Fentanyl (Into the nose)
Analgesic (About this – PubMed Health)
Uses of This Medicine
Fentanyl belongs to the group of medicines called narcotic analgesics, which are medicines used to relieve pain. Fentanyl nasal spray is used to treat breakthrough cancer pain. Breakthrough episodes of cancer pain are the flares of pain which “breaks through” the medication used to control the persistent pain. Nasal fentanyl is only used in patients who are already taking narcotic analgesics and who are tolerant to opioid medicines for cancer pain.
Fentanyl acts in the central nervous system (CNS) to relieve pain. Some of its side effects are also caused by actions in the CNS. When a narcotic is used for a long time, it may become habit-forming (causing mental or physical dependence). However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by reducing the dose gradually over a period of time before treatment is stopped completely. Your doctor will take this into consideration when deciding on the amount of nasal fentanyl you should receive.
This medicine is available only under a restricted distribution program called Lazanda® REMS Program.
Other uses (PubMed Health)
How To Use
Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
If you are using the nasal spray for the first time, you will need to prime the spray. To do this, you should release four sprays into the pouch. Now it is ready to use.
Before using the medicine, gently blow your nose to clear the nostrils.
Insert the tip of the bottle into the nose. Point towards the bridge of the nose and tilt the bottle slightly.
Press down firmly on the finger grips until you hear a “click” sound and the number in the dose counter window adds up. This confirms a spray has been taken.
After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
Use only the brand of medicine your doctor prescribed. Other brands may not work the same way. Lazanda® works differently than other fentanyl products, even at the same dose (number of milligrams). Do not substitute or convert it to other products containing fentanyl.
This medicine is available only under a registered distribution program called Lazanda® REMS (Risk Evaluation and Mitigation Strategy) Program. You will be asked to sign an agreement form before you take this medicine. This form tells you about the benefits and risks of using this medicine. Make sure you understand what is on the form before you sign it.
This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
If a dose is missed:
Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
How to Store and Dispose of This Medicine:
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed. Throw away any unused spray bottle and start using a new one after 5 days or more since it has been used or 14 days or more since it has been primed. Dispose any used, partially used, or unneeded spray bottles by emptying and spraying the remaining solution into the pouch. The sealed pouch and the empty bottle should be placed in a child-resistant container before discarding it in the trash can. Wash your hands with soap and water right away after handling the pouch. If additional assistance is required, call 1-866-435-6775.
Keep all medicine out of the reach of children. Never share your medicine with anyone.
Drugs and Foods to Avoid
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
Make sure your doctor knows if you are also using clarithromycin (Biaxin®), itraconazole (Sporanox®), ketoconazole (Nizoral®), or nefazodone (Serzone®). Tell your doctor if you are also using aprepitant (Emend®), cimetidine (Tagamet®), diltiazem (Cardizem®, Dilacor XR®), erythromycin (Ery-Tab®), fluconazole (Diflucan®), telithromycin (Ketek®), or verapamil (Calan®, Isoptin®, Verelan®). Make sure your doctor knows if you have used an MAO inhibitor (MAOI), such as Eldepryl®, Marplan®, Nardil®, or Parnate® within the past 14 days.
Make sure your doctor knows if you are also using St. John’s wort, modafinil (Provigil®), pioglitazone (Actos®), rifabutin (Mycobutin®), rifampin (Rifadin®, Rimactane®), troglitazone (Rezulin®), a steroid medicine (such as dexamethasone, prednisolone, prednisone, or Medrol®), medicine for HIV or AIDS (such as efavirenz, indinavir, nelfinavir, nevirapine, ritonavir, saquinavir, Crixivan®, Fortovase®, Invirase®, Norvir®, Sustiva®, Viracept®, or Viramune®), medicine for seizures (such as carbamazepine, oxcarbazepine, phenobarbital, phenytoin, Dilantin®, Tegretol®, or Trileptal®), muscle relaxants, or a phenothiazine medicine (such as prochlorperazine, Compazine®, Mellaril®, Phenergan®, Thorazine®, or Trilafon®).
Tell your doctor if you are using other nasal decongestants (such as oxymetazoline, Afrin®, or Sudafed OM®).
Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.
Do not drink alcohol while you are using this medicine.
Do not eat grapefruit or drink grapefruit juice while you are using this medicine.
When Not To Use
You should not use this medicine if you have had an allergic reaction to fentanyl. You should not use this medicine until after you have tried other narcotic medicines. Do not use this medicine if you need pain medicine for just a short time, such as during a headache or migraine attack, tooth pain, or when recovering from surgery or an injury.
Make sure your doctor knows if you are pregnant, or if you have kidney disease, liver disease, lung disease or breathing problems such as asthma or chronic obstructive pulmonary disease (COPD), heart disease, heart rhythm problems (such as slow heart rate), low blood pressure, or if you have had a recent head injury or other problems that could increase the pressure in your head. Tell your doctor if you also have a history of drug or alcohol abuse or addiction.
Do not breastfeed while you are using this medicine.
This medicine may cause problems with breathing, which can be serious and life-threatening. This is more likely in patients with lung disorders, the elderly, very weak patients, or those who use large doses of this medicine. Call your doctor right away if you have shortness of breath, or irregular, fast, slow, or shallow breathing after using this medicine.
After you have been using this medicine for awhile, “breakthrough” pain may occur more often than usual, and it may not be relieved by your regular dose of medicine. If this occurs, do not increase the amount of nasal fentanyl or other narcotic that you are using without first checking with your doctor.
This medicine can cause serious illness or even death if used by a child or by anyone who is not already using prescription medicine on a regular schedule for cancer pain.
This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
Call your doctor if your symptoms do not improve or if they get worse.
Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
Possible side effects
Summary More details
Call your doctor right away if you notice any of these side effects:
Fast, slow, or uneven heartbeat.
Lightheadedness, dizziness, severe drowsiness, or fainting.
Pain on urination, change in how much or how often you urinate.
Pain, redness, or swelling in your arm or leg.
Pale or blue lips, fingernails, or skin.
Shortness of breath, or irregular, fast, slow, or shallow breathing.
Sores or white patches on your lips, mouth, or throat.
Swelling in your hands, ankles, or feet.
Unusual bleeding or bruising.
Unusual tiredness or weakness.
Yellowing of your skin or the whites of your eyes.
If you notice these less serious side effects, talk with your doctor:
Agitation, confusion, or depression.
Back or joint pain.
Change or loss of taste.
If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
More side effects of this drug
Brand names include
There may be other brand names for this medicine.