Benitez-Rosario, M.A., Martin, A.S., & Feria, M. (2005). Oral transmucosal fentanyl citrate in the management of dyspnea crises in cancer patients. Journal of Pain and Symptom Management, 30(5), 395–397.
To evaluate the use of oral transmucosal fentanyl citrate (OTFC) as a rescue or breakthrough medication to relieve dyspnea
This study described four individual case reports. In case 1, the patient received 1,200 mcg of OTFC as breakthrough dose (BT) for dyspnea while on 400 mg/d IV morphine. In case 2, the patient received 800 mcg of OTFC as BT for dyspnea while on 90 mg of oral morphine every 24 hours. In case 3, 600 mcg of OTFC originally was prescribed for pain was reported to relieve dyspnea. In case 4, the patient was given 400 mcg OTFC while on 15 mg/d IV morphine.
The case reports were of four patients who were terminally ill with cancer (two women and two men). Three patients had lung cancer, and one had colon cancer. OTFC was chosen for its rapid effect and ease of administration.
Cases 1, 2, and 4 were conducted at an inpatient hospice unit, and case 3 was conducted at home.
Cases 1 , 2, and 4 used numeric rating scales (NRSs), and case 3 used percent improvement.
These reports showed that OTFC improved dyspnea in individual cases, was easy to administer, and provided rapid onset of relief and minor adverse effects. The specific doses were variable and chosen according to patients’ baseline opioid use.