Benitez-Rosario, M.A., Martin, A.S., & Feria, M. (2005). Oral transmucosal fentanyl citrate in the management of dyspnea crises in cancer patients. Journal of Pain and Symptom Management, 30(5), 395–397.

To evaluate the use of oral transmucosal fentanyl citrate (OTFC) as a rescue or breakthrough medication to relieve dyspnea

This study described four individual case reports. In case 1, the patient received 1,200 mcg of OTFC as breakthrough dose (BT) for dyspnea while on 400 mg/d IV morphine. In case 2, the patient received 800 mcg of OTFC as BT for dyspnea while on 90 mg of oral morphine every 24 hours. In case 3, 600 mcg of OTFC originally was prescribed for pain was reported to relieve dyspnea. In case 4, the patient was given 400 mcg OTFC while on 15 mg/d IV morphine.

The case reports were of four patients who were terminally ill with cancer (two women and two men). Three patients had lung cancer, and one had colon cancer. OTFC was chosen for its rapid effect and ease of administration.

Cases 1, 2, and 4 were conducted at an inpatient hospice unit, and case 3 was conducted at home.

Cases 1 , 2, and 4 used numeric rating scales (NRSs), and case 3 used percent improvement.

• The patient in case 1 experienced a decrease in dyspnea at rest from 7/10 to 2/10 at 22 minutes following OTFC 1,200 mcg with no alteration in oxygen saturation percentage.
• In case 2, the patient experienced a 100% decrease in dyspnea from 5/10 at 15 minutes after second dose of 400 mcg of OTFC (total = 800 mcg) with a decrease in respiratory rate to 18 and no change in oxygen saturation percentage.
• In case 3, the patient experienced 100% relief of dyspnea at 20-30 minutes after use.
• The patient in case 4 showed a 40% improvement from 7/10 rating at 15 minutes, 75% at 30 minutes, and 90% at 45 minutes with 100% at 60 minutes.

These reports showed that OTFC improved dyspnea in individual cases, was easy to administer, and provided rapid onset of relief and minor adverse effects. The specific doses were variable and chosen according to patients’ baseline opioid use.

• Case reports only give anecdotal findings and provide lower levels of evidence.
• Two patients reported moderate somnolence and dizziness side effects after OTFC.