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Fentanyl, Nasal FEN-ta-nil

What are other names for this medicine?

Type of medicine: narcotic analgesic (painkiller)

Generic and brand names: fentanyl, nasal; Lazanda

What is this medicine used for?

This medicine is a nasal spray used to treat breakthrough pain in adults with cancer. It is not to be used to treat short-term pain such as pain after surgery or from headaches, minor injuries, dental procedures, or other causes.

This medicine is prescribed only for people who already take other narcotic pain medicines on a regular schedule. You must not take this medicine if your body is not used to narcotic pain medicines.

You must be enrolled in a special program before you can receive this medicine. Only a few healthcare providers are allowed to prescribe this medicine. Also, only a few pharmacies are allowed to sell it. Your healthcare provider will explain the program.

What should my healthcare provider know before I take this medicine?

Before using this medicine, tell your healthcare provider if you have:

  • an allergic reaction to any medicine
  • a head injury or brain tumor
  • breathing problems or a lung disease such as asthma or COPD
  • heart disease
  • kidney or liver disease
  • low blood pressure
  • mental problems such as depression or hallucinations (seeing or hearing things that are not there)
  • problems with drug or alcohol abuse
  • seizures

Tell your provider if you have never taken narcotic pain medicines before. This medicine is to be used only by those who regularly take narcotic painkillers.

Females of childbearing age: Tell your healthcare provider if you are pregnant or breast-feeding. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

Use this medicine exactly as your healthcare provider prescribes. Using too much of this medicine can be dangerous. Your healthcare provider will adjust your dosage until the lowest effective dosage is determined. Do not stop taking this medicine without your healthcare provider's approval. You may have to gradually reduce your dosage.

Check the label on the medicine for directions about your specific dose. Read the instructions that come in the package with the medicine. Ask your pharmacist about anything you do not understand. Wash your hands with soap and water before and after using this medicine.

Keep the medicine in the sealed child-proof package until you are ready to use it. This medicine is very strong and may be fatal to children.

You must wait at least 2 hours between doses of this medicine. You must never use more than 2 sprays (1 spray in each nostril) for an episode of breakthrough pain. If you have breakthrough pain more than 4 times a day, talk with your healthcare provider. You may need to have your pain medicines adjusted to better control your pain.

The amount of fentanyl in the nasal spray is not the same as the amount of fentanyl in other medicines that contain fentanyl. Do not switch from this medicine to other medicines that contain fentanyl without talking with your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: trouble breathing or shallow breathing, tiredness, extreme drowsiness, lightheadedness, dizziness, confusion, trouble thinking, trouble talking or walking.

What should I watch out for?

This drug is only for people who have taken narcotic painkillers before. It is a controlled substance. It is illegal for you to give it to anyone else. This is a very strong medicine used only to control cancer pain.

This medicine may be habit-forming. Take it exactly as directed by your healthcare provider. Do not take more of it or take it more often than directed. Taking too much of this medicine will increase the chances of side effects. Contact your healthcare provider if your pain does not improve in a few days or if it gets worse.

This medicine may cause serious or life-threatening breathing problems, especially during the first few days. If you have any trouble breathing, contact your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help.

This medicine is very strong and may be fatal to children. Be very careful to keep this medicine out of reach of children. Never leave unused or partly used medicine where children or pets can get to it. Keep this medicine out of the reach of children and discard properly. See the disposal instructions that come in the medicine package.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicine unless your healthcare provider approves.

Your mouth may get dry. Drinking plenty of water, chewing sugarless gum, or sucking on hard sugarless candy may help to relieve dry mouth symptoms.

This medicine may make you constipated. You may need to take a laxative or stool softener while taking this medicine. Talk with healthcare provider or pharmacist about this.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives, itching, rash, tightness in your chest, trouble breathing).

Serious (report these to your healthcare provider right away): Fast or slow heartbeat; cold, clammy skin; blue lips, fingernails, or skin; slow or trouble breathing; hallucinations (seeing or hearing things that are not there); seizures; feeling faint; pinpoint pupils of the eyes; severe confusion, drowsiness, nervousness, restlessness, or weakness.

Other: Dizziness, nausea, vomiting, blurred vision, headache, flushing, sweating, constipation, trouble urinating, dry mouth, mouth sores, mouth pain.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

  • antianxiety medicines such as alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and oxazepam
  • antibiotics such as clarithromycin (Biaxin), erythromycin (Ery-Tabs, E.E.S.), isoniazid, metronidazole (Flagyl), norfloxacin (Noroxin), rifabutin (Mycobutin), rifampin (Rifadin), and telithromycin (Ketek)
  • antidepressants such as amitriptyline, bupropion (Wellbutrin), doxepin, duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox CR), imipramine (Tofranil), nefazodone, nortriptyline (Pamelor), paroxetine (Paxil), sertraline (Zoloft), trazodone, and venlafaxine (Effexor)
  • antifungal medicines such as clotrimazole, fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Monistat, Micatin), posaconazole (Noxafil), and voriconazole (VFEND)
  • antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril), and meclizine (Antivert, Dramamine)
  • anti-HIV medicines such as atazanavir (Reyataz), delavirdine (Rescriptor), efavirenz (Sustiva), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir), and saquinavir (Invirase)
  • antinausea medicines such as aprepitant (Emend), prochlorperazine (Compro) and promethazine
  • antipsychotic medicines such as chlorpromazine, clozapine (Clozaril), fluphenazine, haloperidol (Haldol), olanzapine (Zyprexa), perphenazine, risperidone (Risperdal), thioridazine, trifluoperazine, and ziprasidone (Geodon)
  • antiseizure medicines such as carbamazepine (Tegretol), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), phenytoin (Dilantin), primidone (Mysoline), oxcarbazepine (Trileptal), tiagabine (Gabitril), and topiramate (Topamax)
  • barbiturates such as butabarbital (Butisol), pentobarbital (Nembutal), and phenobarbital
  • cimetidine (Tagamet)
  • dexamethasone
  • grapefruit juice
  • heart medicines such as amiodarone (Cordarone, Pacerone), diltiazem (Cardizem, Dilacor, Tiazac), nicardipine (Cardene, Cardene SR), quinidine, and verapamil (Calan, Covera, Isoptin)
  • MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
  • medicines that block or may partially block the effect of other narcotics such as buprenorphine (Buprenex, Subutex), butorphanol (Stadol), nalbuphine (Nubain), naltrexone (ReVia), and pentazocine (Talwin)
  • muscle relaxants such as baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Flexeril), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
  • nasal decongestants such as oxymetazoline (Afrin)
  • natural remedies such as gotu kola, kava, St. John's wort, and valerian
  • other narcotic pain medicines such as codeine, hydrocodone/acetaminophen (Vicodin, Lortab), hydromorphone (Dilaudid), meperidine (Demerol), methadone (Dolophine), morphine (Kadian, MS Contin), oxycodone (OxyContin, Roxicodone), oxycodone/acetaminophen (Percocet, Tylox), and pentazocine (Talwin)
  • pioglitazone (Actos)
  • sleeping pills such as amobarbital (Amytal), butabarbital (Butisol), flurazepam, phenobarbital, temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien)
  • stimulants such as armodafinil (Nuvigil) and modafinil (Provigil)

Do not drink alcohol while you are taking this medicine.

The effects of this medicine may be increased if you take it with grapefruit or grapefruit juice. Talk with your healthcare provider about this.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Keep the medicine in the sealed child-proof pouch until you are ready to use it. Store it at room temperature. Protect from heat, high humidity, and bright light.

Dispose of the medicine bottle and start a new one if:

  • you have used 8 sprays from the bottle, or
  • you have not used the medicine in 5 days or more, or
  • you have not primed the bottle in 14 days or more.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.


Developed by RelayHealth.
Medication Advisor 2012.1 published by RelayHealth.
Last modified: 2012-01-10
Last reviewed: 2011-09-28
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2012 RelayHealth and/or its affiliates. All rights reserved.
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