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Fentanyl (Into the nose)

Fentanyl Citrate (FEN-ta-nil SIT-rate)

Treats cancer pain in patients whose pain is not always relieved by other pain medicines. This medicine is a narcotic pain reliever.

Brand Name(s):

Lazanda

There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

This medicine is not right for everyone. Do not use it if you had an allergic reaction to fentanyl, if you are not taking pain medicine for around-the-clock pain control, or have severe lung or breathing problems (including severe asthma) or stomach blockage (including paralytic ileus).

How to Use This Medicine:

Spray

  • Take your medicine as directed. Your dose may need to be changed several times to find what works best for you. An overdose can be dangerous. Follow directions carefully so you do not get too much medicine at one time.
  • This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
  • To use:
    • Keep the spray in the child-resistant container until ready to use.
    • If you are using the nasal spray for the first time, you will need to prime the spray. To do this, you should release four sprays into the pouch. Now it is ready to use.
    • If you have not used the medicine for more than 5 days, re-prime by spraying once into the pouch.
    • Before using this medicine, gently blow your nose to clear the nostrils.
    • Insert the tip of the bottle into the nose. Point towards the bridge of the nose and tilt the bottle slightly.
    • Press down firmly on the finger grips until you hear a "click" sound and the number in the dose counter window adds up. This confirms a spray has been taken.
    • Return the spray bottle to the child-resistant container after each use.
  • After using the nasal spray, wipe the tip of the bottle with a clean tissue and put the cap back on.
  • This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
  • Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
  • Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
  • Disposal: Ask your pharmacist about the best way to dispose of medicine that you do not use. Throw away any spray bottle and start using a new one if you have used 8 sprays or if it has been 60 days or more since it has been used. Dispose any used, partially used, or unneeded spray bottles by emptying and spraying the remaining solution into the pouch. The sealed pouch and the empty bottle should be placed in a child-resistant container before discarding it in the trash can. Wash your hands with soap and water right away after handling the pouch.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Do not use this medicine if you have used an MAO inhibitor within the past 14 days.
  • Some medicines can affect how fentanyl works. Tell your doctor if you are using any of the following:
    • Carbamazepine, erythromycin, ketoconazole, linezolid, mirtazapine, phenytoin, rifampin, ritonavir, tramadol, or trazodone
    • Blood pressure medicine
    • Diuretic (water pill)
    • Medicine to treat depression
    • Phenothiazine medicine
  • Do not drink alcohol while you are using this medicine.
  • Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol. Tell your doctor if you are also using buprenorphine, butorphanol, nalbuphine, pentazocine, a benzodiazepine, or a muscle relaxer.
  • Do not eat grapefruit or drink grapefruit juice while you are using this medicine.

Warnings While Using This Medicine:

  • Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart disease, heart rhythm problems (such as slow heart rate), low blood pressure, lung or breathing problems (including COPD, apnea), adrenal problems, pancreas problems, gallbladder problems, or a history of brain tumor, head injury, seizures, alcohol or drug abuse. Do not use this medicine for minor aches and pains, such as headaches, dental pain, or migraines, or after surgery or injuries.
  • This medicine may cause the following problems:
    • High risk of overdose, which can lead to death
    • Respiratory depression (serious breathing problem that can be life-threatening)
    • Serotonin syndrome, when used with certain medicines
  • This medicine may make you dizzy, drowsy, or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Sit or lie down if you feel dizzy. Stand up carefully.
  • Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
  • This medicine can be habit-forming. Do not use more than your prescribed dose. Call your doctor if you think your medicine is not working.
  • This medicine could cause infertility. Talk with your doctor before using this medicine if you plan to have children.
  • This medicine may cause constipation, especially with long-term use. Ask your doctor if you should use a laxative to prevent and treat constipation.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Anxiety, restlessness, fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, seeing or hearing things that are not there
  • Blue lips, fingernails, or skin
  • Extreme dizziness or weakness, shallow breathing, slow or uneven heartbeat, sweating, cold or clammy skin, seizures
  • Severe confusion, lightheadedness, dizziness, fainting
  • Severe constipation, stomach pain, or vomiting
  • Trouble breathing or slow breathing

If you notice these less serious side effects, talk with your doctor:

  • Mild constipation, nausea, vomiting

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 12/4/2023

 
 
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