Initial Dosing of Abstral for Breakthrough Pain in Opioid-Tolerant Patients

Patient Selection and Dosing

• Patients are considered opioid-tolerant if they have been taking at least 60 mg oral morphine daily, 25 mcg/hr transdermal fentanyl, 30 mg oral oxycodone daily, 8 mg oral hydromorphone daily, 25 mg oral oxymorphone daily, or an equianalgesic dose of another opioid for a week or longer, according to the National Comprehensive Cancer Network 1, 2

Monitoring and Safety

• Rescue medication should be available during titration in case of inadequate pain control, as recommended by the National Comprehensive Cancer Network 1, 2
• Heat exposure (fever, hot environments) may increase fentanyl absorption and should be avoided, as noted by the National Comprehensive Cancer Network 1, 2