1 What is Abstral?

Brand: Abstral, Actiq, Fentora, Onsolis, Subsys

Generic: Fentanyl

Abstral is a narcotic analgesic used for severe pain which is non-responsive to other pain remedies. It is mostly used in cancer patients who have agonizing pain which is not relieved by other medications. It is also effective for the break-through pain (pain which occurs while being on pain medication after a period of relief) in cancer patients.

Fentanyl works by acting on the central nervous system and decreases pain sensation. It is used only in those patients who are already on some other narcotics for pain relief.

Like other narcotics, fentanyl is also associated with addiction and withdrawal symptoms. Addiction can be controlled by giving the drug only when pain is intolerable and withdrawal effects can be minimized by gradually stopping the drug.

It is a strict prescription drug which is available only from some distributors. It is available in the form of film, tablet, spray and lozenges.

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2 What to Know Before Using

Abstral is an opioid analgesic with many risks and effects associated ranging from physiological to psychological. It is important that the doctor let the patient know about all the details associated with drug. Patient should clarify all the doubts or any queries in mind about the drug usage and its effects.

Detailed history of a patient is extremely important prior to any medical therapy and in this case, it is more likely that a drug be started after it. Allergies or any history of allergy to any drug, food, preservatives, dyes or animal products; history of drug usage, past medical or surgical procedure should also be kept in record to predict any drug interaction.

Physical examination should be done before starting this drug so that any physiological or pathological condition with which this drug may interfere may be ruled out.

Age specific analysis of patients helps in keeping a safety profile. Some drugs are suitable for one age group and lethal for the other; hence it is necessary to have assessment while keeping age in view.

There is not enough evidence by studies to prove its safety and efficacy in children as well as in adults. However, it is considered to have similar effects like those in young adults.

Old people should use this drug with more caution as chances of having age related kidney disease are more in them as compared to others. There are not many studies to rule out its safety in pregnant and breastfeeding women either and it is used in them only when there is no other alternative.

Drug interactions may happen due to usage of other drugs with fentanyl. It is important for the patient to give a detailed drug history so that the physician can predict these interactions and change the drug or dosage as the physician deems right.

It is not recommended to use this drug with any anti-viral or NSAIDs. If the patient is using any sedative, mood stabilizing drug, drug for schizophrenia, painkiller, antibiotic, anti-metabolite, steroid, antifungal, hormonal agent, anti-depressant, calcium channel blocker or anti-histamine; the doctor will change the medication or decrease the dose of either one of the drugs to avoid serious complications.

Alcohol and grapefruit juice also should be avoided. Patient should ask about the effects of tobacco and certain foods on the working of drug as well.

Other medical conditions may lead to severe effects on the body and may also decrease the efficacy and removal of drug. The patient should inform the doctor about these conditions in detailed medical history to avoid complications. 

The conditions which may interfere include alcohol abuse, drug dependence or history of it, slow heart rhythm, brain tumor, history of breathing problems, history of head injury, diabetes and kidney or liver disease.

3 Proper Usage

Use Abstral as instructed by the doctor. It is usually given only under clinical setting but in some places, patients can take this at home. There are restricted distributors which have the authority to sell this drug after seeing an authorized prescription by the doctor.

Take the brand of medicine which is prescribed by the doctor as different brands may not work in the same way. Obey the dosage regime created by the doctor and do not change it as overuse may lead to dependence while less use will result in withdrawal symptoms.

4 Precautions to Take

Precautions are vital for any therapy to work at optimum rate. These are also necessary to decrease the side effects or at least make these manageable. Abstral, being an opioid analgesic, has more precautions to follow than other drugs.

  • Regular visits to the doctor should be made to check its progress.
  • Avoid overdosing without discussion with a doctor as it will lead to addiction.
  • Avoid its use for minor aches which can be managed with other pain killers. Use it for post-surgical, cancer or other severe pain non-responsive to other pain killers.
  • Avoid alcohol, CNS depressors or anti-histamines with this drug as these may lead to increase in its effects on CNS.
  • Avoid driving, use of machinery or any work which requires one to be alert as fentanyl causes dizziness and drowsiness.
  • Constipation occurs due to long term use of narcotics. Increase fluid intake and add more fibers into the diet to prevent constipation.
  • Do not suddenly stop the drug without consulting your doctor as it will lead to withdrawal symptoms.
  • Diabetics should use this drug with care as some chewable forms have sugar in them.
  • Consult your dentist regularly to stop chances of tooth decay.
  • Do not start any other drug, prescription or non-prescription, without consulting your doctor.
  • Consult the doctor if any serious problem is suspected.
  • Storage of drug should be in a dry environment at room temperature. Keep it away from the reach of children.

5 Potential Side Effects

Abstral is associated with more side effects in comparison to other drugs due to its addictive nature and effects due to over dosage or withdrawal. Whatever the effect has occurred, no matter how trivial it is, consult your doctor about it.

Some symptoms disappear only by adjusting the dose of drug.

Commonly occurring side effects include:

  • Black tarry stools
  • Blurred vision
  • Chest pain
  • Confusion
  • Convulsions
  • Cough
  • Decreased urine
  • Difficulty breathing
  • Dizziness
  • Dry mouth
  • Fainting
  • Fever
  • Increased thirst
  • Irregular heartbeat
  • Lightheadedness
  • Loss of appetite
  • Body pain
  • Mood changes
  • Muscle cramps
  • Nausea or vomiting
  • Nervousness
  • Numbness or tingling sensation
  • Painful urination
  • Pale skin
  • Pounding in the ears
  • Sneezing
  • Sore throat
  • Sunken eyes
  • Swelling of different parts of body
  • Chest tightness
  • Ulcers
  • Inflammation in mouth unusual
  • Bleeding or bruising
  • Unusual tiredness
  • Wrinkled skin

Extremely slow or shallow breathing may be an indication of overdosing and it is an emergency situation. Patient should refer to medical help as soon as possible in this case.