Consumer Information for: FENTANYL INJECTION BP

Consumer Information

Information about the product including what the product is used for, dosage, warnings, proper use and side effects. This summary will not tell you everything about the product. Contact your healthcare professional if you have any questions about the product.


What the medication is used for

Fentanyl Injection BP is indicated for the following uses:

When injected in a vein

  • For pain relief of short duration during prior to, during and immediatelyafter general or regional anesthesia.

When injected in the spine

  • For pain relief after surgery, and during labour and vaginal delivery.
What it does

Fentanyl Injection BP is a painkiller belonging to the class of drugs known as opioids. They relieve pain by acting on specific nerve cells of the spinal cord and brain.

Fentanyl Injection BP will provide pain relief when injected in a vein prior to, during and immediately after general or regional anesthesia. When injected in the spine after surgery, during labour and vaginal delivery, it provides pain relief.

When it should not be used

  • your doctor did not prescribe it for you
  • you are allergic to fentanyl or any of the other ingredients in Fentanyl Injection BP
  • you can control your pain by the occasional use of other pain medications. Thisincludes those available without a prescription
  • you have severe asthma, trouble breathing, or other breathing problems
  • you have any heart problems
  • you have bowel blockage or narrowing of the stomach or intestines
  • you have severe pain in your abdomen
  • you have a head injury
  • you are at risk for seizures
  • you suffer from alcoholism
  • you are taking or have taken within the past 2 weeks a Monoamine Oxidase inhibitor (MAOi) (such as phenelzine sulphate, tranylcypromine sulphate, moclobemide or selegiline)
  • you are going to have, or recently had, a planned surgery

To prevent breathing problems in the newborn baby, fentanyl should not be injected into a vein (intravenous use) during labour or cesarean section before the umbilical cord has been cut. Injection around the spinal cord (epidural use), however, is permitted.

Fentanyl Injection BP should not be injected around the spinal cord (epidural use) if there is shock, severe bleeding, systemic infection, or infection around the injection site. This use should also be avoided if you bleed easily or you are taking a blood-thinner.

What the medicinal ingredient is

Each mL of Fentanyl Injection BP solution contains: fentanyl 50 mcg (as citrate), citric acid and/or sodium hydroxide to adjust pH and water for injection.

What the non-medicinal ingredients are

What dosage form it comes in

Fentanyl Injection BP is supplied in 2 mL ampoules, boxes of 10.

Fentanyl Injection BP is also supplied in:

  • 5 mL single use glass vials, boxes of 10,
  • 20 mL single use glass vials, boxes of 5,
  • 50 mL Pharmacy Bulk Vials, boxes of 1.
Warnings and precautions

Serious Warnings and Precautions

  • Even if you take Fentanyl Injection BP as prescribed you are at a risk for opioid addiction, abuse and misuse. This can lead to overdose and death.
  • You may get life-threatening breathing problems while taking Fentanyl Injection BP. This is less likely to happen if you take it as prescribed by your doctor. Babies are at risk of life-threatening breathing problems if their mothers take opioids while pregnant or nursing.
  • You should never give anyone your Fentanyl Injection BP. They could die from taking it. If a person has not been prescribed Fentanyl Injection BP,taking even one dose can cause a fatal overdose. This is especially true for children.
  • If you took Fentanyl Injection BPwhile you were pregnant, whether for short or long periods of time or in small or large doses, your baby can suffer lifethreatening withdrawal symptoms after birth. This can occur in the days after birth and for up to 4 weeks after delivery. If your baby has any of the following symptoms:
    • has changes in their breathing (such as weak, difficult or fast breathing)
    • is unusually difficult to comfort
    • has tremors (shakiness)
    • has increased stools, sneezing, yawning, vomiting, or fever
    Seek immediate medical help for your baby
  • Fentanyl Injection BP should onlybe administered by persons with the appropriate training and experience with these kind of drugs.
  • Complete resuscitation (life-saving) equipment and an antidote to rapidly counteract the effects of the drug should always be available.
  • Taking Fentanyl Injection BP withother opioid medicines, benzodiazepines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take Fentanyl Injection BP.Talk about any health conditions or problems you may have, including if you:

  • have a history of illicit or prescription drug or alcohol abuse
  • have past or current depression
  • suffer from chronic or severe constipation
  • are an elderly person
  • have a condition with any part of your body, such as your heart, lung, liver, orthyroid
  • have problems with your adrenal or prostate gland
  • are taking any medication, such as blood thinners, and/or pain killers
  • are pregnant or planning to become pregnant
  • have a known allergic reaction to this drug or any other pain medications or any other general anesthetics
  • have had a head injury (history and/or current), or if you experience difficulties breathing
  • suffer from migraines
  • have severe kidney, liver, lung disease
  • have heart disease
  • have low blood pressure
  • have, or had in the past, hallucinations or other severe mental problems

Other warnings you should know about

Opioid dependence and addiction: There are important differences between physical dependence and addiction. It is important that you talk to your doctor if you have questions or concerns about abuse, addiction or physical dependence.

Pregnancy, nursing, labour and delivery:

Opioids can be transferred to your baby while still in the womb, or through breast milk. Fentanyl Injection BP can then cause life-threatening breathing problems in your unborn baby or nursing infant. Your doctor will determine if the benefits of using Fentanyl Injection BP outweigh the risks to your unborn baby or nursing infant.

If you are pregnant and are taking Fentanyl Injection BP, it is important that you don’t stop taking your medication all of a sudden. If you do, it can cause a miscarriage or a still-birth. Your doctor will monitor and guide you on how to slowly stop taking Fentanyl Injection BP. This may help avoid serious harm to your unborn baby.

Driving and using machines: Before you do tasks which may require special attention, you should wait until you know how you react to Fentanyl Injection BP. Fentanyl Injection BP can cause:

  • drowsiness
  • dizziness or
  • lightheadedness

This can usually occur after you take your first dose and when your dose is increased.

Disorder of the adrenal gland: You may develop a disorder of the adrenal gland called adrenal insufficiency. This means that your adrenal gland is not making enough of certain hormones. You may experience symptoms such as:

  • nausea, vomiting
  • feeling tired, weak or dizzy
  • decreased appetite

You may be more likely to have problems with your adrenal gland if you have been taking opioids for longer than one month. Your doctor may do tests, give you another medication, and slowly take you off Fentanyl Injection BP.

Serotonin Syndrome: Fentanyl Injection BP can cause Serotonin Syndrome, a rare but potentially life-threatening condition. It can cause serious changes in how your brain, muscles and digestive system work. You may develop Serotonin Syndrome if you take Fentanyl Injection BP with certain anti-depressants or migraine medications.

Serotonin Syndrome symptoms include:

  • fever, sweating, shivering, diarrhea, nausea, vomiting;
  • muscle shakes, jerks, twitches or stiffness, overactive reflexes, loss of coordination;
  • fast heartbeat, changes in blood pressure;
  • confusion, agitation, restlessness, hallucinations, mood changes, unconsciousness, and coma.

Sexual Function/Reproduction: Long term use of opioids may lead to a decrease in sex hormone levels. It may also lead to low libido (desire to have sex), erectile dysfunction or being infertile.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

Interactions with this medication

The following may interact with Fentanyl Injection BP:

  • Alcohol. This includes prescription and non-prescription medications that contain alcohol. Do not drink alcohol while you are taking Fentanyl Injection BP. It can lead to:
    • drowsiness
    • unusually slow or weak breathing
    • serious side effects or
    • a fatal overdose
  • other sedative drugs which may enhance the drowsiness caused by Fentanyl Injection BP
  • other opioid analgesics (drugs used to treat pain)
  • general anesthetics (drugs used during surgery)
  • benzodiazepines (drugs used to help you sleep or that help reduce anxiety)
  • antidepressants (for depression and mood disorders). Do not take Fentanyl Injection BP with MAO inhibitors (MAOi) or if you have taken MAOi’s in the last 14 days.
  • drugs used to treat serious mental or emotional disorders (such as schizophrenia)
  • antihistamines (drugs used to treat allergies)
  • anti-emetics (drugs used for the prevention of vomiting)
  • drugs used to treat muscle spasms and back pain
  • anti-fungal drugs (used to treat fungal infections)
  • anti-retroviral drugs (used to treat viral infections)
  • some heart medication (such as beta blockers)
  • tranquilizers
  • grapefruit juice
  • drugs used to treat migraines (e.g. triptans)
  • St. John’s Wort

Your doctor should tell you what medication you may or may not use after your surgery or childbirth.

Before taking Fentanyl Injection BP, tell your doctor about any other medications that you are using including certain antidepressants (selective serotonin reuptake inhibitors (SSRI) and serotonin/norepinephrine reuptake inhibitors (SNRI).

After surgery – Side effects and what to do with them:

In rare cases, muscle stiffness and swollen face have been reported. Call your doctor if you have these conditions.

Since Fentanyl Injection BP are commonly used together with general anesthetics and other drugs, other side effects may occur.

This is not a complete list of side effects. For any unexpected effects while taking Fentanyl Injection BP, contact your doctor or pharmacist.

Proper use of this medication

Fentanyl Injection BP can only be used by a doctor in a facility with life-saving equipment.

Usual Starting Dose

Your dose is tailored/personalized just for you. The dose given to you by your doctor will depend on such factors as how much you weigh, your current health status, any diseases you may currently have, and the kind of surgical procedure you will be undergoing.

Your doctor will prescribe the lowest dose that works to control your pain. It is recommended that you only take Fentanyl Injection BP for up to 7 days. If you need to take Fentanyl Injection BP for longer, your doctor will determine the best dose for you to lower the risk of side effects and overdose. Higher doses can lead to more side effects and a greater chance of overdose.

Review your pain regularly with your doctor to determine if you still need Fentanyl Injection BP. Be sure to use Fentanyl Injection BP only for the condition for which it was prescribed.

If your pain increases or you develop any side effect as a result of taking Fentanyl Injection BP tell your doctor immediately.

Stopping your Medication

If you have been taking Fentanyl Injection BP for more than a few days you should not stop taking it all of a sudden. Your doctor will monitor and guide you on how to slowly stop taking Fentanyl Injection BP. You should do it slowly to avoid uncomfortable symptoms such as having:

  • body aches
  • diarrhea
  • goosebumps
  • loss of appetite
  • nausea
  • feeling nervous or restless
  • runny nose
  • sneezing
  • tremors or shivering
  • stomach cramps
  • rapid heart rate (tachycardia)
  • having trouble sleeping
  • an unusual increase in sweating
  • heart palpitations
  • an unexplained fever
  • weakness
  • yawning

By reducing or stopping your opioid treatment, your body will become less used to opioids. If you start treatment again, you will need to start at the lowest dose. You may overdose if you restart at the last dose you took before you slowly stopped taking Fentanyl Injection BP.

Overdose

If you think you have taken too much Fentanyl Injection BP contact your healthcare professional, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

Signs of overdose may include:

  • unusually slow or weak breathing
  • dizziness
  • confusion
  • extreme drowsiness

Missed Dose

If you miss one dose, take it as soon as possible. However, if it is almost time for your next dose, then skip the missed dose. Do not take two doses at once. If you miss several doses in a row, talk to your doctor before restarting your medication.

Side effects and what to do about them

These are not all the possible side effects you may feel when taking Fentanyl Injection BP. If you experience any side effects not listed here, contact your healthcare professional.

Side effects may include:

  • Drowsiness
  • Insomnia
  • Dizziness
  • Fainting
  • Nausea, vomiting, or a poor appetite
  • Dry mouth
  • Headache
  • Problems with vision
  • Weakness, uncoordinated muscle movement
  • Itching
  • Sweating
  • Constipation
  • Low sex drive, impotence (erectile dysfunction), infertility

Talk with your doctor or pharmacist about ways to prevent constipation when you start using Fentanyl Injection BP.

Serious side effects and what to do about them
Symptom / effect Talk to your healthcare professional Only if severe Talk to your healthcare professional In all cases Stop taking drug and get immediate medical help
RARE
Overdose: hallucinations, confusion, inability to walk normally, slow or weak breathing, extreme sleepiness, sedation, or dizziness, floppy muscles/low muscle tone cold and clammy skin.    
Respiratory Depression: slow, shallow or weak breathing.    
Allergic Reaction: rash, hives, swelling of the face, lips, tongue or throat, difficulty swallowing or breathing.    
Bowel Blockage (impaction): Abdominal pain, severe constipation, nausea    
Withdrawal: nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, loss of appetite, sweating.    
Fast, Slow or Irregular Heartbeat: heart palpitations.    
Low Blood Pressure: dizziness, fainting, light-headedness.    
Serotonin Syndrome: agitation or restlessness, loss of muscle control or muscle twitching, tremor, diarrhea.    
High blood pressure: headache, dizziness.    
Difficulty Urinating    

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

How to store
  • Keep unused or expired Fentanyl Injection BP in a secure place to prevent theft, misuse or accidental exposure.
  • Keep out of the reach of children.
  • Store between 15 and 30°C. Protect from light. Protect from freezing. Discard unused portion.
  • Keep Fentanyl Injection BPunder lock, out of sight and reach of children and pets.
  • Never take medicine in front of small children as they will want to copy you. Accidental ingestion by a child is dangerous and may result in death. If a child accidentally takes Fentanyl Injection BP, get emergency help right away.

Disposal:

Fentanyl Injection BP should never be thrown into household trash, where children and pets may find it. It should be returned to a pharmacy for proper disposal.

Reporting side effects

You can report any suspected side effects associated with the use of health products to Health Canada by:

NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

More information

If you want more information about Fentanyl Injection BP:

  • Talk to your healthcare professional
  • Find the full product monograph that is prepared for healthcare professionals and includes this Patient Medication Information by visiting the Health Canada website https://healthproducts.canada.ca/dpd-bdpp/index-eng.jsp ; or by calling SteriMax Inc. at 1-800-881-3550.

This leaflet was prepared by SteriMax Inc.
2770 Portland Drive
Oakville, ON
L6H 6R4

Date of Preparation: February 6, 2020