher dose.

It's also possible to become dependent on fentanyl, even if you take it exactly as prescribed and only for a short time. Your doctor will monitor how you use fentanyl to reduce your chance of harm, including through misuse, abuse and addiction.

If you are concerned that you are becoming addicted to or dependent on fentanyl, let your doctor know so that you can get help. You can also call the National Alcohol and Other Drug Hotline (1800 250 015) for 24/7 support and treatment information.

Opioid overdose

If you take too much fentanyl (known as an overdose), it's important to get immediate medical attention. Overdose of opioid medicines can cause you to stop breathing.

Symptoms of overdose include:

• feeling sleepy
• difficulty breathing
• loss of consciousness
• pinpoint (very small) pupils

Access to overdose-reversing medication

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. The Australian Government is offering this medication free of charge and without a prescription to people who may experience, or witness, an opioid overdose.

Learn more about the Take Home Naloxone program.

How do I take fentanyl?

It is important to follow the directions given to you by your doctor or pharmacist when taking fentanyl.

Never take an opioid medicine that was prescribed for someone else or give another person an opioid that was prescribed for you. Your doctor is the best person to guide you on whether fentanyl is the right medicine for you, how much you need and how long to take it for.

Always make sure you are taking the correct form and dosage of fentanyl. The fentanyl lozenges and tablets are not interchangeable so make sure you are taking the exact brand that your doctor prescribed.

The different forms of fentanyl are taken in different ways.

Transdermal patches

Transdermal patches are placed on dry, non-irritated, hairless skin on the upper torso.

• Make sure to write the date and time on the patch in permanent marker before applying it.
• Do not cut or divide patches and do not use a patch if it is damaged or cut.
• Remove the patch after 7 days and place the new patch on a different area of skin.
• Avoid reusing the same area for at least 3 weeks.
• Between patch changes, check that the patch is still attached.
• When wearing the patch, do not let it come into contact with direct heat sources such as electric blankets, heat pads, saunas, or hot baths.
• After removing the patch, avoid exposing that area of the skin to the sun for 2 days as it may be more sensitive than usual.

Dispose of a used fentanyl patch by folding it over on itself (bringing the sticky sides together).

Lozenges

Lozenges (Actiq®) are placed in the mouth against the cheek and moved around using the applicator.

• Let it dissolve for 15 minutes, without chewing.
• Maintain good dental hygiene while using fentanyl lozenges, since the lozenge contains sugar.
• Any partially used lozenges should be returned to the chemist.

Sublingual tablets

Sublingual tablets (Abstral®) are placed under the tongue and must be left there until they dissolve.

• Do not suck, swallow, chew, or cut the tablets.
• You may experience dry mouth from taking this medicine. If you have a dry mouth, moisten your mouth with water before using the tablet.

Buccal tablets

Buccal tablets (Fentora®) are placed between the cheek and gum near the back (molar) teeth. They can also be placed under the tongue.

• Do not take the tablet out of its blister pack until you are about to use it.
• Allow the tablet to completely dissolve without chewing or sucking.
• If you have a dry mouth, wet it with some water before using the tablet.
• Do not eat or drink while the tablet is in your mouth.
• If there are any bits of tablet left after 30 minutes, you can swallow them with a glass of water.

Intranasal fentanyl

Intranasal fentanyl is a spray applied into the nose. It is used to provide pain relief to children in a hospital setting so healthcare professionals will take care of giving it safely and correctly.

Fentanyl injections

Fentanyl injections are also only given by registered professionals in healthcare settings.

How do I dispose of medicines safely?

Dispose of a used fentanyl patch by folding it over on itself (bringing the sticky sides together) before putting it in a secure bin, out of reach of children and pets.

It's important you dispose of unwanted opioid medicines safely. Unused medicines can be returned to any pharmacy. Don't keep unused medicines 'just in case', as this can lead to unsafe or inappropriate use.

Keep fentanyl out of reach of children and pets. Never throw medicines into a garbage bin or flush them down the toilet, as this is dangerous to others and harmful to the environment.

When should I see my doctor?

If your pain is not well controlled on fentanyl or you have any unexpected or unwanted side effects, see your doctor. There are different options for pain management, and your doctor can suggest other approaches.

Do not adjust your fentanyl dosage without talking to your doctor first.

Are there any alternatives to fentanyl?

Everyone's pain is different and different pain relief medicines are used in different circumstances. If you have been prescribed fentanyl and are still in pain, speak with your doctor about other ways you can manage your pain.

Always check with your doctor or pharmacist before making any change to the dosage or type of medicine you take.

If you have chronic (long-term) pain, your doctor might suggest lifestyle changes to help manage the effects of pain. This may include:

• improving your physical fitness
• activity pacing
• social activities
• relaxation techniques
• overall health management

Find out more about options for managing chronic pain.

Resources and support

Asking about your treatment or medicine is important to help you understand your options.

Here's a guide to questions you should ask your pharmacist or doctor before taking any medicine.

See this list of medicines that contain fentanyl to read the Consumer Medicines Information (CMI) leaflet for the brand prescribed, or:

• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link helpline (1300 340 357) which is staffed by volunteers with personal experience of chronic pain.
• Go to Painaustralia to find pain services and programs in your area.
• Learn more about prescription opioids on the Choosing Wisely

Other languages

The Alcohol and Drug Foundation has translated their guide to using medicines safely into many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

Learn more about chronic pain management on Pain Management Network.