Fentanyl Citrate (Sublimaze)

Binds with opiate receptors in CNS, altering perception of and emotional response to pain.



Onset of Action

Peak Effect

Duration of Action


<1 minute

5-15 minutes

30-60 minutes


5-8 minutes

15-20 minutes

1-2 hours


5-15 minutes

20 – 30 minutes

1-2 hours


Dosage/Administration –



  • 25-100mcg slow IV injection into IV infusion line over 1-2 minutes is required.  Titrate 25 mcg at a time.


  • Total recommended dose for nursing administration, 200 mcg for healthy young adult.


  • Reduce dosage and rate of administration in patients who are elderly, debilitated or have renal or hepatic disease.



  • 0.5 – 2 mcg/kg. Titrate to individual response.


Adverse Reactions –


  • Respiratory effects – potent respiratory depression, apnea.  Use with caution with patients with COPD or other respiratory compromise.


  • Cardiovascular effects – hypotension, bradycardia, tachycardia, palpitations, syncope, shock, cardiac arrest.


  • CNS effects – euphoria, dysphoria, weakness, sedation, agitation, tremors, seizures, use with caution with patients with increased intracranial pressure.


  • GI effects – nausea, vomiting, delayed gastric emptying, biliary tract spasm.


  • Musculoskeletal – may cause muscular rigidity of the thorax to the point that ventilation (spontaneous or controlled) is impossible.  Muscle relaxant can be used for treatment, but is only to be given by anesthesia; therefore, treat with Narcan. 


  • Special considerations – this drug must be titrated to effect and administered slowly to prevent the occurrence of adverse reactions. DO NOT mix with barbiturates.


Reversal Agent –  


  • Naloxone (Narcan) will reverse the respiratory and cardiovascular effects of Fentanyl overdose. 


  • Reversal brought on too rapidly may cause nausea, sweating, and hypertension.

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