芬太尼
Fentanyl
Fentanyl citrate
別名: Sublimaze · Duragesic · Actiq · Fentora · Ionsys · Fentadon · Durogesic · Fentanyl citrate · fentanylum · fentanyli citras · phentanyl citrate · McN-JR-4263-49 · Fentanil
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
小型哺乳類
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
豬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Transdermal Analgesia (17-25 kg) | 50 mcg/hr | Transdermal | — | — | 🌎 NA |
羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Transdermal Analgesia | 25 mcg/hr | Transdermal | — | — | 🌎 NA |
山羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Transdermal Analgesia | 25 mcg/hr | Transdermal | — | — | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
芬太尼 (Fentanyl) 是一種高效、合成的苯基哌啶衍生物，屬於第二級鴉片類鎮痛藥，在獸醫學中廣泛用於控制中度至重度疼痛。
主要藥理特徵：
- 效力： 鎮痛效力約為嗎啡的 75 至 100 倍。
- 脂溶性： 芬太尼具有高度脂溶性，能迅速穿過血腦屏障（靜脈注射時起效極快），這也使其成為經皮給藥 (貼片) 的絕佳選擇。
- 作用時間： 單次靜脈注射時，由於藥物迅速從大腦重新分佈至其他組織，其作用時間極短（15-30 分鐘）。因此，通常透過恆速輸注 (CRI) 或經皮貼片來維持鎮痛效果。
臨床應用：
- 術後疼痛的輔助控制。
- 控制嚴重的慢性、鈍痛或非特異性廣泛性疼痛（例如：癌症、胰臟炎、主動脈血栓栓塞）。
- 圍手術期使用可顯著降低吸入性麻醉劑的最低肺泡有效濃度 (MAC)，為心血管功能受損的病患提供穩定性。
臨床要點： 雖然經皮貼片非常方便，但不同動物個體間的吸收差異極大。依賴芬太尼貼片時，應隨時備妥注射型鎮痛藥物以供「救援」使用。
作用機制
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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
注意事項
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.
藥物相互作用
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
監測
- 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)
藥物動力學
半衰期
吸收
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.
分佈
Rapidly distributes due to high lipophilicity. Exhibits a large volume of distribution (5 L/kg in dogs).
代謝
Hepatic metabolism (implied by interactions with CYP inhibitors like azole antifungals and macrolides).
排除
Total clearance in dogs is 78 mL/min/kg.
過量
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.
可用產品
劑型
- 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
獸醫用
- None (No veterinary-labeled products available)
- Fentadon 50 μg/ml solution
人用標示
- 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
各地核准狀態
POM-V CD SCHEDULE 2
POM-V CD SCHEDULE 2, POM CD SCHEDULE 2
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
寵物主人重要安全指引：
- 對兒童與寵物極度危險： 芬太尼是一種極強的麻醉鎮痛藥。如果貼片脫落或被寵物抓下，一旦被兒童或其他動物咀嚼或吞食，可能會致命。請安全地丟棄使用過的貼片（例如：將黏性面互黏對摺後沖入馬桶，或交回獸醫院處理）。
- 人類意外接觸： 如果您不小心觸碰到貼片的黏性面或凝膠，請立即僅用清水洗手。絕對不要使用肥皂、酒精或洗手乳，因為這些物質會加速藥物穿透您的皮膚吸收。
- 嚴禁接觸熱源： 貼著貼片的寵物絕對不可以躺在電熱毯、保溫墊上，或直接曝曬於強烈陽光下。高溫會導致藥物快速釋放，進而引發致命的藥物過量。
- 延遲起效： 貼片需要一段時間才會開始發揮作用（狗約需 12-24 小時，貓約需 6-12 小時）。您的獸醫師可能會開立其他止痛藥來度過這段空窗期。
- 密切觀察： 請密切觀察您的寵物是否出現極度嗜睡、呼吸發生嚴重變化（非常緩慢或極淺），或出現異常的焦躁不安。如果發生這些情況，請立即聯繫您的獸醫師。
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠方最新藥品說明書。