Actiq (Fentanyl Citrate)
Opioids are the strongest form of medication used to treat pain. Opioids work by attaching to opioid receptors, which are found in many areas of the body, including the brain, spinal cord, and gastrointestinal tract. An opioid attaches to the receptor, which reduces the transmission of pain messages to the brain, reducing pain. Opioids are used to treat moderate to severe pain that is not well managed with other pain medications. They do not treat the underlying cause of the pain. If a cancer is causing the pain, the cancer treatment is aimed at reducing the pain.
There are several different ways to take fentanyl. Fentanyl citrate is a fast-acting form of fentanyl used to treat breakthrough pain. Breakthrough pain is pain that comes on quickly and occurs intermittently (or “flares”), despite the regular use of long-acting pain medications. When this pain occurs, fast-acting pain medication is needed to ease the pain.
How to Take Fentanyl Citrate
Fentanyl citrate delivers pain relief using a lozenge that is attached to a handle and dissolves as patients move it along the inside of their cheeks. The fentanyl citrate unit should be sucked, not chewed. The drug should be consumed over a 15 minute period. You should not eat or drink during this 15 minute period. You also should not bite or chew the lozenge as that will diminish the effect of the medication.
It is important to make sure you are taking the correct amount of medication every time. Before every dose, check that what you are taking matches what you have been prescribed. You should also not replace one type of fentanyl for another. Take only what you have been prescribed.
This medication can interact with other medications that depress the central nervous system like barbituates (including phenobarbital), tranquilizers (including Haldol®, Librium® and Xanax ®), other narcotics and general anesthetic. The blood levels of this medication can be affected by certain foods and medications, so they may require dose adjustment or should be avoided. These include: grapefruit, grapefruit juice, verapamil, ketoconazole, rifampin, phenytoin, St. John’s wort, and modafanil. Be sure to tell your healthcare provider about all medications and supplements you take.
DO NOT share this medication or give it to someone else, as severe breathing problems and death can occur.
This medication can cause dizziness, sleepiness and confusion. You should not drive or operate machinery while taking this medication until you know how it will effect you.
Storage and Handling
Store this medication at room temperature in the original container. Due to the risk of diversion (someone else taking your narcotic medication to obtain a high, rather than for symptom relief), you may want to consider keeping your medication in a lock box or other secure location. After you have used the medication and the medication is totally dissolved, throw away the handle in a trash container that is out of the reach of children. If any of the drug matrix (lozenge) remains on the handle, place the handle under hot running tap water until all of the drug is dissolved, and then dispose of the handle in a place that is out of the reach of children. Keep this medication out of reach of children and pets.
To prevent someone accidentally taking this medication, it should be disposed of when no longer needed through a medicine take-back program or by dropping them off at a DEA-authorized collector. For locations near you, check www.dea.org. Ask your pharmacist or care team for assistance in disposal of unused medications. If you cannot use these options, you can flush these medicines down the toilet as soon as they are no longer needed. Remove the medication from the blister package using scissors and hold it by the handle over the toilet. Use wire-cutting pliers to cut the drug matrix from the handle and let it fall into the toilet. Flush the toilet twice after 5 units have been put into the toilet. Dispose of the handles in a place that is out of reach of children and pets.
Where do I get this medication?
Fentanyl citrate is available through retail/mail order pharmacy. Your oncology team will work with your prescription drug plan to identify an in-network retail/mail order pharmacy for medication distribution. Mail order delivery must be hand delivered and signed for. This medication cannot be “called in” or electronically prescribed to your local pharmacy; you must provide the original prescription to the pharmacist. Many pharmacies do not keep this medication in stock, but will order it for you. There may be a delay in availability, so plan prescription refills accordingly.
This medication requires the patient, prescriber and pharmacist enrollment in the TIRF-REMS program (risk evaluation and mediation program). The purpose of this program is to provide education to patients, caregivers and providers to reduce the risk of misuse, abuse, addiction and overdose. You or your caregiver will be required to read and sign a patient-prescriber agreement form before you can start treatment with this medication.
This medication may be covered under your prescription drug plan. Patient assistance may be available to qualifying individuals without prescription drug coverage. Co-pay cards, which reduce the patient’s co-pay responsibility for eligible commercially (non-government sponsored) insured patients, are also offered by the manufacturer. You insurance company may require you to utilize other narcotic pain medications prior to authorizing a prescription for fentanyl citrate. This is called step therapy. Due to risk for diversion and misuse, the quantity of medication you receive may be limited to a 2 week or 1 month supply.
Possible Side Effects of Fentanyl Citrate
There are a number of things you can do to manage the side effects of fentanyl citrate. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
Slowed Breathing or Low Blood Pressure
You may experience low blood pressure or slowed breathing while taking opioid pain medication. This usually only occurs when the dose of medication is too high or it is increased too quickly. This rarely happens to patients who have been taking opioid medications for a long time.