Talk:Fentanyl/Archive 1

Archive 1

Oxygen displacement

After having copyedited the phrase about oxygen displacement in the Moscow theatre siege, I'm uneasy about the ways in which a complex situation (including pharmacologically-speaking) has been rendered with a rather brittle 2-D certainty. What about respiratory depression? The chance that no provision was made for antagonist/naloxone-type reversal? See: * Wax PM, Becker CE, Curry SC. Unexpected "gas" casualties in Moscow: a medical toxicology perspective. Ann Emerg Med 2003;41:700-5. PMID 12712038. Armeria 16:21, 22 November 2005 (UTC)

"other examples of chronic, nonmalignant pain"

I added the phrase 'other examples of chronic, nonmalignant pain' because the four nonmalignant disorders listed are not exclusive to treatment with Actiq. I also changed the flavor from citrus to berry, because Actiq is not citrus-flavored. It's tastes like a cross between raspberry and grape, and the flavoring decreases in effectiveness as the concentration of medication in the lozenge increases, so the 1200mcg lozenge actually tastes more bitter than sweet. My source: me. I'm a patient who has taken this drug, in both Duragesic and Actiq forms, for nearly 4 years. Trust me - I know how the stuff tastes. :-) ddlamb 02:54, 30 November 2005 (UTC)

External links about MPTP and Parkinsons'

The article definitely needs an explanation about why the two external links about MPTP and Parkinsons's disease are here. I know MPTP is a by-product of the illegal manufacture of fentanyl, but I'm unable to find very much about it and at what point in the manufacturing process MPTP is made. Someone with a better knowledge of the chemical structure needs to address it. There's no mention of MPTP or Parkinson's in the article's body - just those two external links. ddlamb 08:27, 1 December 2005 (UTC)

Well, after crawling through those links and some other searches, it seems that those externals have no reason to be there. MPTP is a failed attempt at synthesizing MPPP - which was supposed to be a meperidine (aka Demerol and a zillion other names) derivative. The unfortunate chemist attempted to make MPPP, and made MPTP instead, a highly toxic and Parkinson-causing substance. Someone sold it on the street, and several young users came were admitted to hospitals with Parkinson's symptoms (taken from one of the external links). So, while that's a fascinating tale in and of itself, it does not seem to be pertinent to Fentanyl. Their only similarities are 1) being synthetic opioids and 2) being sold as synthetic herion. These, I feel, do not constitute enough of a similarity to merit an external link (or two), with or without explanation. I will take the liberty of removing the links if no other explanation comes forth.
Most of my information was obtained from this erowid page and from here. (EDIT): I removed the external links. --Silvem 09:12, 7 January 2006 (UTC)

LD50

LD50 isn't really a useful parameter for most drugs used in humans because doses used are pretty much always far sub-lethal (except with cancer chemo and stuff). ED50 (effective dose) and therapeutic range are more relevant. I reckon LD50 should be chopped out of the intro paragraph... ben 04:25, 16 May 2006 (UTC)

I wouldn't object to moving that content, but I don't think it should be removed. The ratio between the ED50 and LD50 is commonly used to identify how safe it is to administer a medication. Of course, we don't have the ED in the article, but I still think that the LD is relevant. --Arcadian 20:10, 19 May 2006 (UTC)

Especially since there are news reports about how fentanyl is deadly when mixed with illegal drugs: "Just one hundred and twenty-five micrograms -- the equivalent of six grains of salt -- is enough fentanyl to kill." (Kim Norris, Detroit Free Press, June 16, 2006) I originally came to this page to see how accurate that statement is. If the LD50 is 3 mg/kg, that number is probably a bit sensationalized. -- Tmhand 14:08, 16 June 2006 (UTC)

For opiod-tolerant patients or "recreational" users, 125 mcg. is probably safe, but for those who are not, 125 mcg. can kill. So any user should always start with the lowest dose, under doctor supervision; a doctor that knows about opiods. MeekMark 17:57, 2 August 2006 (UTC)

Um... I've consumed 5mg of fentanyl before. Repeatedly. Without overdosing. That is about 200mg oxycodone. So... —Preceding unsigned comment added by 64.222.147.58 (talk) 06:56, 9 January 2009 (UTC)

Half-life

I think the thing with the half-life is that heroin itself has a half-life of a few minutes, because it's broken down into morphine, but then morphine has a half-life of several hours. That's why fentanyl is considered to have a shorter half-life (I've read in multiple places that its effects are shorter-lasting). I'm too tired to find a good source for this right now, but if it's correct it should be noted (probably in both articles). --Galaxiaad 08:28, 2 August 2006 (UTC)

It was good to remove the information on half-life for the Duragesic transdermal patch, as it continuously administers the drug while the patch is on, and some of the drug is continued to be absorbed even after the patch is removed; IE: After the patch is removed, some of the drug is in the process of being absorbed and transmitted through the skin. MeekMark 17:53, 2 August 2006 (UTC)

Added the section about the different ways the patch flow rate is altered by external factors. Was amused by a package insert that suggested shaving over the sub clavian artery to fix the patch there. I find that putting them over an area with a layer of fat underneath helps to keep the flow steady. I put them on my side which is convenient for positioning a cold pack over if I want to be outside for a while in the heat. Hard to concentrate at my dosage so clarity edits on the language is appreciated. I understand that that was a major edit but Am not sure how to do the instruction for that or how to do the name sign thing. New knowledge doesn't retain well at significant doses. Tomo1952 04:01, 24 August 2006 (UTC)

Oral pill

Hey, fentanyl is now available in an oral pill form called fentora. It is primarily used to treat breakthrough pain in cancer patients. Breakthrough pain is pain that comes on very quickly and is considerably above the average level of the patients pain. Fentora is used to treat this because it is quick acting (ten to fifteen minutes) but can still be taken in pill form for the user's convenience. Someone should probably add something about fentora to the fentanyl section, as I don't think it is currently on there. —Preceding unsigned comment added by 76.121.127.82 (talk) 22:29, 17 June 2008 (UTC)

Tomo1952 04:01, 24 August 2006 (UTC)The text of the original version of this article was taken from the public domain source at http://www.usdoj.gov/dea/concern/fentanyl.html

Fentanyl and length of action

I use the 50mcg/hr patch. I place this on my thigh due to reasons where I can't place them on my arm/back due to using a heating pad for neck/shoulder pain. Since the uptake seems to increase and can become dangerous from my understanding if heated. (Note: you are absolutely correct. Once case I saw involved a man wearing a patch and was working on his car out in the hot sun. The combination of hot day and his physical exertion raising his body temperature caused an overdose --206.194.127.112 (talk) 20:39, 15 May 2008 (UTC)) I am an opiate tollarant patient and using this for pain management. My curiousity is why is this patch only lasting 36+/- hrs? Is is due to the placement on my thigh (which btw, I don't have much adipose tissue)? I've tried placing them on my side, but have a problem with the patch coming off too early. And if I placed it on my chest which there's no adipose tissue there either; would this increase the uptake and half life of the medication due to location of a main artery? Also, does the uptake of the medication stay at a constant delivery if the body temp is cool? I stay cold all the time. Or is the uptake of delivery depend on the metabolism of each patient? I am thinking that I will need to increase this dose and will speak to my doctor concerning this issue. I don't have any other medications for "break through" pain at this moment. We have tried Dilaudid, which MS, be it synthetic or the real thing is not a good drug for me since I have horrible side affects. So, what's next? Anyone have any ideas? 75.12.45.205 05:21, 18 September 2006 (UTC)

I am currently taking Duragesic patches for fibro mayalga and another disease of the muscles' surrounding tissue that I am not too adept in remembering the name of. My current dose is 200ug/h, with two 100ug patches placed on the soft part of the bottom of my back. I switch it up every three days, I'll put the two 100ug patches on the lower part of my back, then the next three, days, on my thighs (well, two patches on a single leg, to avoid any problem with one of the patches ripping off, as I can always ensure that a side will be "patchless"). Anyways, I've found (like you, I use heating pads as well for back and neck pain), that the patches on my back seem to metabolize more quickly. For me this may be a bit different from you, because the fat on my back is rather thin, and the doses on my back take effect within 11 hours usually, and always feel more potent than 11-12hours later than the ones placed on my thighs. The heating pads also ALWAYS increase the potentcy, or, rather the intake of trandermal doses on my back. I've even felt doses take effect almost an hour more quickly while sleeping on a heating pad than without, though I am not an expert in this field, so this is mainly a personal notice. I've asked about placement of the patches, and I've been told that physical placement has a rather profound effect on intake of trandermal fentanyl, with respect to an increase in the time it take the fentanyl to be metabolized. It has to do mainly with the tissues that the fentanyl has to work its way through physically, to make it to the bloodstream. Also, heat can decrease the viscosity and increase the intake of fentanyl transdermally as well. None of these effect though is so huge as to create a dramatic difference in the placement of the patches, so it really becomes a comfort issue, and where you can place the patches to feel most comfortable.

PS - have you ever had a patch rip-off, and had to place another one on in place of it (that's what I've been instructed to do)

Answer -

It's the worst feeling, because it takes a few extra hours to "quick-start" the next patch you place on, and will make the next few hours of the day a little more annoying than they should be. I even did this so often one month that they thought I was selling them or something; I say "something" because I have no idea. I tried to order more when I was getting low, and for the first couple minutes of the conversation they weren't gonna give them to me. However, they finally realized how ridiculous they were sounding and I was ok. Having chronic use for opiates, I think you would know how horrible it would be to suddenly find yourself without the proper medication for almost two weeks, which is an ETERNITY when you suffer from chronic pain.

I'm actually having some breakthrough pain right now, so I'll write back later and check over my writing when I'm feeling a little better, but that brings me perfectly to your next question. I have been prescribed Statex brand Morphine Sulfate tablets, 25mg, about 20-30 a day. My tolerance is so high that it doesn't matter so much how varied my morphine doses are, as they are relatively non-potent. Orally, I receive about 8mg per 25mg pill I believe is what I've been told. Initially, they made me very itchy when I first took them, but to combat that, all I had to do was take some dimenhydrinate or diphenhydramine (anti-histamines) to combat what they told me was a histamine reaction with the morphine and some people. It worked perfectly! And it has been handling my break-through pain for the last 3 years and 7 months.-TAz69x 17:23, 29 September 2006 (UTC)

Duragesic Patches

I heard this somewhere, and although I've been using Duragesic patches for over two years now, I don't know if this is true. I heard that the adhesive layer of the Duragesic patches (I have the 25's, 50's, 75's, and 100's, although I use two 100's currently every three days), anyways, I heard that the adhesive layer of the patches contains fentanyl itself. I was wondering if this is true. In a few of my old patches that had remained unused, usually from dosage changes or simply having a couple left over, over time in a few of them a crystalline pattern appears within the patch itself and along the outer-part of the patch, where there's still an adhesive layer, but no gel above it. Even on some of my empty patches that I had forgotten to flush, there formed a crystalline pattern underneath and somewhat within (I think, it looks like it's inside the patch, but I'm not sure, it might be formed on the under-part of the patch). So I was wondering a couple of things:

1. Does the adhesive part of the Duragesic-brand patches (the one with the gel) contain fentanyl itself?

Answer -

Depends. Janssen's Durogesic (here in central Europe) comes in two variants -- Durogesic TTS (with active compound reservoire) and Durogesic SMAT (matrix-based patches). The TTS's contains fentanyl in a reservoir behind a permeable membrane, in the patch, in a form of gellified, alcohol-water solution. The fentanylö absorption rate is regulated via the semipermeable membrane in this case. The SMAT variant contains fentanyl mixed up with additives in the adhesive layer matrix. The absorption is here regulated by the concentration of fentanyl in the adhesive layer matrix and its polymer-based composition. So, Durogesic TTS does not contain fentanyl in its adhesive layer, while Durogesic SMAT does.--84.163.111.204 02:46, 1 April 2007 (UTC)

and 2. Is that crystalline structure that sometimes forms on older used patches perhaps pure fentanyl dried to form its original crystalline structure?

Answer -

No, it certainly is not. It is a mixture of gellifying additives and admixture of fentanyl that precipitates.--84.163.111.204 02:46, 1 April 2007 (UTC)

or perhaps simply non-exposure to air but simply age has instructed the fentanyl to form these crystalline structures?

Answer -

See 2.. It is not pure fentanyl.--84.163.111.204 02:46, 1 April 2007 (UTC)

Thanks so much for your help.

E-Trans(tm) Fentanyl

There appears to be a new product utilizing iontophoresis to deliver fentanyl quickly via a patch for acute post-operative pain management. It's the "E-trans" from the same company that makes Duragesic (Alza).

I should note that Alza also makes a "generic" fentanyl patch (unrelated to the above one) that is identical to their Duragesic patch for less money. I guess they want to make money from what people think is generic, while also making money from the brand name.

Njyoder 71.166.141.31 04:36, 19 February 2007 (UTC)

Respiratory depression references

I have added in references referring to respiratory depression relating to fentnayl.
--Claud regnard 00:11, 10 May 2007 (UTC)

Fentanyl Abuse

I would just like to make anybody reading on Fentanyl who is using it illicitly that it is nothing to get in to. I have used fentanyl for year and spent so much of my life and money on it. I was always a popular, hard working, athletic kid and never thought anything like this could happen to me. i started off takin hydrocodones and eventually went on to oxys, morphine, fentanyl, heroin and everything else in this category. fentanyl was the most powerful out of all of these even heroin which surprises alot of people. the withdrawal symptons are horrible. i have stopped using and go to a out patient rehab. the only way to stop use is throught the suboxone program.

Scott from NY age 22

Skooter80 05:12, 28 September 2007 (UTC)

Anybody have results with the "generic" of the fentanyl patch? My doctor recently was thrilled that the patches I had been given weren't "large, sticky and gooey and slide all over the place". Is that the generic patch or is that by manufacturer? The patches I have are very thin and your skin must be completely oil free, like washed with alcohol or some other cleanser besides normal shower soap or the patch won't adhere well. Put on "right" they adhere very well. Mylan is the name on the box so I assume that's the pharmacuetical that makes them. Thanks in advance and God bless. V.Holland

Indications for TD fentanyl

I have undone a change in the first indication for fentanyl about patients with swallowing problems. It had been changed to mention a trade name preparation of fentanyl (I note the IP address of the person changing the text is registrered to the Johnson and Johnson Company and I hope the contributor is not trying to promote one product!), had removed mention of subcutaneous administration (the most common parenteral route used in palliative care) and had changed 'persistent swallowing' to 'diffcult swallowing' (temporary swallowing problems are not an indiation for switching to TD fentanyl). I am happy to discuss these issues further. --Claud Regnard (talk) 10:18, 6 April 2008 (UTC)

I have made minor changes/additions to the indications for fentanyl and its use in spinal analgeisa. --Claud Regnard (talk) 22:20, 12 May 2008 (UTC)

Recent edits, 48 hours instead of 72

During a year on fentanyl every 72 hours, I experienced withdrawal every other day and basically lost half of the 365 days. A pain doctor told me that I did not have enough body fat for it to last 72 hours and the drug was all dumping the first day and then I would go into withdrawal on the second. On the third day, I put on a new patch and started over. We reduced my dose to 50 mcg (from 75) but changed the patch every two days and I got my life back. One reason I was so thin was that I had lost 10 pounds the first month I was on the fentanyl patch. I have never had trouble gaining weight before but I could not do it while on the 72 hour regimen regardless of dose. When I went to 48 hours I gained the weight back in about two months and then stopped at my normal weight, which probably also helped. The patch does not work for everybody at a 72 hour regimen and I think it's important to mention that. The pain doctor said this problem was quite common. After three years, I am attempting to get off the patch. I think there should be a section here on withdrawal--symptoms, lengthiness, and generally how to get off the fentanyl patch.Eperotao (talk) 08:12, 28 May 2008 (UTC)

I, too, was put on a 48-hour regimen instead of the standard 72-hours. Your idea isn't too bad; but it doesn't belong here - it would be better suited within the Duragesic article itself (which is also in need of someone such as yourself to begin to add greatly to it, as it's really in need of someone to finally do a write-up on it), as this page is more suited to Fentanyl itself and its pharmacology/chemistry, where the Duragesic page would be greatly benefitted by the addition of some of those elements. The Fentanyl page as it is itself right now could be cleaned up, and perhaps the layout gone over and cleaned up as well.

I suppose when I have the time I'll go over the page and start to fix the layout and contents, where necessary.

If you want though, you could begin to add to the Duragesic page, where the patch information would be most suited. I even have taken pictures of the 25μg, 50μg, 75μg, and 100μg patch packages (out of the Box, the newer metallic packages, as opposed to the older paper-ish ones), and could also take a picture of the same corresponding Boxes as well.-TAz69x (talk) 01:16, 31 May 2008 (UTC)

PS - Have you ever quit the patch before? There are several methods that I have developed myself, some of which are completely painless and without any real noticeable effect. Though I wouldn't list them and they involve several different individual distinctions for each method, such as the addition of another drug(s) or some perhaps seemingly strange methods.
Anyways, generally a good method (I'm assuming that you should have been prescribed something for breakthrough-pain, such as Morhpine Sulfate), is to use your secondary opioid to step-down usage (depending on your supply), disregarding the patch entirely. Or to use the patches as normal, but gradually increase a portion of the plastic-backing on to reduce the surface-area of the drug-permeable membrane to the skin, reducing the drug-absorption into body fats per-hour.
But regardless, you really should consult your doctor on this, as I myself would never really take any info online over my doctor's advice. So my advice right now would be to consult your doctor on quitting, perhaps even as a hypothetical if you do not wish to inform them of quitting entirely.-TAz69x (talk) 01:16, 31 May 2008 (UTC)

New fentanyl preperations

I have updated the text to prepare us for a wide range of new fentanyl preparations which will appear from several companies over the next two years. We need to be clear about the comparative evidence that these new products are better or safer than current preparations. --Claud Regnard (talk) 15:29, 23 June 2008 (UTC)

Fentanyl safety warning in the UK

I have added a reference to the Drug Saftey warning issued in the UK in Sept 2008. --Claud Regnard (talk) 20:23, 5 September 2008 (UTC)

More complete cross tolerance with methadone.

I read that there is incomplete cross tolerance to certain opioids because they activate the mu-receptor by binding to different protein residues. Both fentanyl and methadone supposedly have structural elements that bind to distinct regions on the mu-opioid receptor that are the same apparently. This might be worth it to elaborate on in general (different binding sites on the Mu receptor itself) in another article and compile the opioids with similar affinities 65.102.21.219 (talk) 04:04, 16 November 2008 (UTC)

Article status

This article is pretty terrible as it now stands - it reads like a cross between an advertisement for Janssen and some Texas law firm. There's very little mention of the use, efficacy and side effects of fentanyl in epidural anasthaesia, which is where the majority of healthy individuals will encounter the drug. I'm also perplexed by the lack of any reference here to the Moscow Theatre Siege. —Preceding unsigned comment added by 130.102.137.84 (talk) 05:11, 9 December 2008 (UTC)

LD50 problems and who wrote this?

I just went in and changed the LD50 to "approximated", because there is no such thing as a human LD50, as an LD50 measurement requires lab conditions and intentionally-caused death. So unless Himmler is still around, there is no verifiable LD50 in humans,

And, if you do the math, 1mg fentanyl = 40mg oxycodone. The standard first recreational dose of oxycodone is 20-80mg, so I think this LD50 may be made up.

Fentanyl is only the strongest available narcotic, as poison dart frogs are coated with narcotic that is up to 200xmorphine.

Also, I replaced some of the made up or misused words, such as efficability, absorbance, and localised (misspelled).

(December 24, 2008)

Actually, the analgesic produced by poison dart frogs (epibatidine) is not considered a narcotic. However, sufentanil and carfentanil (and perhaps other analogues) are far more "potent" than fentanyl, so it isn't even the strongest available narcotic; etorphine and carfentanil are probably the most potent commercially available opioids. Fvasconcellos (t·c) 13:48, 25 December 2008 (UTC)

True; also, LD₅₀'s of humans are generally ascribed from clinical information into effective dosing thresholds for humans, which is often utilized as the general "LD₅₀" for patients in their dosing regiments, especially when considering the ED₅₀ and therapeutic ranges. As far as I know, Nazi Germany is the only nation in modern times to achieve direct values of LD₅₀ attributed to human administration. Because of fentanyl's wide variable LD₅₀ when circumscribed to human doses, stemming from its unreliable cross-species LD₅₀, they are currently attempting to determine a definite value for a proper LD₅₀ for fentanyl, currently being conducted by Johnson and Johnson if I remember right. I have the paper here somewhere in my pile of medical texts here =P -TAz69x (talk) 20:37, 10 June 2009 (UTC)

Strength Stupidity

The intro says "80x heroin and 100x morphine". Ok, heroin is 1.8x morphine. And fentanyl is 80x morphine. So this is BS in 2 regards. You can't take what you see in CSI or the evening news and apply it as fact. As a result, the idea that 1mg fentanyl is an LD50 is BS because that equals 40mg oxycodone. That is, 8 standard Percocet, and that may be fatal for some noobs, but LD50 means that dose kills 50% of the time.

You really should learn your facts before posting. First of all, you can't equate relative potency with the LD50's of the respective drugs. If one drug is 10x as potent as another drug, then that does not imply that the LD50 of the first drug is also one-tenth of the LD50 of the second drug.

Secondly, the LD50 is not a dose that kills 50% of the time. LD50 is based on studies done on rats (obviously you don't want to dose up humans until half of them die) and has only very limited application to humans. 206.194.127.112 (talk) 00:24, 7 March 2009 (UTC)

Fentanyl

To me it seems like alot of junkies trying another way to grt high,Ido fentanyl for a reason not one to get high on,all i want to know is how addict is fentanyl05:51, 6 February 2009 (UTC) —Preceding unsigned comment added by Hatchett946 (talk • contribs)

Fentanyl is just as addictive as it sounds. However, since it delivers a low-quality high (not as euphoric as heroin or oxycodone) it has a lower potential for abuse.

-Having experience and being opiate tolerant, In my opinion Fentanyl has the strongest buzz/loopy/high affect out of all the opiates, and I've taken everything as prescribed and by illicit use/abuse. Just trying to give fair warning that anyone who wants to fool around with Fentanyl be aware that it is really strong and will have you nodding and puking if abused and not used to it. —Preceding unsigned comment added by 204.52.215.151 (talk) 00:42, 13 June 2010 (UTC)

Fentanyl

If this drug is so powerful why is givenHatchett946 (talk) —Preceding undated comment was added at 05:53, 6 February 2009 (UTC).

For painkilling... duh. It is (at least the patches) given only to people who have not gotten effective relief from the standard measures of pain treatment. —Preceding unsigned comment added by 70.20.60.40 (talk) 07:53, 17 February 2009 (UTC)

It is also used as a painkiller/sedative durign surgery AriaNo11 (talk) 09:06, 4 December 2009 (UTC)

Taken appropriately under the supervision of a medical professional, fentanyl is a very useful drug for people with chronic pain that doesn't respond to other treatments such as morphine or oxycodone. 206.194.127.112 (talk) 00:18, 7 March 2009 (UTC)

Strength

Fentanyl is not the most powerful opioid by FAR, carfentanyl is much stronger. 97.100.222.79 (talk) 19:24, 21 April 2009 (UTC)

It is the most powerful opioid that you can use in humans, unless you wish to administer a veterinary anesthetic to a human being, dude. Carfentanyl (or Wildnil) is used for anesthetising large animals, such as Elephants, Lions and Rhinos (usually during major surgery, when you don't want them waking up, or during long distance transportation).  BarkingFish  01:06, 27 July 2012 (UTC)

Sublimaze is NOT sufentanil

Sublimaze is not a trade name for sufentanil, at least not in the United States. In fact, confusing both has proven extremely dangerous in the past[1]. Fvasconcellos (t·c) 19:41, 10 June 2009 (UTC)

Just to clarify Sublimaze and sufentanil (the latter is 5-10 times more potent than fentanyl) The U.S. Drug Enforcement Agency states...

First synthesized in Belgium in the late 1950s, fentanyl, with an analgesic potency of about 80 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze®. Thereafter; two other fentanyl analogues were introduced; alfentanil (Alfenta®), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta®), an exceptionally potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and analgesia. Duragesic®, for example, is a fentanyl transdermal patch used in chronic pain management, and Actiq® is a solid formulation of fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals.

Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues to be a problem in the United States. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. Fentanyls are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted.

http://www.justice.gov/dea/concern/fentanyl.html —Preceding unsigned comment added by Stephl67 (talk • contribs) 17:15, 15 September 2010 (UTC)

adverse events/ adverse effects

This section should be merged into one, also there needs to be a more citations for adverse events. Opiods in general cause constipation and not diarrhea. Is it really that common (10% of patients) --> i think it needs to be verified.

AriaNo11 (talk) 09:04, 4 December 2009 (UTC)

• I agree. It's been a year; why hasn't this been done already? I might do it myself sometime.

SlimNm (talk) 03:18, 22 December 2010 (UTC)

mechanism

What happened to the mechanism section? "It works on the brain to make you happy!" is just ridiculous. It's an opioid, which have a ton of uses and "getting high" isn't a medically-accepted use last time I checked. Isn't "it hooks up to those opioid things in the brain!" a little simplistic? Was it always like this? I could have sworn it had a lot better wording. I know that the mechanism of opioids is widely reported on in Wikipedia, but if nothing else link to a more thorough explanation of the pharmacology (like in the morphine or diacetylmorphine articles) instead of tossing that rubbish at the reader. —Preceding unsigned comment added by 66.225.223.4 (talk) 22:19, 3 September 2010 (UTC)

The whole section sounds like it was intended for the "simple english" site, and even then it's just misrepresenting things. The first impression I get is that the intended purpose of fentanyl is euphoria. It is an opioid that produces typical opioid effects and side-effects. This is a miserable excuse for pharmacology. —Preceding unsigned comment added by 156.40.110.40 (talk) 22:24, 3 September 2010 (UTC)

That made me laugh. Even with the corrections, this article is pretty ridiculous. I would personally rather this article be semi-protected. I have a hunch that some junkies are adding their crap to this page from personal experience or just to troll. SlimNm (talk) 03:20, 22 December 2010 (UTC)

Fentanyl Transdermal

I have read that the onset is 6 to 12 hours and 8 to 12 hours and skin type makes a difference. Please expand and specifically can this patch be woking after five hours? Thanks 24.185.225.231 (talk) 02:49, 7 November 2010 (UTC)

chirality - fentanyl is achiral, unlike its 3 methyl derivative, so levo fentanyl is probably a misnomer

In the ==military use== section mention is made of levo fentanyl, implying that fentanyl has left and right handed isomers. I believe this is a incorrect, probably due to an innocent mistake by an original source writer unfamiliar with stereochemistry, since the only possible center of asymmetry in fentanyl---the nitrogen adjacent to the carbonyl group---most probably rapidly racemizes at room temperature, as in other unhindered tertiary amines. Thus there should be only one form of fentanyl corresponding to the structural formula given, making levo fentanyl a misnomer. In a brief Internet search, I have not been able to find any other mentions of chirality of fentanyl nor other mentions of levo fentanyl besides ones seemingly descended from the one report on the Khalid Mishal incident. By contrast, because of its lower symmetry due to the methyl group, 3-methylfentanyl should have 4 stereoisomers: a left and right-handed cis form and a left and right handed trans form. If anyone knows about whether such a thing as levo fentanyl exists, let them speak up. If my impression that levo fentanyl is a misnomer is confirmed, someone (maybe me) should correct the Fentanyl and Khalid Mishal pages to point this out.CharlesHBennett (talk) 12:44, 10 October 2011 (UTC)

Having found a reliable source for Fentanyl being non-chiral, I revised the articles on Fentanyl and Khaled Meshal to reflect this. Does anyone know where the term "levofentanyl" was first used, and by whom? I can only find it in sources related to the attempt on Meshal's life.CharlesHBennett (talk) 14:47, 31 May 2012 (UTC)

Hot shower

I haven't seen it mentioned that the patch should NOT be used while taking a HOT shower. I know from experience and also read an article about 5 years ago that the companies were going to mention this Hazard in their enclosed usage and precautions. It seriously almost killed me.Moey311 (talk) 01:14, 14 February 2012 (UTC)

Alterations of free molecule images for fentanyl

They need be redrawn (except for the first from Wikimedia commons), but these contrast the one given in the article at top:

[2] [3] [4]

71.32.253.184 (talk) 19:23, 2 June 2012 (UTC)

Sorry, I don't see the problem. Can you specify? --ἀνυπόδητος (talk) 20:03, 2 June 2012 (UTC)

A source on recreational Fentanyl use in Australia

[5] - ABC News, retrieved Saturday 20th, October, 2012.--Senor Freebie (talk) 03:20, 20 October 2012 (UTC)

"narcotic"

Why is the term "narcotic" used when it is much more accurate and useful to call it by its chemical family name of "opioids." Narcotic is an ambiguous term that generally refers to any drug with numbing effect, but the Wikipedia article itself says it is not a useful term. The articles on the other opioids do not use the term "narcotic" in the intro. Eridani (talk) 18:34, 10 December 2012 (UTC)

your information

I find your information helpful,to a point.I was looking for sif=de effects as I'm using above drug in a sub-dermal pain medication pump.I'm looking for side effects and there is nothing that I couls see from your articles or information. — Preceding unsigned comment added by BigSwede58 (talk • contribs) 04:35, 5 February 2013 (UTC)

Have you looked at the section Fentanyl#Adverse effects? --ἀνυπόδητος (talk) 18:16, 5 February 2013 (UTC)

Transdermal halflife

Is the transdermal halflife listed correct? I think someone should read into this. When I was in the hospital I read a critical care nursing book and I remember the half life being around 20 hours. The book said because the continuous in this fashion makes your body store it up in your lipids.

Update

I just went and read on the Duragesic webpage stating this

"and ADMINISTRATION – Initial DURAGESIC® Dose Selection - section of full Prescribing Information for further information). Due to the mean elimination half-life of approximately 20-27 hours, patients who are thought to have had a serious adverse event, including overdose, will require monitoring and treatment for at least 24 hours."

I am going to do my first edit ever on wikipedia hopefully I am going to get this right— Preceding unsigned comment added by 65.128.191.67 (talk) 08:31, 9 April 2013 (UTC)

Thanks for catching this; transdermal fentanyl indeed has a longer half-life because it accumulates in the fatty tissue under the skin. Any by the way, welcome to Wikipedia! Hope this won't be your last edit ;-) --ἀνυπόδητος (talk) 19:02, 9 April 2013 (UTC)

your information

I find your information helpful,to a point.I was looking for sif=de effects as I'm using above drug in a sub-dermal pain medication pump.I'm looking for side effects and there is nothing that I couls see from your articles or information. — Preceding unsigned comment added by BigSwede58 (talk • contribs) 04:35, 5 February 2013 (UTC)

Have you looked at the section Fentanyl#Adverse effects? --ἀνυπόδητος (talk) 18:16, 5 February 2013 (UTC)

Transdermal halflife

Is the transdermal halflife listed correct? I think someone should read into this. When I was in the hospital I read a critical care nursing book and I remember the half life being around 20 hours. The book said because the continuous in this fashion makes your body store it up in your lipids.

Update

I just went and read on the Duragesic webpage stating this

"and ADMINISTRATION – Initial DURAGESIC® Dose Selection - section of full Prescribing Information for further information). Due to the mean elimination half-life of approximately 20-27 hours, patients who are thought to have had a serious adverse event, including overdose, will require monitoring and treatment for at least 24 hours."

I am going to do my first edit ever on wikipedia hopefully I am going to get this right— Preceding unsigned comment added by 65.128.191.67 (talk) 08:31, 9 April 2013 (UTC)

Thanks for catching this; transdermal fentanyl indeed has a longer half-life because it accumulates in the fatty tissue under the skin. Any by the way, welcome to Wikipedia! Hope this won't be your last edit ;-) --ἀνυπόδητος (talk) 19:02, 9 April 2013 (UTC)

Merging articles about brands

For some reason, there are the articles Abstral, Actiq and Duragesic. We don't normally have separate articles on brands (as far as I am aware of primarily because of WP:CFORK) except under special circumstances; eg. when there is a lot of content belonging specifically to one brand (as opposed to the pharmaceutical substance), or when a notable brand can contain different active substances or combinations.

Basically, I think the three mentioned articles violate WP:CFORK and don't merit more than a section in Fentanyl. What do other people think? (NB: The answer need not be the same for all three.) --ἀνυπόδητος (talk) 17:38, 11 April 2013 (UTC)

Reply: The different products represent more than just different brands. They are entirely different drug delivery systems that have their own unique implications, history and uses. The point about brands is well-taken. Instead of merging, I think titling these articles by their generic names would be most appropriate. Actiq should be renamed transmucosal fentanyl citrate. Duragesic should be renamed fentanyl transdermal patches. Abstral should be renamed fentanyl sublingual tablets. The brands should be referenced in the articles, and searches for the brands should point to these generic articles.Fielddan (talk) 01:09, 21 June 2013 (UTC)

I would have supported a merge but since these represent different delivery routes, a generic naming should be advisable. Duragesic could be moved to Fentanyl transdermal patch or Fentanyl transdermal system with the brand name being placed in brackets and the respective article should primarily focus on the delivery route aspect of the drug.Diptanshu^Talk 13:43, 20 July 2013 (UTC)

Article needs reorganization

This article is difficult to follow. It seems like the History should be first and the Overdose section should be closer to the section on Recreational Use. Anyone care to reorganize the page? 69.125.134.86 (talk) 18:49, 20 July 2013 (UTC)

Addition of a Section to Address Storage and Disposal Safety Information

Because fentanyl (oral dosage forms and unused and used fentanyl patches) carry significant risks for those who are not prescribed the drug (children, pets and others in the household who are not opioid-tolerant), we suggest a separate subheading to herald a warning about proper storage and disposal. There is not wide understanding that even used fentanyl patches contain sufficient residual medicine to harm or kill. There have been 26 cases of accidental exposure to fentanyl since 1997, most of them involving children younger than 2 years old. Among these 26 cases, there were 10 deaths and 12 cases requiring hospitalization. The following three paragraphs are suggested for addition to the page:

Storage and Disposal

Fentanyl is one of a small number of drugs that may be especially harmful, and in some cases, fatal with just one dose, if used by someone other than the person for whom the drug was prescribed.(2) All fentanyl medicine should be kept in a secure location that is out of children’s sight and reach, such as a locked cabinet.

When they cannot be disposed of through a drug take-back program, flushing is recommended for these medicines because it is the fastest and surest way to remove these potent medicines from the home so they cannot harm children, pets, and others who were not intended to use them.(2,1)

Fentanyl patches should be flushed down the toilet as soon as they are removed from the body and unused fentanyl patches should be flushed as soon as they are no longer needed. Detailed “Instructions for Use” with complete information on how to apply, use and dispose of fentanyl patches are available on the FDA website.(3)

Other forms of fentanyl should be flushed down the sink or toilet in the home as soon as they are no longer needed. Specific use and disposal information for other fentanyl medicines are available.(1,2)

1. Medicines Recommended for Disposal by Flushing <http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#MEDICINES>

2. Disposal of Unused Medicines: What You Should Know <http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm>

3. Medication Guide and Instructions for Use – Duragesic (fentanyl) Transdermal System, <http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088584.pdf>

Safeusefitz (talk) 18:17, 14 August 2013 (UTC)

Corrections to References

The following does not represent a comprehensive review of this webpage by FDA, but these are some edits or additions suggested to improve the accuracy, supplement with additional resources and bring up-to-date some of the existing information provided on this page.

• References 3 and 17, both entitled, “FDA Professional Drug Information” are both resources that link to www.drugs.com’s representations of FDA-approved drug labeling. Because www.drugs.com may not always have access to the most current labels, and these are not the exact FDA labeling, please provide instead for these references the link to official FDA-approved drug labeling on the FDA website. We suggest the following link which provides a list of the current, approved fentanyl-containing drugs: called: "Regulatory History and Labeling for Fentanyl," accessible at <http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&SearchTerm=fentanyl&SearchType=BasicSearch>. This and linked sites that are on this page are continually updated with the most current, available labeling and other information.

Alternately, please rename these references to accurately inform readers these sites reside on the www.drugs.com website.

• Reference 27 is a link to a www.drugs.com representation of an FDA article. While the article is a faithful representation of an FDA article, the name of the link implies the link goes to the FDA website. Please rename that link to accurately inform readers that this site resides on the www.drugs.com website, not on the FDA website.

• Reference 31 is misplaced. That footnote should be placed at the end of this sentence: ”Manufacturers of fentanyl transdermal pain patches have voluntarily recalled numerous lots of their patches, and the U.S. Food and Drug Administration (FDA) has issued public health advisories related to fentanyl patch dangers.” Reference 31 refers to the advisories issued by FDA that are mentioned in that sentence. As it is placed, it the reference is placed after a sentence about “affected manufacturers.”

In addition, the current link associated with Reference 31 goes to an old advisory from 2005, revised in 2007. The following link should be substituted for Reference 31: <http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm114961.htm>. This link goes to a page on FDA’s site that is up-to-date and includes all the advisories that FDA has issued, and will include any future advisories on fentanyl. In addition, this link will make other safety and labeling information on fentanyl patches available to the reader.

Safeusefitz (talk) 18:17, 14 August 2013 (UTC)

Misleading and unsubstantiated claim

• Under the “Overdoses and Fatalities,” section, this statement is made: "Regardless, fentanyl is considered the safest opioid medication on the market, as well as the least physically harmful to the body, especially with long-term or life-term use."[29][30] This statement needs evidence-based research documentation to substantiate that claim. If the statement cannot be substantiated, we suggest it be removed. Neither of the references (29 and 30) substantiates the claim that “fentanyl is considered the safest opioid medication on the market.” References 29 and 30 both are to law firm sites that conduct personal injury cases.

Safeusefitz (talk) 18:17, 14 August 2013 (UTC)

out-of-date link for relative strength of fentanyl

The reference for the strength of fentanyl is a dud link. Could someone else please find an up-to-date replacement link? I know nothing about this subject.

"Fentanyl is approximately 50-100 times more potent than morphine on a dose-by-dose basis."

--Alan U. Kennington (talk) 01:17, 22 April 2014 (UTC)

Kristin Rossum

Article elsewhere on Wikipedia notes the use of fentanyl in the case of Kristin Rossum, who was convicted of the murder of her husband. — Preceding unsigned comment added by 128.63.16.20 (talk) 17:00, 19 May 2014 (UTC)

Minor TYPO (?)

There is a suspected TYPO near the end of the "Medical_uses" section (Fentanyl#Medical uses), in a list with 3 bullets, right near the end of that section. The easiest way to find it, -- ("as of" this version of the article) -- is to go to (click on the link to) the "Adverse effects" section, and then go up a few lines.

There seems to be a mistake in the third "bullet", of that bulleted list. It says "Troublesome adverse effects on morphine, hydromorphone, or oxycodone."

I think that the word "on" is a TYPO there, [!] and that (instead), it should say "of".

(right?)

--Mike Schwartz (talk) 17:53, 6 August 2014 (UTC)

Use in non-lethal incapacitation

This drug has been used for decades in dart guns to stun wild animals. Procedures performed while the animal is incapacitated include removal of rhino or elephant horns to reduce poaching, installing tagging or tracking devices and preparation for transport or more extensive anesthesia. It can take 5 to 10 minutes after the animal is darted before the drug takes effect, so wildlife veterinary teams must track and monitor the animal until they are able to safely approach.

Dart guns are also under consideration by police forces as non lethal takedown devices, however the time between darting and takedown precludes use when fast takedown is required.

50.196.158.93 (talk) 17:49, 11 August 2015 (UTC)

External links modified

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Terminology

The heading "recreational use" is problematic as it only covers some scenarios under which the drug is used illicitly. Addiction is a complex process involving physiological and psychological factors. An individual who is addicted to Fentanyl and other opiates is not necessarily using the drug for recreational purposes even though they are using it outside of a medically supervised or recommended parameter. Perhaps a better heading would be Illicit Use or some such as the term "recreational" really does fit all the non-medical uses of the drug. — Preceding unsigned comment added by 69.158.165.141 (talk) 22:36, 24 December 2015 (UTC)

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What kind of citation do you want for the lead section?

The lead section says this:

"[fentanyl is] commonly used in pre-procedures as a pain reliever as well as an anesthetic in combination with a benzodiazepine.[citation needed]"

I am in the US, I know trends in other countries are different. I don't think fentanyl is commonly given before the procedure, unlike midazolam, but fentanyl is extremely common as an anesthetic and analgesic during conscious sedation, heavy sedation, and surgical-depth general anesthesia. Fentanyl plus midazolam or another benzodiazepine is very common for conscious sedation here. Fentanyl plus propofol or etomidate is extremely common for heavy sedation and surgical-depth general anesthesia, if the IV route is desired. Fentanyl analogs and meperidine can also be substituted for fentanyl itself, although fentanyl is cheaper than its analogs and meperidine has toxicity problems. In anesthesia, ranging all the way from mild conscious sedation to blockage of autonomic response, fentanyl is one of the most common drugs in the US.

Do you want me to find a paper that it is a good idea? That is an easy citation to find. Or do you want a paper saying it is indeed common? That is harder to find, except as original research. Many papers say fentanyl is a good drug for use in anesthesia and go on to include guidelines. Fluoborate (talk) 04:41, 26 March 2016 (UTC)

unsourced

moved here per PRESERVE - none of this is sourced

Analogs

Structural analogs of fentanyl include:

• Alfentanil, an ultra-short-acting (five- to 10-minute) analgesic.
• Sufentanil, a potent analgesic (five to 10 times more potent than fentanyl) for use in specific surgeries and surgery in heavily opioid-tolerant/opioid-dependent patients. Its binding affinity is high enough to theoretically break through a buprenorphine blockade to offer pain relief from acute trauma in patients taking high-dose buprenorphine.
• Remifentanil, currently the shortest-acting opioid, has the benefit of rapid offset, even after prolonged infusions.
• Carfentanil is an analog of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals such as elephants.
• Lofentanil is an analog of fentanyl with a potency slightly greater than that of carfentanil.
• 3-Methylfentanyl (thought to be the active constituent of Kolokol-1, a chemical weapon)
• 3-Methylthiofentanyl
• Acetyl-α-methylfentanyl
• α-Methylfentanyl (see below)
• α-Methylthiofentanyl
• β-Hydroxy-3-methylfentanyl
• β-Hydroxyfentanyl
• p-Flurorofentanyl
• Thiofentanyl
• Acetylfentanyl
• Butyrfentanyl
• Furanyl-fentanyl

-- Jytdog (talk) 23:25, 12 September 2016 (UTC)

proposed updates on epidemic. data from the New York City Health Department

I propose to add the sentence "In 2016, approximately half of the drug overdose deaths in New York City were due to Fentanyl."

The proposed reference is: http://www.nytimes.com/interactive/2016/12/28/nyregion/new-york-city-overdose-data.html Hotornotquestionmarknot (talk) 22:50, 28 December 2016 (UTC)

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Undated entries

OK, someone on a TV show that most people haven't heard of or have seen died of a fentanyl overdose. Is this a really big story that increases the notoriety of the drug? Opiate overdose isn't all that big of a story.

Halothane is definitely not a fentanyl derivative.

This is an enormous story in BC - 800 hundred people have died of fentanyl overdoses in 2016. — Preceding unsigned comment added by 174.1.241.155 (talk) 16:07, 31 December 2016 (UTC)

---

It seems like it would be more appropriate to list C22H28N2O as the formula, rather than including the HCl. http://www.genome.jp/dbget-bin/www_bget?dr:D00320

UN new controls

The U.N. Commission on Narcotic Drugs has added chemicals ANPP and NPP (4-anilino-N-phenethylpiperidine) to a list of controlled substances. The full story should be added to this article.--Dthomsen8 (talk) 23:12, 17 March 2017 (UTC)

Patent covering almost all analogues

US 4584303 Gives a long list of virtually all of the possible structural alterations. I believe a QSAR like those seen in 'Opioids' by R.Lenz would be of value so that both students and law enforcement agencies can see the vast breadth that the scaffold modifications. That, apart from the infamous carfentanil case, most of the illicitly produced drug is the original fentanyl gives an insight into the limited ability of the 'cooks'. Fentanyl should never have escaped from the operating theatre but, apparently, someone is trying to get sufentanil (R 30730) patches to market. The TI of sufentanil in rodents is 2304 compared to 71 for morphine. — Preceding unsigned comment added by 81.99.74.135 (talk) 11:21, 24 March 2017 (UTC)

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Tom Petty

As for accidental overdose, it would appear that fentanyl was the primary problem with Tom Petty's accidental overdose. Being that he was such an international star for a number of decades, he may be worth mentioning in the proper section. [6]. Since this is a drug article, I might let someone more familiar with MEDRS put it in, although I think the source here is good, and other sources surely exist. Dennis Brown - 2¢ 02:51, 20 January 2018 (UTC)

Edits

This edit adds a bunch of stuff not supported by the references.

1) Pinpoint pupils are not a side effect though common.

2) No need to refer to nasal spray and inhalers as parenteral

3) We already call decreasing breathing a serious side effect, no need to also call it "life-threatening" Doc James (talk · contribs · email) 17:02, 14 June 2018 (UTC)

Section on Synthesis

I've been reading a few papers on this topic and came across considerable literature on fentanyl synthesis, given that there's continually developing new ways to create the compound from a variety of reagents and through a variety of pathways. some of these contain quite good information on how the science of its development keeps evolving (new total synthesis pathways have been developed in the last 3 years) and a variety of images although not sure if they are open-sourced. it might provide a clearer picture if some editors are willing to write up a short piece on how its brewed, and what it's brewed from alongside common brew routes. 66.229.17.212 (talk) 14:22, 2 July 2018 (UTC)

Expanding information on treatment

I noticed there's overt coverage of fentanyl as a drug, its routes of delivery and forms but not nearly enough balance on its medical usages. t might be fair to provide some further information on its most commonly prescribed usages particularily in the form of chronic pain management. furthermore, expansion of its role as a common general anesthetic how widely its used. the drug itself gets a bad wrap lately in the news, but its still considered an urgent drug and shortages are an ongoing health issues in many countries for some time since there is no available access to it (partly due to its recreational expansion/diversion). 66.229.17.212 (talk) 14:28, 2 July 2018 (UTC)

Side effects

This source lists common AE as:[7]

"Headache, nausea, vomiting, constipation, diarrhea, somnolence, confusion, asthenia, fatigue, dizziness, insomnia, anxiety, dyspnea, peripheral edema, dehydration, anemia."

Not sure why "confusion" keeps getting removed User:Krb19?

Also why is "serotonin syndrome and low blood pressure" as serious side effects being removed? We mentioned deaths a little lower already so it is obvious these occur. Falls and syncope are not generally serious though can be. Doc James (talk · contribs · email) 19:05, 16 June 2018 (UTC)

I was using the other cited US monograph because it had more detailed frequency info. Low BP you're right for the patients that do experience it severely, syncope probably the side effect that is first noticed.

Serotonin syndrome is not reported at all in that 5 ROA monograph but as an interaction it's clearly an issue, maybe in pharmacology section?

I strongly believe that something like "death especially in overdose" should be in the intro and not too far from the top. The main concern in this common overdose is death by respiratory arrest and this should be clear

And removing "decreased effort to breathe (respiratory depression)" and putting respiratory depression or reduced breathing seems clearer. Like naively "asthma med decreased effort to breathe" sounds okay.Krb19 (talk) 21:09, 16 June 2018 (UTC)

Low blood pressure is often very serious. Which source says syncope is the first side effect noticed? Decreased breathing and loss of consciousness are much more common.

Serotonin syndrome is a major condition which should not be missed. It is an adverse effect and is mentioned here.[8] So IMO it is perfectly appropriate for it to be listed.

Yes I agree "reduced breathing" is more clear and have added that per your suggestion.

We mention death and give and entire sentence just to this "In 2016, more than 20,000 deaths occurred in the United States due to overdoses of fentanyl and analogues, half of all opioid overdose deaths." I have moved it to the second paragraph of the lead per your suggestion. Doc James (talk · contribs · email) 16:16, 17 June 2018 (UTC)

Seretonin syndrome, is likely not true,and has no recognized mechanism, but is mentioned in some references ( eg micromedex). It should be moved to somewhere less prominentJhunt29 (talk) 10:49, 12 July 2018 (UTC)

Respiratory Depression

It is unlikely that any mu opioid receptor agonist causes more or less respiratory depression than any other, in comparison to its other mu effects. The observed variation in frequency of overdoes and death has explanations other than the intrinsic properties of the drug ( for instance, the differences in who takes a drug and why, or how it is taken, and the risks of taking an unknown purity of drug.) Some drugs which are less abused ( such as codeine) may have a lower risk of death in overdose because of slower onset of effects. This slow onset is also why they are not important drugs of abuse. [Codeine has other problems related to variability of metabolism]

I note that the statement "significantly more respiratory depression" is tagged as 'citation needed' I have deleted that statement. Some of the citations on 'delayed respiratory depression' clearly relate to sustained release "patch" preparations. The raison d'etre for such a preparation is that effects are delayed and sustained. This is a feature of the preparation, not of the drug. I have changed this section to more closely indicate the import of the citations.

The observation that many people die from respiratory depression due to fentanyl overdose is true. It is a potent drug of which most supply is illicit, with variable purity. Oxycodone, by contrast, has more reliable purity and so is less risky to inject, because it is largely diverted from high quality medical supply. I have no reference for that observation, so I will not include it in the article.Jhunt29 (talk) 09:45, 12 July 2018 (UTC)

Under "recreational use" I have removed the phrase " Once the fentanyl is in the user's system, it is extremely difficult to stop its course because of the nature of absorption." and replaced it with "Like all opioids, the effects of fentanyl can be reversed with naloxone, or other opiate antagonists. Naloxone is increasingly available to the public. Long acting or sustained release opioids may require repeat dosage." Jhunt29 (talk) 10:58, 12 July 2018 (UTC)

What is the difference between synthetic and semi-synthetic opioids in chart?

Many laypeople, myself included, have this question. See:

• Category:Synthetic opioids

Chart currently in the article (in the overdose section):

US yearly overdose deaths, and some of the drugs involved. Among the more than 64,000 deaths estimated in 2016, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids in the chart) with over 20,000 deaths.

I am also using this info outside Wikipedia, so any info is appreciated.

References

--Timeshifter (talk) 16:02, 23 November 2017 (UTC)

I found this category:

Category:Semisynthetic opioids

I linked to it from

Category:Synthetic opioids, and vice-versa.

--Timeshifter (talk) 22:26, 30 November 2017 (UTC)

You'd have to doublecheck on this and get a good source but I'd assume semisynthetic refers to derivatives of existing drug classes (e.g. hydrocodone and so-on are offshoots of morphine and so-on which are found in nature). The compound fentanyl, however I don't believe have a similar drug that resembles it in nature, hence it is entirely synthetic. Drugs which share its structural features are members of the fentanyl class (e.g. carfentanyl) which are also henceforth synthetic. 66.229.17.212 (talk) 14:41, 2 July 2018 (UTC)

Excellent Question. Here's another: Why does this chart not differentiate between legal and illegal opioids? This clearly highlights a rapidly increasing trend, but is that just for illegally-obtained opioids, or does that apply to lawfully prescribed opioids, as well? If so, to what extent? It would be nice to see a chart that makes this distinction.Clepsydrae (talk) 18:13, 3 March 2019 (UTC)

Recreational fentanyl

Fentanyl powder seized by a sheriff.

Yes it is often not pure. Actually it is usually not pure. What is the issue? Doc James (talk · contribs · email) 07:03, 1 February 2019 (UTC)

The issue is that this image doesn't represent fentanyl – so it's not a good illustration for this article. Just because mannitol in the picture has been contaminated with relatively minor amounts of fentanyl (less than a quarter in the mix), doesn't make it a suitable as an illustration of the subject – not more than, say, a photo of the topsoil contaminated with mercury salts being a good illustration for the article on mercury. cherkash (talk) 22:07, 4 February 2019 (UTC)

I believe that the fentanyl mixture shown in the picture is perfectly reasonable for inclusion on the page, particularly in the section on "Enforcement and seizures". The common name for the substance shown in the picture is "fentanyl", even through chemically it is no doubt a mixture of a the chemical compound "fentanyl" and excipients like mannitol (or other bulking agents). To take another example, tablets of prescription drugs are almost never supplied in pure form to consumers, yet common use would still use the active (drug) name to describe the whole tablet (e.g. a paracetamol tablet). Similarly, with illicit drugs, it is common use to use the drug chemical name to describe the mixture of drug + excipient + bulking agents. Klbrain (talk) 13:22, 5 February 2019 (UTC)

Klbrain: your "with illicit drugs, it is common use" statement is ambiguous: it's not clear what you meant by it – i.e. common use where? Common use in some discussions/articles outside of Wikipedia? Than it's irrelevant to this discussion – as this discussion is about suitability of an image as an illustration to the article. Or did you mean common use on Wikipedia? Then you have to provide better examples and relevant policies – of using this kind of image being a de facto common practice here on Wikipedia.

I also find your reference to prescription drugs and their common delivery form as irrelevant: such images may be a good illustration of common delivery vehicle for prescription drugs, but only when it's understood as such. E.g., there are already 3 images like this in this article – and I personally have no problem with them, as their meaning is clear. As for illicit form of drugs delivery (as being the case of the illustration in question) – and also specifically this particular case of powder containing a minor proportion of fentanyl in the mix that was a custom preparation by one specific drug user – it's not clear at all what this illustration was supposed to show. E.g. is this a common enough method of delivery? If you claim that it is so, then what's your evidence? If not, then how is this relevant except for being a simple anecdote (and it was used as such an anecdote in the original DEA article from which it was taken). So how is this a good illustration for anything, without really providing a good background for this specific image (in which case, bringing this anecdote up would likely become irrelevant and too much of a digression for this article anyway).

So I'd like not to continue speculating on what you meant and how to interpret your words. Please be explicit in your arguments if you are intending to provide some useful and constructive insights to this discussion. Thank you. cherkash (talk) 14:49, 5 February 2019 (UTC)

Agree with User:Klbrain. This is what the stuff called fentanyl often looks like. Doc James (talk · contribs · email) 15:35, 5 February 2019 (UTC)

@Cherkash: To be explicit, the image shows seized fentanyl, so helpfully enhances the Fentanyl#Enforcement and seizures section. Klbrain (talk) 21:18, 5 February 2019 (UTC)

@Klbrain: It was not even "seized fentanyl" – it was discovered as spilled on the floor of a public restroom coincidental to someone having overdosed there. Read the source for the details to know what we are talking about. So again, outside of this particular anecdote (as told in the DEA Microgram Bulletin publication) – and without this photo being shown alongside that story – this particular powder mix photo doesn't deserve any mention in the Fentanyl#Enforcement and seizures section. As I mentioned elsewhere, there are photos floating around of fentanyl seizures of much higher concentrations than 23% in question. And the illustration is dubious anyway: if it pretends to show what fentanyl looks like (illicit or not), then it fails – it shows mostly mannitol; and if it's related somehow to the narrative of the Fentanyl#Enforcement and seizures section, then so far I fail to see how. cherkash (talk) 13:40, 6 February 2019 (UTC)

Referring to quote from image source (linked above): "The exhibit was seized by a Lake County Deputy Sheriff ..."Klbrain (talk) 23:16, 6 February 2019 (UTC)

@Klbrain: You chose to object to a minor point on the meaning of "seized" (which I already explained), yet you ignore the main issue I raised. cherkash (talk) 17:14, 9 February 2019 (UTC)

Please see my discussion of common use above (13:22, 5 February 2019). Klbrain (talk) 12:50, 16 February 2019 (UTC)

@Klbrain: Your common use discussion doesn't justify the illustration being placed in this article. Again: it's an illustration to demonstrate a single anecdote from the life of law enforcement – there's no reliable sources claiming anything like "this is the mix most commonly encountered on the streets". As such, there is no value in this image to illustrate the subject of the article (i.e. fentanyl itself – and not arbitrary mixes in which it may have been encountered in a single murky case). cherkash (talk) 16:48, 12 March 2019 (UTC)

Illicit vs legal OD rates

Under the "Enforcement and Seizures" heading, "In a separate study conducted by the CDC, 82% of fentanyl overdose deaths involved illegally manufactured fentanyl, while only 4% were suspected to originate from a prescription.[106]"

Reference given for 106 is a study conducted by CDC ONLY in Massachussets, yet no mention of this leading people to believe these might be national stats

Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016 (Report). Centers for Disease Control and Prevention. April 14, 2017. — Preceding unsigned comment added by 162.104.167.54 (talk) 01:08, 23 May 2019 (UTC)

---

Dangerous lethal dose misunderstanding

Hi, I am not wikipedia expert but I think I've some knowledge about pharmacology. The lethal dose in the article is given as "2mg/kg". In my opninion this is wrong and dangerous as it leads to extreme underestimating of the lethal dose! It should be given as "2mg" for every adult regardless the weight. The used citations (https://www.dea.gov/galleries/drug-images/fentanyl; http://www.emcdda.europa.eu/publications/drug-profiles/fentanyl) are correct and both say "2mg" and do not indicate any relation to the weight. This makes sense because for example for anaesthesia the initial dose of fentanyl is often 0.1-0.2mg - and not mg/kg. 193.171.77.3 (talk) 10:21, 10 June 2019 (UTC)

Entry into the sewage system

"When patches cannot be disposed of through a medication take-back program, flushing is recommended for fentanyl patches because it is the fastest and surest way to remove them from the home so they cannot harm children, pets and others who were not intended to use them.[28][29][30]"

All three sources there are U.S. About fentanyl specifically I don't know but in the U.K the entry of pharmaceuticals into the environment via sewage is a serious concern when chemicals do not break down & cannot be removed by normal waste water treatment. The need to keep medicines away from kids etc is understandable but outside of the U.S I would be surprised if there are governments in the developed world currently recommending flushing medicines down the toilet? 86.150.252.241 (talk) 11:20, 2 September 2019 (UTC)

Passive toxicity

There's an interesting mass panic of sorts amongst first responders over passive exposure to fentanyl, when attending to or arresting people involved with it. There doesn't seem to be any real risk, but that message isn't getting through. I'm not sure if this is notable enough to go on the page, or where. Anyway, see and. — Preceding unsigned comment added by 149.14.21.6 (talk) 18:47, 5 April 2019 (UTC)

References

NIOSH has this resource page regarding occupational exposure, particularly among first responders. Agreed that there doesn't appear to be any real risk, other than on Twitter https://www.cdc.gov/niosh/topics/fentanyl/risk.html — Preceding unsigned comment added by Richardjames444 (talk • contribs) 23:54, 18 September 2019 (UTC)

WikiProject Medicine Fall 2019

Hello, all!

My name is ILikeToIntubate, and I am a 4th year medical student at the University of Central Florida College of Medicine. I am taking a course called "WikiProject Medicine" to contribute to online medical knowledge. This article will be enhanced using medical textbooks, with some clarifications in certain aspects of the page. This is an important page because it gets over 7,500 views per day and fentanyl is used in so many patients perioperatively, on a regular basis. This is a grade "B" article, and I'm hoping to improve it with some changes:

Medical uses: This section initially had routes of administration, instead of medical uses. The two are not always mutually exclusive, so reorganization and clarification are the main goals here.

Adverse effects: I want to highlight the most dangerous effects of fentanyl, as well as the common side effects. Clarifications on respiratory depression, cardiac effects, and vocal cords (muscles).

Overdose: None.

Pharmacology: Location of most edits - more clarity on classification of the drug, structure/activity, mechanism of action, therapeutic effects. No changes to the detection in biological fluids section.

History/Society/Culture/Veterinary use: None.

I want to help the public understand some basic principles associated with this widely used drug and add some textbook references with accurate medical information. I am hoping to achieve a personal goal of avoiding medical jargon, but also want to have enough information for those in the scientific community. I value any and all input.... thank you for letting me be a part of this community!

Sincerely, ILikeToIntubate — Preceding unsigned comment added by ILikeToIntubate (talk • contribs) 02:29, 11 November 2019 (UTC)

Peer Review WikiProject Medicine

I believe the edits made greatly improved the page. The article was easy to read and will be very helpful to future readers. The clarifications on the common side effects was a great addition. It is important for future viewers to understand the possible side effects of the potent medication. The pharmacology section was greatly improved by the addition of mechanism of action and therapeutic effects. The work was cited appropriately from reputable sources and links. Overall, great job!. Jasmine3093 (talk) 19:47, 12 November 2019 (UTC)

Medical uses: This section initially had routes of administration, instead of medical uses. The two are not always mutually exclusive, so reorganization and clarification are the main goals here. - I like the breakdown of the medical uses of fentanyl. Using the categories of anesthesia, obstetrics, and pain management made the page more organized.

Adverse effects: I want to highlight the most dangerous effects of fentanyl, as well as the common side effects. Clarifications on respiratory depression, cardiac effects, and vocal cords (muscles). - The clarifications on the common adverse effects was a great addition. Adding the percentage of people who experience respiratory depression, cardiac effects, and muscle weakness would be a good addition. It would have clarify if these reaction are common or rare events.

Overdose: None. - I don't believe you made additions to this section, nonetheless there are really interesting facts in this section.

Pharmacology: Location of most edits - more clarity on classification of the drug, structure/activity, mechanism of action, therapeutic effects. No changes to the detection in biological fluids section. - Really like the categories added in this section. Consider moving this section toward the beginning of the article. History/Society/Culture/Veterinary use: None.

Jasmine3093 (talk) 01:12, 15 November 2019 (UTC)

Stereochemistry

The structure activity section claimed that the family didn't follow stereochemical naming rules because there is no chiral center. This is garbage. First, I can easily draw the structures of hundreds of members of that family that DO (or would) have a chrial center - where stereo designation would be necessary for completeness. There should be no question about that. Second, because there is no chiral center it IS a "stereochemisty rule" that no stero-designation be used --that is, the rules ARE being followed/used. I've reworded it. Please feel free clean it up a bit, I don't see much value in the sentence, especially in its current location in the article. Are there really people who care about the chemical (IUPAC) name but can't see that there is no chiral center? (other than organic chemistry students doing homework).40.142.191.32 (talk) 09:17, 21 November 2019 (UTC)

I agree that the prior wording was nonsense and what you've written is better. However, I also agree that there isn't much value to the sentence, so I have simply removed it. -- Ed (Edgar181) 14:29, 21 November 2019 (UTC)

"Fent" listed at Redirects for discussion

A discussion is taking place to address the redirect Fent. The discussion will occur at Wikipedia:Redirects for discussion/Log/2021 April 15#Fent until a consensus is reached, and readers of this page are welcome to contribute to the discussion. _signed, Rosguill ^talk 15:20, 15 April 2021 (UTC)

Information removed from lede

Riventree, you made an edit to the lede which removed the phrase "Fentanyl patches for cancer pain are on the" (WHO Model, etc.). Your edit summary said "Use the macro", and I can see that you did something marvelous there, to consolidate the ref, but why did you remove the phrase regarding cancer pain? Should we restore the information?

Also, can you link me to info that explains how you did this "macro"? I've never seen this before. Thanks, Tribe of Tiger ^{Let's Purrfect!} 00:37, 8 September 2021 (UTC)

Macro looks miraculous to me as well. Could we include the patch/cancer detail somewhere in the body instead? Firefangledfeathers (talk) 02:29, 8 September 2021 (UTC)

The macro lets you parameterize the year of the WHO LEM that's being referenced, so when the next one comes out, all the pages get pointed to the correct doc and link automatically. Likewise we can "zero out" the text for the current one, removing the text from the no-longer-listed medicines.

I removed the "cancer pain via patches only" because I couldn't find a reference for that. AFAICT, it's prescribable for anything the local doc thinks is worthy of fentanyl. If I'm wrong, definitely put it back.

Riventree (talk) 03:12, 9 September 2021 (UTC)

Riventree, ah ha, I see your point. Yes, the transdermal patches treat other types of pain. This was a correct removal, I agree. Thanks for being patient and explaining both the removal and the wonderful macro. Tribe of Tiger ^{Let's Purrfect!} 04:42, 9 September 2021 (UTC)

Cheers, keep up the good work.

Riventree (talk) 04:44, 9 September 2021 (UTC)

Firefangledfeathers the information is in the text, under Pain management...chronic pain. But Riventree is correct, these "patches" are used for many other types of chronic pain, not "just for cancer". I shouldn't have raised the question, it was late at night, not thinking clearly. So I don't think this belongs in the lede, which is a general overview. My mistake. Tribe of Tiger ^{Let's Purrfect!} 04:51, 9 September 2021 (UTC)

The info I was referring to was about the essential list use being specifically the patch and specifically for cancer pain. I also appreciate Riventree's correction! Firefangledfeathers (talk) 04:55, 9 September 2021 (UTC)

Lethal dose

The article contains an image, originally from a US FDA website, of some powder adjacent to a US 1 cent coin. The image is captioned “2 milligrams of fentanyl, a lethal dose in most people”, which is the caption in the original FDA document According to this document from the US National Institutes of Health the lethal dose in humans is not known. However, it lists LD50s (lethal to 50% of test population) for other species under various scenarios. E.g. the LD50 for intravenous administration of fentanyl to rats is listed as approximately 2.9mg per kilogram of body weight. The average weight of a human female in the US is 76.4kg. Extrapolating the LD50 for rats, this would mean an intravenous dose of approx. 221.6mg would be lethal to 50% of average weight US females. This is two orders of magnitude greater than the amount given in the Wikipedia (and FDA) articles. On the basis of this information, I propose the article be changed to reflect the information cited. — Preceding unsigned comment added by Dettifoss (talk • contribs) 20:30, 28 December 2020 (UTC)

References

• I have to agree, and will now attempt to change the article accordingly. Also, the first "common side effect" mentioned is "death", which sounds absurd-- death is a common side effect of being shot in the head to cure a headache, and no one is suggesting we cure headaches with bullets, though they may be very effective. Am going to place "death" at the end of the list of common side effects, or else remove it altogether-- the article makes very clear the possibility of dying from use. A loose necktie (talk) 00:28, 8 December 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 October 2019 and 15 November 2019. Further details are available on the course page. Student editor(s): ILikeToIntubate. Peer reviewers: Jasmine3093.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 21:20, 16 January 2022 (UTC)

Does Fentanyl cause a positive opiod result in drug screens

Does Fentanyl cause a positive opioid result on drug screens 70.40.85.201 (talk) 02:27, 25 January 2022 (UTC)

Wikipedia is not a discussion forum, and we do not give medical advice. –LaundryPizza03 (dc̄) 12:33, 25 January 2022 (UTC)

"Duragesic®" listed at Redirects for discussion

An editor has identified a potential problem with the redirect Duragesic® and has thus listed it for discussion. This discussion will occur at Wikipedia:Redirects for discussion/Log/2022 April 15#Duragesic® until a consensus is reached, and readers of this page are welcome to contribute to the discussion. BD2412 T 04:45, 15 April 2022 (UTC)

Missing statement of positive effects of recreational use

There's nothing which says why people use it recreationally - what desirable effects do they experience? 87.10.122.1 (talk) 01:00, 4 June 2022 (UTC)

Fentanyl myths

Given the myths about fentanyl in popular culture, do you think there should be more about it in this article or in a separate article? I decided to add a heading to at least make that section more prominent in the article. ScienceFlyer (talk) 16:24, 1 August 2022 (UTC)

I think it deserves a separate article, given how prevalent misinformation is on the topic. Having at least a longer section with more citations is important. 76.79.177.66 (talk) 21:27, 4 October 2022 (UTC)

Pronunciation

I've always heard this pronounced "fentenol" rather than "fentanyl". Does anyone know why that is, and can someone put a pronunciation guide in the lede? Thanks. Softlavender (talk) 07:35, 15 October 2022 (UTC)

Uncited and ridiculous claims right in the intro

"It is also used recreationally, sometimes mixed with heroin, cocaine, benzodiazepines or methamphetamine...Fentanyl is commonly used to create counterfeit pills disguised as Oxycodone, Xanax, and Adderall, among others."

Aside from one actually sourced statement (which I've omitted with ellipses) there is no citation for these claims. Additionally, some of these drugs are the complete opposite of a relaxant / painkiller in terms of effects. No one could possibly think any sort of opiate would make a convincing adderall counterfeit. If they do think that, brokering illicit drug transactions is perhaps not the right profession for them. By the same token, it makes very little sense to recreationally mix a stimulant like methamphetamine or cocaine with a depressant like fentanyl or any pain killer. Without any medical training its blatantly obvious that in the best case both drugs cancel each others intended effects and in the worst case both drugs interact badly in ways your layman self don't understand. It's all risk with no apparent reward. There's no rational reason for anyone to engage in that behaviour, and no citation given that anyone was ever irrational enough to do it anyway.

I move that these two lines be deleted. — Preceding unsigned comment added by 103.179.202.32 (talk) 12:07, 9 January 2023 (UTC)

A few comments.

1. New talk page comments 'traditionally' go at the bottom of the page, for your future reference.
2. Generally speaking, the lead/lede of an article does not require inline sourcing; it is expected that material in the lede is expanded within the body of the article, where the inline sourcing will occur.
3. It is not uncommon within the recreational drug culture for people to mix 'contrary' drugs for different effects. It is simplistic to suggest that taking a stimulant and depressant at the same time will 'cancel each others intended effects' - that's not how drugs biologically. Look up 'speedball'.
4. Being unfamiliar with the recreational drug culture isn't a bad thing, but it also means you're making your argument from ignorance. The very reason there are so many overdoses and other bad outcomes with some recreational drug use is that the desire to get high supersedes common sense; the reward is all that matters, so the risk is ignored. So the layman dies, or is permanently damaged. "Rational" thought processes are not part of the formula.
5. With regard to Adderall, it is indeed not specifically sourced within the body, so I will remove it. cheers. anastrophe, an editor he is. 20:26, 9 January 2023 (UTC)

Place brand name of narcan to any mention of naloxone on page

Could help bring awareness, as many know what narcan is but not naloxone 209.242.39.40 (talk) 02:48, 12 August 2022 (UTC)

I had heard of naloxone, but not Narcan, before this comment. Ei9ther way, drugs are conventionally named after their generic name. –LaundryPizza03 (dc̄) 15:15, 12 August 2022 (UTC)

I've added a brief mention of the brand name in the overdose section discussing use of naloxone. I think this mostly clears up the issue. JumbledPasta (talk) 06:05, 28 January 2023 (UTC)

Article fails to identify why fentanyl causes respiratory depression

Under Adverse effects, the article should indicate that fentanyl's high propensity to cause significant respiratory depression is likely due in part to its biased agonism/functional selectivity for β-arrestin-2 at the MOR. This liability is compounded by the fact that fentanyl exhibits extremely high binding affinity to the MOR.

Podlewska, S.; Bugno, R.; Kudla, L.; Bojarski, A.J.; Przewlocki, R. Molecular Modeling of µ Opioid Receptor Ligands with Various Functional Properties: PZM21, SR-17018, Morphine, and Fentanyl—Simulated Interaction Patterns Confronted with Experimental Data. Molecules 2020, 25, 4636. https://doi.org/10.3390/molecules25204636 (See table 1)

Stahl EL, Schmid CL, Acevedo-Canabal A, et al. G protein signaling-biased mu opioid receptor agonists that produce sustained G protein activation are noncompetitive agonists. Proceedings of the National Academy of Sciences of the United States of America. 2021 Nov;118(48):e2102178118. DOI: 10.1073/pnas.2102178118. PMID: 34819362; PMCID: PMC8640941. 2601:6C5:300:B230:3CF1:F729:3B3D:C887 (talk) 06:11, 19 March 2023 (UTC)