6/10/2023

Janusmed kön och genus

Janusmed kön och genus – Fentanyl ratiopharm

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

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Fentanyl

Fentanyl

Klass: A

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Produkter

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Abstral, Actiq, Durogesic, Effentora, Fentanyl 2care4, ......

Abstral, Actiq, Durogesic, Effentora, Fentanyl 2care4, Fentanyl Actavis, Fentanyl Citrate Injection USP, Fentanyl Hexal, Fentanyl Lavipharm, Fentanyl Mylan, Fentanyl Orion, Fentanyl Sandoz, Fentanyl Takeda, Fentanyl ratiopharm, IONSYS, Instanyl, Ionsys, Matriban, Matrifen, PecFent, Submena
ATC-koder

N02AB03

N02AB03
Substanser

fentanyl, fentanylcitrat, fentanylhydroklorid

fentanyl, fentanylcitrat, fentanylhydroklorid
Sammanfattning

Det saknas kontrollerade studier om skillnader mellan könen avseende effekt för fentanyl. Förekomst av opioidinducerat illamående är högre hos kvinnor. Dosen måste individualiseras hos både kvinnor och män.

Det saknas kontrollerade studier om skillnader mellan könen avseende effekt för fentanyl. Förekomst av opioidinducerat illamående är högre hos kvinnor. Dosen måste individualiseras hos både kvinnor och män.
Background

The prevalence of several clinical pain conditions is higher in women than in men. Differences in pharmacokinetics, sex hormones, stress response, or socio-cultural aspects may be of importance [1-3]. Therefore, sex and gender differences of pain medications are difficult to interpret [4].
Studies on abuse potential of opioids have not been included in this document.

Pharmacokinetics and dosing
The influence of patient’s sex on fentanyl pharmacokinetics has been studied only in patients using transdermal patches.
Patient’s sex did not influence delivery rate of transdermal fentanyl in patients undergoing palliative care (33 men, 35 women). Also, a pharmacokinetic model describing the relationship between fentanyl transdermal dose rate and urinary fentanyl excretion was established and showed fentanyl excretion for higher transdermal doses (>75 µg/h) to be substantially lower for women than men [5]. The clinical relevance of this study is unclear.
No sex differences in pharmacokinetics of transdermal fentanyl were found in healthy volunteers [6] or patients [7, 8] when receiving a v......

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The prevalence of several clinical pain conditions is higher in women than in men. Differences in pharmacokinetics, sex hormones, stress response, or socio-cultural aspects may be of importance [1-3]. Therefore, sex and gender differences of pain medications are difficult to interpret [4]. Studies on abuse potential of opioids have not been included in this document. # Pharmacokinetics and dosing The influence of patient’s sex on fentanyl pharmacokinetics has been studied only in patients using transdermal patches. Patient’s sex did not influence delivery rate of transdermal fentanyl in patients undergoing palliative care (33 men, 35 women). Also, a pharmacokinetic model describing the relationship between fentanyl transdermal dose rate and urinary fentanyl excretion was established and showed fentanyl excretion for higher transdermal doses (>75 µg/h) to be substantially lower for women than men [5]. The clinical relevance of this study is unclear. No sex differences in pharmacokinetics of transdermal fentanyl were found in healthy volunteers [6] or patients [7, 8] when receiving a variation of doses. Additionally, it’s unclear if the studies had enough power to detect clinically significant sex differences. However, a large variation in drug absorption was noted, both between individuals and between different type of cancers [8]. # Effects The effect of opioids for pain-relief may differ between men and women. According to a systematic review, women may require lower doses of opioids, both in treatment of acute and chronic pain. However, no specific data on fentanyl in acute pain were presented. No other studies with a clinically relevant sex analysis regarding the effects of fentanyl have been found. # Adverse effects The risk of postoperative opioid-induced nausea and emesis are higher in women than in men [9, 10]. However, postoperative nausea and vomiting are more common in women in general [11]. If the higher risk is pertained to opioid treatment or related to a higher baseline risk in women is not known. # Reproductive health issues Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Försäljning på recept

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Fler kvinnor än män hämtade ut läkemedel innehållande fentanyl (ATC-kod N02AB03) på recept i Sverige år 2021, totalt 9 251 kvinnor och 5 903 män. Det motsvarar 1,8 respektive 1,1 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 85 år och äldre hos båda könen. I genomsnitt var läkemedel innehållande fentanyl 1,4 gånger vanligare hos kvinnor [12]. Observera att ATC-koden N02AB03 innehåller fentanyl i beredningsformerna plåster, sugtablett, resoriblett och nässpray.
Referenser

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  1. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB et al. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007;132 Suppl 1:S26-45.

  2. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52-8.

  3. Sorge RE, Totsch SK. Sex Differences in Pain. J Neurosci Res. 2017;95(6):1271-1281.

  4. Dance A. Why the sexes don't feel pain the same way. Nature. 2019;567(7749):448-450.

  5. Van Nimmen NF, Poels KL, Menten JJ, Godderis L, Veulemans HA. Fentanyl transdermal absorption linked to pharmacokinetic characteristics in patients undergoing palliative care. J Clin Pharmacol. 2010;50:667-78.

  6. Gupta SK, Hwang S, Southam M, Sathyan G. Effects of application site and subject demographics on the pharmacokinetics of fentanyl HCl patient-controlled transdermal system (PCTS). Clin Pharmacokinet. 2005;44 Suppl 1:25-32.

  7. Gourlay GK, Kowalski SR, Plummer JL, Cherry DA, Gaukroger P, Cousins MJ. The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. Pain. 1989;37:193-202.

  8. Solassol I, Caumette L, Bressolle F, Garcia F, Thézenas S, Astre C et al. Inter- and intra-individual variability in transdermal fentanyl absorption in cancer pain patients. Oncol Rep. 2005;14:1029-36.

  9. Zun LS, Downey LV, Gossman W, Rosenbaumdagger J, Sussman G. Gender differences in narcotic-induced emesis in the ED. Am J Emerg Med. 2002;20:151-4.

  10. Koivuranta M, Läärä E, Snåre L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia. 1997;52:443-9.

  11. Conti D, Ballo P, Boccalini R, Boccherini A, Cantini S, Venni A et al. The effect of patient sex on the incidence of early adverse effects in a population of elderly patients. Anaesth Intensive Care. 2014;42:455-9.

  12. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2021 [cited 2022-03-15.]

  1. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB et al. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007;132 Suppl 1:S26-45.
  2. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52-8.
  3. Sorge RE, Totsch SK. Sex Differences in Pain. J Neurosci Res. 2017;95(6):1271-1281.
  4. Dance A. Why the sexes don't feel pain the same way. Nature. 2019;567(7749):448-450.
  5. Van Nimmen NF, Poels KL, Menten JJ, Godderis L, Veulemans HA. Fentanyl transdermal absorption linked to pharmacokinetic characteristics in patients undergoing palliative care. J Clin Pharmacol. 2010;50:667-78.
  6. Gupta SK, Hwang S, Southam M, Sathyan G. Effects of application site and subject demographics on the pharmacokinetics of fentanyl HCl patient-controlled transdermal system (PCTS). Clin Pharmacokinet. 2005;44 Suppl 1:25-32.
  7. Gourlay GK, Kowalski SR, Plummer JL, Cherry DA, Gaukroger P, Cousins MJ. The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. Pain. 1989;37:193-202.
  8. Solassol I, Caumette L, Bressolle F, Garcia F, Thézenas S, Astre C et al. Inter- and intra-individual variability in transdermal fentanyl absorption in cancer pain patients. Oncol Rep. 2005;14:1029-36.
  9. Zun LS, Downey LV, Gossman W, Rosenbaumdagger J, Sussman G. Gender differences in narcotic-induced emesis in the ED. Am J Emerg Med. 2002;20:151-4.
  10. Koivuranta M, Läärä E, Snåre L, Alahuhta S. A survey of postoperative nausea and vomiting. Anaesthesia. 1997;52:443-9.
  11. Conti D, Ballo P, Boccalini R, Boccherini A, Cantini S, Venni A et al. The effect of patient sex on the incidence of early adverse effects in a population of elderly patients. Anaesth Intensive Care. 2014;42:455-9.
  12. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2021 [cited 2022-03-15.]
Uppdaterat

Litteratursökningsdatum 12/16/2022

Litteratursökningsdatum 12/16/2022