Korean J Intern Med.  2018 May;33(3):577-584. 10.3904/kjim.2016.044.

Initial titration with 200 μg fentanyl buccal tablets: a retrospective safety analysis in Korean cancer patients

• Kwon MY
• Cho HN
• Koo DH
• Lee YG
• Oh S
• Lee SS

• KMID: 2411586
• DOI: http://doi.org/10.3904/kjim.2016.044

Abstract

BACKGROUND/AIMS
Managing breakthrough pain (BTP) is important for many cancer patients because of the rapid onset and unpredictable nature of the pain episodes. Fentanyl buccal tablets (FBTs) are a rapid-onset opioid indicated for BTP management. However, FBT titration is needed to optimize BTP management. In this study, we aimed to evaluate the safety and efficacy of initiating 200 μg FBTs in Korean cancer patients.
METHODS
A retrospective analysis of medical records was performed on all advanced cancer patients treated with FBTs for BTP between October 2014 and July 2015. Patients who received initial doses of 200 μg FBTs for at least 3 days and cases in which FBT was available at doses of 200, 400, and 800 μg were included.
RESULTS
A total of 56 patients with a median age of 62 years (range, 32 to 80) were analyzed, 61% of whom were male. The median and mean values of morphine equivalent daily doses were 60 mg/day (range, 15 to 540) and 114.8 ± 124.8 mg/day, respectively. The most frequent effective doses of FBT were 200 μg (41 patients, 74%) and 400 μg (12 patients, 21%). Three patients (5%) could not tolerate 200 μg of FBT and discontinued treatment. Nausea, vomiting, somnolence, and dizziness were the most frequent treatment-related adverse events (AEs), and all AEs were grade 1 (mild) or 2 (moderate).
CONCLUSIONS
FBT at the initial 200 μg dosage was well-tolerated and effective as a BTP management strategy in Korean cancer patients. Further prospective studies are needed to determine appropriate initiating doses of FBT in Korean patients with opioid tolerance.

Keyword

Fentanyl; Breakthrough pain; Analgesics, opioid; Neoplasms

MeSH Terms

Analgesics, Opioid
Breakthrough Pain
Dizziness
Fentanyl*
Humans
Male
Medical Records
Morphine
Nausea
Prospective Studies
Retrospective Studies*
Tablets*
Vomiting
Analgesics, Opioid
Fentanyl
Morphine
Tablets