Instanyl can be used concomitantly in patients receiving maintenance opioid therapy that is at least 60mg of oral morphine daily, 25 microgram of transdermal fentanyl per hour, 30mg oxycodone daily, 8mg of oral hydromorphone daily or an equianalgesic dose of another opioid for at least a week.
A double-blind crossover study looked at 111 patients with cancer receiving stable long-term opioid treatment and rated pain intensity on an 11-point scale. Pain intensity was reduced by an average of 2.36 points within 10 minutes of intranasal fentanyl administration, reaching the threshold considered clinically significant, unlike with the placebo.1
Another trial compared intranasal fentanyl with oral transmucosal fentanyl in an open-label treatment of six episodes of breakthrough cancer pain. In the majority of the 139 opioid-tolerant adults, the nasal spray relieved pain faster than the oral formulation. The median time to onset of pain relief was 11 mins for intranasal fentanyl, compared with 16 mins for the oral formulation.2 More than twice as many of the patients in the study considered the nasal spray easy or very easy to administer compared to oral transmucosal fentanyl.3
Instanyl was found to be generally well tolerated with nausea and vertigo being the most common adverse events.1,2
- Kress HG et al. Clin Ther 2009; 31: 1177-91.
- Mercadante S et al. Poster presented at 6th Congress of European Federation of IASP Chapters. Lisbon, Portugal, September 2009; P1316.
- Mercadante S et al. Poster presented at 6th Congress of European Federation of IASP Chapters. Lisbon, Portugal, September 2009; P1384.
Further information: Nycomed
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