Do you sometimes experience unbearable pain and aches? At such times, even the painkillers we usually take may not provide relief. Fentanyl is a special type of medicine that is given to control such severe pain, or to make you a little sleepy before surgery. Today, let's talk about this Fentanyl injection.

What is this drug called Fentanyl?

Simply put, Fentanyl is a drug used to relieve severe pain. Sometimes, it is also used to calm you down and make you sleepy before a major medical test or surgery . Doctors often give you Fentanyl when other painkillers don't work or when you can't tolerate them. It works by blocking pain signals from reaching your brain. It belongs to a class of drugs called opioids. This drug may also be used for other things. If you have any questions about it, ask your doctor or pharmacist.

What should I tell the medical team before taking this medicine?

Okay, now before you start taking this Fentanyl medication, there are a few things your care team needs to know. It's important to tell them these things, because that's how they can decide if this medication is right for you. If you have any of these conditions, you should definitely tell them:

• If you have a brain tumor
• If you are addicted to drugs (Drug abuse or addiction)
• If you have gallbladder disease
• If you have a head injury
• If you have heart disease
• If you are a regular drinker
• If you have kidney disease
• If you have liver disease
• If you have low blood pressure
• If you have a lung disease, for example, asthma.
• If you have a mental illness
• If you have problems urinating
• If you have seizures
• If you have stomach or intestine problems
• If you have ever had an allergic or unusual reaction to fentanyl, another medicine, food, dye, or preservative.
• If you are pregnant or trying to get pregnant
• If you are a breastfeeding mother

How should I use this medicine?

This medicine, called Fentanyl, is given as an injection into a vein or muscle. It is usually given to you in a hospital or clinic under medical supervision.

Special care should be taken when giving this medicine to young children, so talk to your medical team about it.

Most importantly, this medicine can be dangerous if taken in excess (overdose). If you think you have taken too much of the medicine, call a poison control center or emergency room immediately.

Another thing, this medicine is for you only. Never share it with others.

What if I miss a dose of medicine?

This is not a medication that you would normally take regularly, every day. That is, this is a medication that is given only when needed, as directed by your doctor. Therefore, the phrase 'missed a dose' does not apply to this.

What other things can interact with this medicine?

There is one type of medication that should never be taken with Fentanyl. That is:

• Mifepristone

Also, there are other medications, foods, and things that can interact with Fentanyl, meaning they can affect each other. Taking them together can cause unwanted side effects or change how the medicine works. So, if you are using any of the following, you should also tell your healthcare team:

• Alcohol
• Types of antihistamines for allergies, coughs, and colds
• Antiviral medications for HIV or AIDS
• Atropine
• Some antibiotics, for example clarithromycin, erythromycin, rifampin
• Some medications for anxiety or sleep
• Some medications for bladder problems, for example oxybutynin, tolterodine
• Some medications for high blood pressure, heart disease, and irregular heartbeat
• Some medications for depression, for example amitriptyline, fluoxetine, sertraline
• Some medications for diabetes, for example pioglitazone, troglitazone
• Some medications for fungal infections, such as ketoconazole and itraconazole
• Some medications used for migraine headaches, for example, almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
• Some medications for nausea or vomiting, for example, aprepitant, dolasetron, granisetron, ondansetron
• Some medications used for seizures, for example phenobarbital, phenytoin, primidone
• Some medications for stomach problems, for example dicyclomine, hyoscyamine
• Some medications used to treat travel sickness, such as scopolamine
• Some medications used to treat Parkinson's disease, such as benztropine and trihexyphenidyl
• Cimetidine
• Diuretics (medicines that increase urine output)
• Some types of general anesthetics, for example halothane, isoflurane, methoxyflurane, propofol
• Grapefruit juice
• Ipratropium
• Linezolid
• Types of local anesthetics, for example lidocaine, pramoxine, tetracaine
• MAOI medications (e.g., Carbex, Eldepryl, Marplan, Nardil, Parnate)
• Muscle relaxants for surgery
• Methylene blue
• Other narcotic medications for pain or cough
• Phenothiazines, for example chlorpromazine, mesoridazine, prochlorperazine, thioridazine
• St. John's wort (this is an herb)
• Steroid medications, such as prednisone or cortisone

This list is not exhaustive. Tell your healthcare team about all the medications you take, including herbal remedies, over-the-counter medications, and dietary supplements. Tell them if you smoke, drink alcohol, or use illegal drugs. Some things can interact with your medications.

What are the things to be careful about when using this medicine?

When using this medication, there are a few things you should be aware of.

• If the pain does not go away, if it gets worse, or if you have new types of pain, tell your healthcare team. You may have developed a tolerance to this medication, which means you are getting used to it. Simply put, tolerance means you need a higher dose of the medication than you used to to get the same pain relief. It is normal for this type of tolerance to develop if you have been taking this medication for a long time. Think about it, some people may be satisfied with half a cup of tea at first, but over time they need a full cup to feel the same effect.

• Never stop taking this medicine suddenly. Doing so could cause a severe reaction. This is because your body has become accustomed to the medicine. This does not mean that you are addicted to the medicine. Addiction is a behavior that involves obtaining and using a medicine for a non-medical reason. If you are in pain, you have a medical reason for taking painkillers. Your medical team will tell you how much medicine you need to take. If they want you to stop taking the medicine, they will do so by gradually reducing the dose to prevent side effects.

• If you are taking other medications that make you sleepy, such as other narcotic pain medications, benzodiazepines, or other medications that help you sleep, you may have more side effects. Give your healthcare team a list of all the medications you are taking. They will tell you how much to take. Never take more medication than your doctor tells you to. If you have trouble breathing, feel unusually tired, or feel sleepy, seek emergency medical attention right away.

• Ask your healthcare team about naloxone and how to get it. Naloxone is an emergency medicine given in case of an overdose of an opioid. An overdose can happen if you take too much of an opioid. Or it can happen if you take an opioid with other medicines or substances, such as alcohol. It is important to know the signs of an overdose. For example, trouble breathing, unusual tiredness or sleepiness, or an inability to respond or wake up. Tell your family, caregivers, and loved ones where naloxone is located. Make sure they know how to use it. After giving naloxone, you should definitely call emergency services. Naloxone is a temporary treatment, and may require repeated doses.

• You may feel sleepy or dizzy . Do not drive, operate machinery, or do anything else that requires mental alertness until you know how this medicine affects you. Do not stand or sit up suddenly, especially if you are elderly. This reduces the risk of dizziness and falls. Alcohol can interfere with the way this medicine works. So avoid drinking alcohol.

• This medicine may cause constipation . If you do not have a bowel movement after three days, call your healthcare team.

• Your mouth is dry.Yes. Chewing sugarless gum, sucking on a piece of ginger, and drinking plenty of water can help. If this problem persists or becomes severe, contact your medical team.

What are the possible side effects of this medicine?

You may experience some side effects from this Fentanyl medication. If you experience any of these side effects, you should let your healthcare team know as soon as possible:

• Allergic reactions — skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Central Nervous System depression (CNS depression) — slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
• Low adrenal gland function — nausea, vomiting, loss of appetite, unusual weakness or fatigue, dizziness
• Low blood pressure — dizziness, feeling faint or lightheaded, blurred vision
• Muscle stiffness

There are also side effects that usually do not require medical attention, but if they persist or become bothersome, you should report them to your medical team:

• Dizziness
• Drowsiness
• Nausea
• Vomiting

This list may not include all possible side effects. Talk to your doctor for medical advice about side effects. You can report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088 in the United States. In Sri Lanka, you can report them to the relevant health authorities through your doctor.

How should I store the medicine?

This Fentanyl medication is given to you in a hospital or clinic, so it is not a medication you should keep at home.

Finally, the most important thing for you to remember

Okay, so now you understand that Fentanyl is a very powerful painkiller . It is used for severe pain only, under medical supervision.

The most important thing is to follow your doctor's instructions exactly and to inform them about any health conditions you have and other medications you are taking.

This medication can cause drowsiness and dizziness, so be careful. Also, remember that it is not a good idea to stop taking it suddenly.

If you have any questions or concerns, don't be afraid to ask your doctor, nurse, or pharmacist. They are there to help you. Your health is what matters!

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