Authors' Response to: Prophylactic Fentanyl Sublingual Spray for Episodic Exertional Dyspnea in Cancer Patients: A Pilot Double-Blind Randomized Controlled Trial
We appreciate the comments from Kako and colleagues. At this time, there is still a paucity of literature to inform the opioid of choice for management of dyspnea. To our knowledge, randomized trials examining the prophylactic use of opioids for episodic dyspnea in cancer patients to date have only involved fentanyl.1-5 No head-to-head comparison of opioids has been conducted for this indication. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 26, 2019 Category: Palliative Care Authors: David Hui, Eduardo Bruera Tags: Letter Source Type: research

“Prophylactic Fentanyl Sublingual Spray for Episodic Exertional Dyspnea in Cancer Patients: A Pilot Double-Blind Randomized Controlled Trial.”
We read with great interest the recent paper titled, “Prophylactic fentanyl sublingual spray for episodic exertional dyspnea in cancer patients: A pilot double-blind randomized controlled trial.” by Hui et al., (1) which reported the results of a pilot double-blind randomized controlled trial comparing the effect of two-dose schedules of fentanyl sublingual spray for exertional dyspnea. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 26, 2019 Category: Palliative Care Authors: Jun Kako, Kohei Kajiwara, Hiroko Noto, Yasufumi Oosono, Masamitsu Kobayashi Source Type: research

Authors ’ Response to: Prophylactic Fentanyl Sublingual Spray for Episodic Exertional Dyspnea in Cancer Patients: A Pilot Double-Blind Randomized Controlled Trial
We appreciate the comments from Kako and colleagues. At this time, there is still a paucity of literature to inform the opioid of choice for management of dyspnea. To our knowledge, randomized trials examining the prophylactic use of opioids for episodic dyspnea in cancer patients to date have only involved fentanyl.(1-5) No head-to-head comparison of opioids has been conducted for this indication. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 26, 2019 Category: Palliative Care Authors: David Hui, Eduardo Bruera Source Type: research

Response to “Response to “Prophylactic Fentanyl Sublingual Spray for Episodic Exertional Dyspnea in Cancer Patients: A Pilot Double-Blind Randomized Controlled Trial.”
We read with great interest the recent paper titled, “Prophylactic fentanyl sublingual spray for episodic exertional dyspnea in cancer patients: A pilot double-blind randomized controlled trial.” by Hui et al., (1) which reported the results of a pilot double-blind randomized controlled trial comparing the effect of two-dose schedules of fentanyl sublingual spray for exertional dyspnea. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 26, 2019 Category: Palliative Care Authors: Jun Kako, Kohei Kajiwara, Hiroko Noto, Yasufumi Oosono, Masamitsu Kobayashi Source Type: research

Prophylactic Fentanyl Sublingual Spray for Episodic Exertional Dyspnea in Cancer Patients: A Pilot Double-Blind Randomized Controlled Trial
The optimal dose of fentanyl sublingual spray (FSS) for exertional dyspnea has not been determined. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - July 2, 2019 Category: Palliative Care Authors: David Hui, Farley Hernandez, Liliana Larsson, Diane Liu, Kelly Kilgore, Jane Naberhuis, Avery Virgilio, Suresh Reddy, Akhila Reddy, Shalini Dalal, Ali Haider, Larry Driver, Ahsan Azhar, Rony Dev, Eduardo Bruera Source Type: research

Pharmacokinetics of Fentanyl Sublingual Spray in Opioid-Na ïve Participants: Results of a Phase 1, Multiple Ascending Dose Study
ConclusionDose-dependent fentanyl pharmacokinetics following multiple doses of fentanyl sublingual spray were well characterized in an opioid-na ïve population.ClinicalTrials.gov identifierNCT02641340. (Source: Clinical Drug Investigation)
Source: Clinical Drug Investigation - June 16, 2018 Category: Drugs & Pharmacology Source Type: research

Opioids for Pain
Date: April 9, 2018 Issue #:  1544Summary:  Use of nonopioid drugs for pain was reviewed in a previous issue. For many types of moderate to severe acute pain, acetaminophen and/or an NSAID may be as effective as an opioid. Immediate-release formulations of full opioid agonists should generally be used for acute pain that is severe enough to require treatment with an opioid. Use of extended-release or long-acting opioid formulations initially and treatment durations>1 week have been associated with an increased risk of unintended long-term use. (Source: The Medical Letter)
Source: The Medical Letter - March 21, 2018 Category: Drugs & Pharmacology Authors: admin Tags: Abstral Acetaminophen Actiq Alertec amitiza Antidepressants Apadaz Arymo Aspirin Belbuca benzhydrocodone Buprenex Buprenorphine Butorphanol Butrans Cancer pain capsaicin Codeine Codeine Contin ConZip Dialudid Dolo Source Type: research

Pharmacokinetics and safety of fentanyl sublingual spray and fentanyl citrate intravenous: a multiple ascending dose study in opioid-na ïve healthy volunteers.
CONCLUSION: Fentanyl sublingual spray (100 mcg, 200 mg, and 400 mcg) administered every 0.5, 1, 2, and 4 h was generally well tolerated in an opioid-naïve population. The results suggest that doses of 200 mcg or lower may be safe for use in an opioid-naïve population. PMID: 28942715 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)
Source: Current Medical Research and Opinion - September 27, 2017 Category: Research Tags: Curr Med Res Opin Source Type: research

Pharmacokinetics and safety of fentanyl sublingual spray and fentanyl citrate intravenous: a single ascending dose study in opioid-na ïve healthy volunteers.
CONCLUSIONS: Overall, single-dose fentanyl sublingual spray (100-800 mcg) was generally well tolerated, with greater incidences of AEs (eg, nausea, vomiting, hypoxia) at higher doses. Doses up to 200 mcg may be safely administered to healthy opioid-naïve individuals with routine monitoring; doses between 400-800 mcg may be administered in settings with nasal cannula oxygenation. PMID: 28681626 [PubMed - as supplied by publisher] (Source: Current Medical Research and Opinion)
Source: Current Medical Research and Opinion - July 8, 2017 Category: Research Tags: Curr Med Res Opin Source Type: research

Long-term safety of fentanyl sublingual spray in opioid-tolerant patients with breakthrough cancer pain
Conclusions This long-term maintenance study demonstrated that fentanyl sublingual spray was generally safe and well tolerated for managing BTCP over a 90-day period. (Source: Supportive Care in Cancer)
Source: Supportive Care in Cancer - April 26, 2016 Category: Cancer & Oncology Source Type: research

Single-dose fentanyl sublingual spray for breakthrough cancer pain.
This article reviews the six rapid-onset formulations of fentanyl approved in the USA for the management of BTCP with emphasis on describing the published literature on fentanyl sublingual spray. The different fentanyl formulations vary in pharmacokinetic properties and ease of use, but all have a rapid onset and a relatively short duration of analgesia. Fentanyl sublingual spray has demonstrated absorption within 5 minutes of administration, with fentanyl plasma concentrations increasing over the first 30 minutes and remaining elevated for 60-90 minutes in pharmacokinetic studies in healthy subjects. Fentanyl sublingual s...
Source: Clinical Pharmacology: Advances and Applications - November 29, 2015 Category: Allergy & Immunology Tags: Clin Pharmacol Source Type: research

Effective Dose Titration of Fentanyl Sublingual Spray in Patients With Breakthrough Cancer Pain
ConclusionsIn patients with BTCP, fentanyl sublingual spray can be rapidly and safely titrated to an effective dose, resulting in greater satisfaction with fentanyl sublingual spray than previous BTCP medications. (Source: Pain Practice)
Source: Pain Practice - September 1, 2015 Category: Anesthesiology Authors: Richard Rauck, Janet Bull, Neha Parikh, Larry Dillaha, Lisa Stearns Tags: Original Article Source Type: research

(459) Evaluation of liquid spray technology for sublingual drug delivery
Sublingual drug administration may be appropriate in multiple disease states, such as in patients who require rapid onset of effect (eg, transmucosal immediate-release fentanyl for breakthrough cancer pain [fentanyl sublingual spray]) or have conditions that negatively impact oral medication administration (eg, dysphagia, xerostomia), or when hepatic first-pass metabolism avoidance is desired. It is important for a sublingual spray device to accurately deliver microliter quantities of appropriate droplet size (eg, to prevent lung deposition) and have a simple, easy-to-use, durable mechanical design (eg, no springs). (Sourc...
Source: The Journal of Pain - March 27, 2015 Category: Materials Science Authors: K. Vangara, C. Cognata Smith, N. Parikh, A. Chavan, V. Goskonda Source Type: research

Lack of correlation between the effective dose of fentanyl sublingual spray for breakthrough cancer pain and the around-the-clock opioid dose.
CONCLUSIONS: These findings highlight the importance of titrating the dose of fentanyl sublingual spray to optimize dosing for individual patients. PMID: 25162604 [PubMed - in process] (Source: Journal of Opioid Management)
Source: Journal of Opioid Management - December 2, 2014 Category: Addiction Tags: J Opioid Manag Source Type: research

Patient Satisfaction with Fentanyl Sublingual Spray in Opioid‐Tolerant Patients with Breakthrough Cancer Pain
Abstract ObjectivesBreakthrough cancer pain (BTCP) is associated with decreased satisfaction with around‐the‐clock opioid therapy. This analysis examined patient satisfaction with fentanyl sublingual spray for BTCP during the open‐label titration period of a randomized, placebo‐controlled study. MethodsOpioid‐tolerant patients with 1 to 4 daily BTCP episodes were included. During a 26‐day, open‐label titration phase, a successful dose (100 to 1600 mcg) of fentanyl sublingual spray was established that provided effective analgesia for 2 consecutive BTCP episodes with tolerable side effects. The Treatment ...
Source: Pain Practice - July 1, 2014 Category: Anesthesiology Authors: Richard Rauck, Neha Parikh, Larry Dillaha, Jerry Barker, Lisa Stearns Tags: Original Article Source Type: research

A Network Meta-Analysis of the Efficacy of Opioid Analgesics for the Management of Breakthrough Cancer Pain Episodes
Conclusion: From current evidence, although all BTCP medications provided pain relief within the time frames assessed, transmucosal fentanyl medications achieved a greater level of pain relief in a shorter time frame than placebo or oral morphine. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - August 26, 2013 Category: Palliative Care Authors: Giovambattista Zeppetella, Andrew Davies, Indra Eijgelshoven, Jeroen P. Jansen Tags: Review Article Source Type: research

Single-dose fentanyl sublingual spray for breakthrough cancer pain
Taylor DR (Source: International Journal of COPD)
Source: International Journal of COPD - July 27, 2013 Category: Respiratory Medicine Source Type: research

Fentanyl Sublingual Spray for Breakthrough Pain in Cancer Patients
Abstract Breakthrough pain is a transient exacerbation of pain that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background pain. Typically, breakthrough pain has a fast onset and short duration, and a significant impact on patients’ quality of life. Normal-release oral opioids are the traditional pharmacological approach for patients who are receiving an around the clock opioid regimen; however, their onset and duration of action may not be suitable for treating many breakthrough pains. Efforts to provide...
Source: Pain and Therapy - June 1, 2013 Category: Anesthesiology Source Type: research

Single-dose pharmacokinetics of fentanyl sublingual spray and oral transmucosal fentanyl citrate in healthy volunteers: a randomized crossover study.
CONCLUSIONS: Absorption of fentanyl in this study was faster and bioavailability was greater with FSS than with OTFC. The pharmacokinetic profile of the sublingual spray closely matches the duration of onset to pain intensity in a breakthrough cancer pain episode. These findings suggest that FSS is appropriate for the treatment of breakthrough cancer pain. ClinicalTrials.gov identifier: NCT01780233. PMID: 23497761 [PubMed - in process] (Source: Clinical Therapeutics)
Source: Clinical Therapeutics - March 1, 2013 Category: Drugs & Pharmacology Authors: Parikh N, Goskonda V, Chavan A, Dillaha L Tags: Clin Ther Source Type: research