Drug Warning: Signs and Symptoms of Fentanyl Toxicity

Because Of The Delivery System Of The Pain Patch Fentanyl Toxicity Is A Possibility

About 100 times stronger than morphine, fentanyl is an extremely powerful synthetic opioid. It is typically prescribed to treat severe chronic pain, sometimes known as “breakthrough pain,” for which lesser painkillers are ineffective. The most common patients are those already conditioned to narcotics, such as cancer patients.

Though created in 1959, the drug gained popularity in the 1990s when the Duragesic patch was introduced. Distributed by the pharmaceutical company PriCara, the transdermal system consists of a patch that contains the fentanyl in gel form inside a reservoir. It is then released gradually into the patient’s skin over a period of a few days.

The opioid comes in other forms as well, including injections. Fentanyl citrate can be added to an intravenous fluid that drips through a needle or catheter placed in a patient’s vein, delivered continuously for around-the-clock relief.

As with any powerful narcotic there is the risk of adverse effects. Particularly serious among these is fentanyl toxicity, in which the body has a toxic reaction to the substance, typically via a strong allergic reaction or overdose.

Another potential cause of fentanyl toxicity is a drug interaction. One in particular that should not be taken in this combination is ritonavir (with the trade name Norvir), an antiretroviral used to treat HIV and AIDS. Ritonavir can increase the effects of fentanyl in a patient’s system, leading to the same symptoms as an overdose and possible respiratory depression.

The signs and symptoms of fentanyl toxicity vary, but can include any of the following:

• Respiratory depression

• Hypotension

• Circulatory failure

• Coma

• Convulsions

• Renal failure

• Pinpoint pupils

• Agitation

• Vivid dreams or nightmares

• Hallucinations

• Confusion

• Involuntary muscle spasms

Typically, an overdose is characteristic of a central nervous system depression, and becomes critical due to respiratory depression. The following are the immediate signs:

• Slowed heartbeat

• Slowed breathing

• Pinpoint pupils

• Cold, clammy skin

• Fainting

• Seizures

Anyone experiencing these symptoms after taking the opioid should immediately seek medical attention; there are a number of treatments available. There have been hundreds of deaths related to fentanyl poisoning since the FDA began issuing warnings about the dangers of overdosing. Though these deaths are sometimes related to inappropriate or recreational use, some have been tied to defective products such as leaky Duragesic patches, to doctors prescribing the drug for less than severe pain, or to confusion or misunderstanding of directions for use it. There have already been class action lawsuits relating to injuries.

The potential risk of overdose has proven to be particularly high. This danger tends to be highest when:

• They are used by patients who do not have a tolerance for opioid medications

• There is off-label use

• The medication is combined with other narcotics

• The instructions are not followed exactly

• The product is leaky or defective

As always, patients should consult with their doctors about the potential risks of toxicity, in addition to reading all of the appropriate prescribing information. An additional resource for more detailed information is the Professional Guide to Diseases (Eight Edition), a guide to disease management and patient care for health care professionals.