Respiratory: respiratory depression or arrest, bronchoconstriction, laryngospasm
GI: nausea/vomiting, constipation
Use with caution in head injuries, suspected or known increased intracranial pressure; the elderly, debilitated or immuno-compromised patients; COPD or other respiratory problems and those with kidney or liver dysfunction.
Alcohol and other CNS depressants potentiate effects of fentanyl; MAO inhibitors may precipitate hypertensive crisis.
IV, IO, IM (also found in home medication form in the transdermal patch)
onset and duration
Onset is immediate; peak effect in 3-5 min IV, 5-15 IM; duration is 30-60 minutes (or hours with transdermal patch).
Adult: 25-100 mcg SLOW IV push (over 2-3 minutes)
Pediatric (child > 2 years): 2.0 mcg/kg SLOW IV push or IM
Fentanyl provides much faster acting, more prolonged pain relief. Duration of respiratory depressant effects may be significantly longer than analgesic effects – always have oxygen immediately available and be prepared with intubation equipment and a narcotic antagonist (i.e. naloxone).
mechanism of action
Most potent of all Benzodiazepines; its effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are all mediated by increasing the levels of the inhibitory neurotransmitter GABA. GABA works mostly at the hypothalamus, limbic system and thalamus in the brain.
1. status epilepticus
2. sedation prior to cardioversion/pacing
1. pregnancy or nursing mothers
2. Use with caution in shock, coma, acute alcohol intoxication, suicidal patients and those with depressed respirations.
Respiratory: respiratory depression or arrest, bronchospasm
GI: nausea / vomiting, constipation
Use with caution in head injuries; the elderly, debilitated or immuno-compromised patients; COPD or other respiratory problems and those with kidney or liver dysfunction.
Other CNS depressants, general anesthetics, MAO inhibitors, other opioid analgesics, sedatives, tranquilizers, and tricyclic antidepressants may potentiate the effects of Dilaudid.
IV, IO, IM, SQ, PR and PO
onset and duration
IV and IM administration most common in the hospital setting – IV: onset in 10-15 minutes, peaks in 15-30 minutes and lasts 2-3 hours. IM: onset in 15 minutes, peaks in 30-60 minutes, and lasts 4-5 hours.
For Pain Control:
Adults: 1-4 mg IM, SQ or SLOW IV push (over at least 2-5 minutes) every 4-6 hours
Pediatrics: Rarely given for pain control – primarily for cough suppressant effects.
Adults and children > 12 years: 1 mg cough syrup PO every 3-4 hours
Children ages 6-12 years: 0.5 mg of cough syrup every 3-4 hours