Fentanyl:

Intravenous opioid

ECMO Dose Adjustment:

YES—an increased dose may be warranted in some patients.

Renal Impairment Dose Adjustment:

NONE

CRRT Dose Adjustment:

NONE

Hepatic Impairment Dose Adjustment*:

YES—a decreased dose may be warranted in some patients.

Adult Starting Dose^:

Adult Intermittent: 0.35-0.5 mcg/kg IV every 30-60 min (25-50 mcg IV every 30-60 minutes)

Adult Continuous infusion: 0.7-1.0 mcg/kg/hr (25-50 mcg/hr)

Pediatric Starting Dose^:

Pediatric Intermittent: 1-1.5 mcg/kg IV every 30-60 min

Pediatric Continuous Infusion: 1-1.5 mcg/kg/hr

Neonatal Starting Dose^:

Neonatal Intermittent: 1-1.5 mcg/kg IV every 30-60 min

Neonatal Continuous Infusion: 1-1.5 mcg/kg/hr

*Dose adjustment will be dependent on acuity and severity of impairment.

^Always use the lowest-effect dose to an objective endpoint (e.g., pain).

Intravenous opioid physicochemical and pharmacokinetic characteristics

Drug	Fentanyl


Onset (min)	1-3
Log P	4.1
Protein Binding (%)	80-85
Metabolism / Elimination	Hepatic
Dose Adjustment on ECMO	+++
Dose Range*	Adult: 0.7-10 mcg/kg/hr
	Pediatric: 1-10 mcg/kg/hr
	Neonatal: 1-10 mcg/kg/hr

- Minimal sequestration; no need for dose adjustment

++ Moderate sequestration; may require dose adjustment

+++ Significant sequestration; need for dose adjustment

*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.