Tolerance of Fentanyl Pectin Nasal Spray for Procedural Pain in Geriatric Patients.

Abstract

We aimed to assess the tolerance of fentanyl pectin nasal spray (FPNS) when used to treat procedural pain caused by wound dressing or physiotherapy in patients older than 75years with or without opioid background treatment. This is a prospective monocentric, noncontrolled, nonrandomized study conducted from December 2014 to October 2017 in 2 geriatric wards (rehabilitation and acute medicine). Fifty-seven patients were included and 314 procedures were monitored. For each patient, 6 procedures were monitored: the first 2 without specific treatment, then fentanyl was started at 100μg with a titration over a few procedures up to 800μg in non-opioid-naïve patients and 400μg in opioid-naïve. Sedation and respiratory scale were monitored during the procedures. All adverse drug events occurring from inclusion to 5days after the intervention were collected and their imputability was assessed separately by 2 pharmacovigilance experts. Overall, 14.4% of the sessions with FPNS administration resulted in adverse drug events. Main adverse drug events were nausea and vomiting, somnolence, and confusion. Most of them were of mild to moderate severity. Four severe adverse events were due to accidental overdoses. No unexpected adverse event occurred. Tolerance was similar for opioid-naïve and non-opioid-naïve patients (P value= .93). FPNS was overall well tolerated in geriatric patients. Given its interesting pharmacokinetics, fentanyl is a promising lead for procedural pain treatment in geriatric patients, even those who are opioid naïve.