title: Transmucosal Immediate-Release Fentanyl for Breakthrough Cancer Pain: Opportunities and Challenges for Use in Palliative Care.
abstract: Opioids are used to treat breakthrough cancer pain (BTCP) and can be classified by relative duration and onset of action. Regulatory approvals of numerous transmucosal immediate-release fentanyl (TIRF) formulations provide alternative options to palliative care-trained providers in the management of BTCP. TIRFs have been formulated as a sublingual tablet, sublingual spray, intranasal spray, pectin-based nasal spray, buccal tablet, and buccal soluble film. Differences exist between TIRFs regarding formulation design and dosing to treat BTCP. Opportunities for use include palliation of BTCP in head and neck cancer and/or radiation-induced mucositis. The purpose of this review is to discuss TIRF formulation and dosing, pharmacokinetics, clinical efficacy, patient acceptability, and safety/tolerability. In addition, barriers to TIRF utilization will be discussed.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chang
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Roeland
authors.forename: Rabia S
authors.initials: RS
authors.lastname: Atayee
authors.forename: Carolyn
authors.initials: C
authors.lastname: Revta
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ma
mesh_terms: D000278:Administration, Buccal; D000281:Administration, Intranasal; D000286:Administration, Sublingual; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D059390:Breakthrough Pain / Q000188:drug therapy*; D002626:Chemistry, Pharmaceutical; D004305:Dose-Response Relationship, Drug; D005283:Fentanyl / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D059408:Pain Management; D010166:Palliative Care; D057240:Patient Preference
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl
keywords: fentanyl; opioid; pain management; palliative care; rapid onset