fentanyl (Instanyl)

following a full submission:

fentanyl nasal spray (Instanyl) is accepted for restricted use within NHS Scotland for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain.

In an open-label comparative study intranasal fentanyl was superior to another fentanyl formulation used in the treament of breakthrough pain in terms of time to onset of pain relief, although more episodes using the intranasal formulation required a second dose.

Use of fentanyl nasal spray should be restricted to patients who are unsuitable for other short-acting oral opioids (e.g. oral morphine) as an alternative to other buccal and sublingual fentanyl preparations. It should be noted that the doses of fentanyl nasal spray are significantly lower than doses of fentanyl given by other routes of administration for this indication.