펜타닐
Fentanyl
Fentanyl citrate
다른 이름: Sublimaze · Duragesic · Actiq · Fentora · Ionsys · Fentadon · Durogesic · Fentanyl citrate · fentanylum · fentanyli citras · phentanyl citrate · McN-JR-4263-49 · Fentanil
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Perioperative pain | The combination of a 10 micro-grams/kg loading dose IV followed by a CRI of 10 micrograms/kg/hour | IV/CRI | Continuous | Perioperative | 🌎 NA |
| Pain management | 2-5 micrograms/kg IV, followed by a CRI at 2-5 micrograms/kg/hr | IV/CRI | Continuous | — | 🌎 NA |
| Surgical analgesia | CRI at 10-45 micrograms/kg/hr | CRI | Continuous | Intraoperative | 🌎 NA |
| Analgesia | 2-6 micrograms/kg/hour | CRI | Continuous | — | 🌎 NA |
| Induction | 0.001-0.005 mg/kg IV | IV | Single dose | — | 🌎 NA |
| MAC reduction during general anesthesia | 10-45 micrograms/kg/hr CRI | CRI | Continuous | Intraoperative | 🌎 NA |
| Severe to excruciating pain in the emergent patient | Fentanyl at 1050 micrograms/kg, administered IV titrated to effect; use the effective dose as an hourly CRI. | IV/CRI | Titrated to effect | — | 🌎 NA |
| Epidural for pain control | 0.004 mg/kg (4 micrograms/kg), diluted with 0.2 mL with preservative-free saline or local anesthetic. | Epidural | Single dose | 1/2 hour | 🌎 NA |
| Transdermal Analgesia (<5kg) | 25 mcg/hr or 12.5 mcg/hr | Transdermal | q72h | — | 🌎 NA |
| Transdermal Analgesia (5-10 kg) | 25 mcg/hr | Transdermal | q72h | — | 🌎 NA |
| Transdermal Analgesia (10-20 kg) | 50 mcg/hr | Transdermal | q72h | — | 🌎 NA |
| Transdermal Analgesia (20-30 kg) | 75 mcg/hr | Transdermal | q72h | — | 🌎 NA |
| Transdermal Analgesia (>30 kg) | 100 mcg/hr | Transdermal | q72h | — | 🌎 NA |
| Intraoperative analgesia | Intermittent bolus doses or continuous rate infusion (exact dose not specified) | IV | Intermittent or CRI | Intraoperative | 🌍 EU |
| Postoperative analgesia | Low end of the dose range by continuous rate infusion | IV | CRI | Postoperative | 🌍 EU |
| Postoperative or chronic pain | Transdermal patch (size based on patient requirement) | Topical | Apply 24 hours before surgery | Up to 72 hours | 🌍 EU |
- Perioperative pain: Guideline for CRI during general anesthesia
- Pain management: Loading dose followed by CRI
- Severe to excruciating pain in the emergent patient: Note: '1050' appears exactly as written in source text, likely a typo for 10-50. May combine with ketamine and lidocaine.
- Epidural for pain control: Onset in less than 10 minutes
- Transdermal Analgesia (<5kg): Apply 12-24 hours prior to need. Half-patch dosing may be desired for very small dogs.
- Transdermal Analgesia (5-10 kg): Apply 12-24 hours prior to need.
- Transdermal Analgesia (10-20 kg): Apply 12-24 hours prior to need.
- Transdermal Analgesia (20-30 kg): Apply 12-24 hours prior to need.
- Transdermal Analgesia (>30 kg): Apply 12-24 hours prior to need.
- Intraoperative analgesia: Give slowly to avoid severe bradycardia/asystole.
- Postoperative analgesia: Monitor respiratory function closely.
- Postoperative or chronic pain: Takes ~24 hours to attain adequate plasma concentrations. Use as an adjunctive analgesic.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Perioperative pain | 2-3 micrograms/kg IV plus 2-3 micrograms/kg/hour IV infusion | IV/CRI | Continuous | Perioperative | 🌎 NA |
| Pain management | 1-3 micrograms/kg IV, followed by a CRI at 1-4 micrograms/kg/hr | IV/CRI | Continuous | — | 🌎 NA |
| Surgical analgesia | CRI at 10-30 micrograms/kg/hr | CRI | Continuous | Intraoperative | 🌎 NA |
| Analgesia | 2-4 micrograms/kg/hour | CRI | Continuous | — | 🌎 NA |
| Induction | 0.001-0.002 mg/kg IV | IV | Single dose | — | 🌎 NA |
| MAC reduction during general anesthesia | 10-20 micrograms/kg/hr CRI | CRI | Continuous | Intraoperative | 🌎 NA |
| Severe to excruciating pain in the emergent patient | Fentanyl at 1050 micrograms/kg, administered IV titrated to effect; use the effective dose as an hourly CRI. | IV/CRI | Titrated to effect | — | 🌎 NA |
| Epidural for pain control | 0.004 mg/kg (4 micrograms/kg), diluted 0.2 mL with preservative-free saline or local anesthetic. | Epidural | Single dose | 1/2 hour | 🌎 NA |
| Maintenance analgesia/heavy sedation in critically ill hypotensive animals | fentanyl at 0.5-0.8 micrograms/kg/minute (equivalent to 30-50 micrograms/kg/hr). | CRI | Continuous | — | 🌎 NA |
| Transdermal Analgesia | 25 mcg/hr or 12.5 mcg/hr | Transdermal | q120h | Up to 5 days | 🌎 NA |
| Intraoperative analgesia | Intermittent bolus doses or continuous rate infusion (exact dose not specified) | IV | Intermittent or CRI | Intraoperative | 🌍 EU |
| Postoperative analgesia | Low end of the dose range by continuous rate infusion | IV | CRI | Postoperative | 🌍 EU |
| Postoperative or chronic pain | Transdermal patch (size based on patient requirement) | Topical | Apply 7 hours before surgery | Up to 72 hours | 🌍 EU |
- Pain management: Loading dose followed by CRI
- Severe to excruciating pain in the emergent patient: Note: '1050' appears exactly as written in source text, likely a typo for 10-50.
- Epidural for pain control: Onset in less than 10 minutes
- Maintenance analgesia/heavy sedation in critically ill hypotensive animals: Used in addition to a local line block. May combine with midazolam.
- Transdermal Analgesia: Apply 6-24 hours prior to need. 12 mg patches are available for very small cats.
- Intraoperative analgesia: Give slowly to avoid severe bradycardia/asystole.
- Postoperative analgesia: Monitor respiratory function closely.
- Postoperative or chronic pain: Takes ~7 hours to attain adequate plasma concentrations. Use as an adjunctive analgesic.
소형 포유류
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Perioperative pain (Rabbits/Rodents/Small Mammals) | 5-20 micrograms/kg IV bolus | IV | Single dose | 30-60 minute duration | 🌎 NA |
| Postoperative analgesia (Rabbits) | 1/2 small patch (25 micrograms/hr) per medium sized rabbit (3 kg) every 3 days. Do not cut patch | Transdermal | q72h | — | 🌎 NA |
- Perioperative pain (Rabbits/Rodents/Small Mammals): Causes sedation and respiratory depression
페렛
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Pre-op dose | 5-10 micrograms/kg IV | IV | Single dose | Pre-op | 🌎 NA |
| Intra-operatively | CRI at 10-20 micrograms/kg/hr with a ketamine CRI (0.3-0.4 mg/kg/hr) | CRI | Continuous | Intraoperative | 🌎 NA |
| Postoperatively | 2-5 micrograms/kg/hr with a ketamine CRI. | CRI | Continuous | Postoperative | 🌎 NA |
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Transdermal Analgesia (350-500 kg) | 100 mcg/hr | Transdermal | q48h | — | 🌎 NA |
- Transdermal Analgesia (350-500 kg): Apply 6+ hours prior to need. ARCI UCGFS Class 1 Drug.
돼지
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Transdermal Analgesia (17-25 kg) | 50 mcg/hr | Transdermal | — | — | 🌎 NA |
양
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Transdermal Analgesia | 25 mcg/hr | Transdermal | — | — | 🌎 NA |
염소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Transdermal Analgesia | 25 mcg/hr | Transdermal | — | — | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
펜타닐(Fentanyl)은 매우 강력한 합성 페닐피페리딘 유도체로, 수의학에서 중등도에서 중증의 통증 관리에 광범위하게 사용되는 2급 아편양 진통제입니다.
주요 약리학적 특징:
- 역가: 모르핀보다 약 75~100배 더 강력합니다.
- 지용성: 펜타닐은 지용성이 매우 높아 혈액-뇌 장벽을 빠르게 통과하며(정맥 주사 시 작용 발현이 매우 빠름), 경피 투여(패치)에 매우 적합합니다.
- 지속 시간: 단회 정맥 주사 시, 뇌에서 다른 조직으로 빠르게 재분포되기 때문에 작용 시간이 매우 짧습니다(15~30분). 따라서 지속적인 진통을 위해 지속적 정맥 주입(CRI) 또는 경피 패치를 통해 투여하는 것이 가장 일반적입니다.
임상 적용:
- 수술 후 통증의 보조적 조절.
- 중증의 만성 통증, 둔통 또는 비특이적 광범위 통증(예: 암, 췌장염, 대동맥 혈전색전증) 관리.
- 수술 전후에 사용하여 흡입 마취제의 최소 폐포 농도(MAC)를 크게 낮추어 심혈관계 기능이 저하된 환자에게 안정성을 제공합니다.
임상 요점: 경피 패치는 매우 편리하지만 개체 간 흡수율의 차이가 매우 큽니다. 펜타닐 패치에 의존할 때는 항상 '구조(rescue)'용 주사 진통제를 준비해 두어야 합니다.
작용 기전
Fentanyl is a highly selective full agonist at the mu-opioid receptor (MOR).
Mechanism Pathway:
- Receptor Binding: Fentanyl binds to presynaptic and postsynaptic mu-receptors primarily located in the central nervous system (limbic system, spinal cord, thalamus, midbrain) and peripheral tissues.
- G-Protein Activation: Binding activates inhibitory G-proteins (Gi/Go).
- Cellular Effects:
- Inhibits adenylate cyclase, decreasing intracellular cAMP.
- Promotes the opening of inward-rectifying potassium (K+) channels, leading to neuronal hyperpolarization.
- Inhibits the opening of voltage-gated calcium (Ca2+) channels on presynaptic nerve terminals.
- Analgesia: This cascade profoundly inhibits the release of excitatory, nociceptive neurotransmitters (such as Substance P and glutamate) and decreases the excitability of postsynaptic neurons, effectively blocking pain transmission.
안전성·주의사항
금기사항
- Known hypersensitivity to fentanyl or patch adhesive
- Conditions where additional respiratory or CNS depression would be deleterious
- No specific contraindications available in the monograph (use with caution in patients with respiratory compromise)
부작용
- Dose-related respiratory depression
- CNS depression (sedation)
- Circulatory depression (bradycardia)
- Dysphoria or agitation (especially in cats)
- Urine retention
- Constipation
- Contact dermatitis/rash at patch site
- Altered thermoregulation (hypothermia or hyperthermia)
- Severe bradycardia
- Asystole (with rapid IV injection)
- Reduction in heart rate
주의
Patient Selection: Use with extreme caution in geriatric, severely ill, or debilitated patients, and those with preexisting respiratory compromise.
Transdermal Patch Warnings:
- Heat Exposure: Do NOT allow the applied patch to be exposed to exogenous heat sources (e.g., heating pads, heated cages, direct sunlight). Heat significantly increases drug release and absorption, which has resulted in fatal overdoses.
- Fever: Febrile patients may have increased absorption of fentanyl and require intense monitoring. Consider removing the patch if a fever develops.
- Patch Integrity: Do NOT cut patches unless specifically advised by a pharmacist (cutting alters the drug-releasing membrane of gel-reservoir patches, leading to rapid, uncontrolled drug release).
- Variable Absorption: Absorption is highly variable. Always have injectable rescue analgesia available.
Feline Specifics: Opioids may cause mydriasis (dilated pupils) in cats. Approach slowly to avoid startling them, and keep them out of bright light.
Laboratory Alterations: Opiates can increase biliary tract pressure, potentially elevating plasma amylase and lipase values for up to 24 hours post-administration.
약물 상호작용
May inhibit fentanyl metabolism, increasing risk of toxicity
Additive CNS and respiratory depressant effects
Opiates may decrease diuretic efficacy in congestive heart failure patients
May inhibit fentanyl metabolism
Severe and unpredictable opiate potentiation; generally not recommended within 14 days of MAOI use
Fentanyl may enhance neuromuscular blockade
High fentanyl doses combined with nitrous oxide may cause cardiovascular depression
May increase the metabolism of fentanyl, reducing its efficacy
May increase the metabolism of fentanyl
Fentanyl may exacerbate the effects of tricyclic antidepressants
Opiates may potentiate anticoagulant activity
Reduces the dose requirement for other anaesthetic agents
모니터링
- Analgesic efficacy (pain scoring)
- Heart rate (monitor for bradycardia)
- Respiratory rate and depth
- Body temperature (monitor for fever which increases patch absorption)
- Neurologic status (sedation, dysphoria)
- Heart rate and rhythm (monitor for bradycardia)
- Blood pressure
- Adequacy of analgesia
- Body temperature (avoid external heat on patches)
약동학
반감기
흡수
Transdermal absorption is highly variable among patients. Cats tend to achieve therapeutic levels faster than dogs. Dogs require patch application 12-24 hours in advance; cats 6-24 hours; horses ~6 hours. Febrile patients may have significantly increased absorption.
분포
Rapidly distributes due to high lipophilicity. Exhibits a large volume of distribution (5 L/kg in dogs).
대사
Hepatic metabolism (implied by interactions with CYP inhibitors like azole antifungals and macrolides).
배설
Total clearance in dogs is 78 mL/min/kg.
과다투여
Clinical Signs of Overdose: Profound respiratory and/or CNS depression, cardiovascular collapse, bradycardia, hypothermia, tremors, neck rigidity, and seizures. Newborns are particularly susceptible.
Treatment:
- Naloxone is the specific reversal agent of choice for treating respiratory depression.
- Because naloxone's duration of action is often shorter than fentanyl's, repeated doses or a CRI of naloxone may be required.
- Patients must be closely monitored for re-narcotization.
- Mechanical respiratory support should be instituted in cases of severe respiratory depression.
제품
제형
- Injectable solution (0.05 mg/mL)
- Transdermal patch (12, 25, 50, 75, 100 mcg/hr)
- Buccal tablets
- Transmucosal lozenges
- Iontophoretic transdermal system
- Oral tablets: 100 μg, 200 μg, 400 μg, 600 μg, 800 μg
- Injectable solution: 50 μg/ml
- Transdermal patches: 12.5 μg/h, 25 μg/h, 50 μg/h, 75 μg/h, 100 μg/h
동물용의약품
- None (No veterinary-labeled products available)
- Fentadon 50 μg/ml solution
인용의약품
- Fentanyl Buccal Tablets: 100 mcg, 200 mcg, 400 mcg, 600 mcg, & 800 mcg (Fentora)
- Fentanyl Injectable: 0.05 mg/mL (50 mcg/mL) in various ampules and vials (Sublimaze)
- Fentanyl Transdermal System: 12 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr (Duragesic)
- Fentanyl Iontophoretic Transdermal System: 40 mcg/dose (Ionsys)
- Fentanyl Transmucosal System (Lozenges): 200 mcg to 1600 mcg (Actiq)
- Durogesic patches
- Fentanyl patches/tablets
- Fentora tablets
- Sublimaze solution
규제 현황
POM-V CD SCHEDULE 2
POM-V CD SCHEDULE 2, POM CD SCHEDULE 2
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Transdermal patches: Store below 25°C (77°F). Apply immediately after removing from the sealed package. Do not cut patches. Buccal tablets: Store at room temperature; do not refrigerate or freeze. Injectable: Protect from light; it is hydrolyzed in acidic solutions.
보호자 정보
반려동물 보호자를 위한 중요 안전 안내:
- 어린이와 반려동물에게 매우 위험: 펜타닐은 매우 강력한 마약성 진통제입니다. 패치가 떨어지거나 반려동물이 떼어낸 경우, 어린이나 다른 동물이 씹거나 삼키면 치명적일 수 있습니다. 사용한 패치는 안전하게 폐기하십시오(예: 끈적이는 면을 마주 보게 반으로 접어 변기에 내리거나 동물병원에 반납).
- 사람의 우발적 접촉: 실수로 패치의 끈적이는 면이나 겔을 만진 경우, 즉시 물로만 손을 씻으십시오. 비누, 알코올 또는 손 소독제는 피부를 통한 약물 흡수를 증가시킬 수 있으므로 절대 사용하지 마십시오.
- 열원 노출 금지: 패치를 붙인 반려동물이 전기장판, 온열 패드 위에 눕거나 강한 직사광선에 직접 노출되지 않도록 하십시오. 열은 약물을 빠르게 방출시켜 치명적인 과다 복용을 유발할 수 있습니다.
- 지연된 효과: 패치가 효과를 나타내기까지는 시간이 걸립니다(개는 12
24시간, 고양이는 612시간). 수의사가 이 공백기를 메우기 위해 다른 진통제를 처방할 수 있습니다. - 모니터링: 반려동물에게 극심한 무기력증, 심각한 호흡 변화(매우 느리거나 얕음) 또는 비정상적인 불안 증세가 나타나는지 주의 깊게 관찰하십시오. 이러한 증상이 나타나면 즉시 수의사에게 연락하십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.