Transdermal fentanyl: Pharmacology and toxicology

Journal of Medical Toxicology

Volumn 5, Issue 4, 2009, Pages 230-241

  Nelson, Lewis ^a   Schwaner, Robert ^b  

^a NEW YORK UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b RESURRECTION MEDICAL CENTER   (United States)

Author keywords

Fentanyl; Opioid; Pharmacology; Poisoning; Toxicology; Transdermal

Indexed keywords

CYTOCHROME P450 INHIBITOR; FENTANYL; FENTANYL CITRATE; METHADONE; MORPHINE; NALOXONE; NARCOTIC ANALGESIC AGENT; DRUG CARRIER;

ARTIFICIAL VENTILATION; AUTOPSY; CANCER PAIN; CARDIOVASCULAR DISEASE; CHRONIC PAIN; CLINICAL TRIAL; DIARRHEA; DOSE RESPONSE; DRUG ABSORPTION; DRUG ABUSE; DRUG BIOAVAILABILITY; DRUG BLOOD LEVEL; DRUG CONTROL; DRUG DELIVERY SYSTEM; DRUG DISTRIBUTION; DRUG DOSE ESCALATION; DRUG DOSE INCREASE; DRUG DOSE TITRATION; DRUG EFFICACY; DRUG ELIMINATION; DRUG FATALITY; DRUG HALF LIFE; DRUG INTOXICATION; DRUG METABOLISM; DRUG MISUSE; DRUG OVERDOSE; DRUG PENETRATION; DRUG POTENCY; DRUG POTENTIATION; DRUG SAFETY; DRUG SOLUBILITY; DRUG TOLERANCE; DRUG WITHDRAWAL; DYSPNEA; FIRST PASS EFFECT; FORENSIC TOXICOLOGY; GASTROINTESTINAL SYMPTOM; HISTAMINE RELEASE; HUMAN; LOW DRUG DOSE; LOZENGE; MIOSIS; MOLECULAR WEIGHT; MYDRIASIS; PAIN; PATIENT COMPLIANCE; PATIENT CONTROLLED ANALGESIA; PATIENT EDUCATION; POSTOPERATIVE PAIN; PRIMARY PREVENTION; PRURITUS; REFLEX; REVIEW; RISK BENEFIT ANALYSIS; SIDE EFFECT; SUICIDE ATTEMPT; TABLET FORMULATION; TEMPERATURE SENSITIVITY; THERAPEUTIC ERROR; TRANSDERMAL PATCH; VOMITING; CHRONIC DISEASE; HISTORY; INTOXICATION; INTRADERMAL DRUG ADMINISTRATION; MORTALITY; OPIATE ADDICTION; RISK ASSESSMENT;

ADMINISTRATION, CUTANEOUS; ANALGESICS, OPIOID; CHRONIC DISEASE; DRUG CARRIERS; FENTANYL; HISTORY, 20TH CENTURY; HUMANS; OPIOID-RELATED DISORDERS; OVERDOSE; PAIN; RISK ASSESSMENT;

EID: 75349092325     PISSN: 15569039     EISSN: 19376995     Source Type: Journal    
DOI: 10.1007/BF03178274     Document Type: Review

References (114)

1. Stewart WF, Ricci JA, Chee E, et al. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443-2454.
2. Food and Drug Administration [webpage on the Internet]. Public Health Advisory: Safety warnings regarding use of fentanyl transdermal skin patches [updated 15 July 2005; cited 1 March 2008]. Available from: http://www.fda.gov/cder/drug/advisory/ fentanyl.htm
3. Health Canada [webpage on the Internet]. Important Safety Information: Duragesic® fentanyl transdermal system [updated 13 September 2005; cited 1 March 2008]. Health Canada. Available from: http://www.hc-sc.gc.ca/dhp-mps/medeff/advisories-avis/prof/2005/duragesic_hpc-cps_e.html
4. Food and Drug Administration [webpage on the Internet]. Information for Healthcare Professionals: Fentanyl Transdermal System (marketed as Duragesic and generics) [updated 21 December 2007; cited 24 Feb 2008]. Available from: http://www. fda.gov/cder/drug/InfoSheets/HCP/fentanyl_2007HCP.htm
5. Stanley TH. The history and development of the fentanyl series. J Pain Symptom Manage. 1992;7:S3-S7.
6. Foley KM. Preface. J Pain Symptom Manage. 1992;7:S1-S2.
7. Payne R. Transdermal fentanyl: Suggested recommendations for clinical use. J Pain Symptom Manage. 1992;7:S40-S44.
8. Patt RB, Hogan LA. Transdermal fentanyl for chronic cancer pain: detailed case reports and the influence of confounding factors. J Pain Symptom Manage. 1992;7:S51-S53.
9. Newshan G, Lefkowitz M. Transdermal fentanyl for chronic pain in AIDS: A pilot study. J Pain Symptom Manage. 2001;21:69-77.
10. Slover R. Transdermal Fentanyl: Clinical Trial at the University of Colorado Health Sciences Center. J Pain Symptom Manage. 1992;7:S45-S47.
11. Simmonds MA, Richenbacher J. Transdermal fentanyl: long-term analgesic studies. J Pain Symptom Manage. 1992;7: S36-39.
12. Herbst LH, Strause LG. Transdermal fentanyl use in hospice home-care patients with chronic cancer pain. J Pain Symptom Manage. 1992;7:S54-S57.
13. van Lersberghe C, Camu F, de Keersmaecker E, et al. Continuous administration of fentanyl for postoperative pain: a comparison of the epidural, intravenous, and transdermal routes. J Clin Anesth. 1994;6:308-314.
14. van Bastelaere M, Rolly G, Abdullah NM. Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo. J Clin Anesth. 1995;7:26-30.
15. Gourlay GK, Kowalski SR, Plummer JL, et al. Fentanyl blood concentration-analgesic response relationship in the treatment of postoperative pain. Anesth Analg. 1988;67:329-37.
16. Gourlay GK, Kowalski SR, Plummer JL, et al. The transdermal administration of fentanyl in the treatment of postoperative pain: pharmacokinetics and pharmacodynamic effects. Pain. 1989;37:193-202.
17. Sandler AN, Baxter AD, Katz J, et al. A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy: analgesic, respiratory, and pharmacokinetic effects. Anesthesiology. 1994;81:1169-1180.
18. Miguel R, Kreitzer JM, Reinhart D, et al. Postoperative pain control with a new transdermal fentanyl delivery system: a multicenter trial. Anesthesiology. 1995;83:470-477.
19. Hammack JE, Mailliard JA, Loprinzi CL, et al. Transdermal fentanyl in the management of cancer pain in ambulatory patients: an open-label pilot study. J Pain Symptom Manage. 1996;12:234-240.
20. Grond S, Zech D, Lehmann, KA, et al. Transdermal fentanyl in the long-term treatment of cancer pain: a prospective study of 50 patients with advanced cancer of the gastrointestinal tract or the head and neck region. Pain. 1997;69: 191-198.
21. Ahmedzai S. New approaches to pain control in patients with cancer. Eur J Cancer. 1997;6:S8-S14.
22. Donner B, Zenz M, Strumpf M, et al. Long-term treatment of cancer pain with transdermal fentanyl. J Pain. Symptom Manage. 1998;15:168-175.
23. Sloan PA, Moulin DE, Hays H. A clinical evaluation of transdermal therapeutic system fentanyl for the treatment of cancer pain. J Pain Symptom Manage. 1998;16:102-111.
24. Gourlay GK. Treatment of cancer pain with transdermal fentanyl. Lancet. 2001;2:165-172.
25. Viscusi ER, Reynolds L, Chung F, et al. Patient-controlled transdermal fentanyl hydrochloride vs intravenous morphine pump for postoperative pain: a randomized controlled trial. JAMA. 2004;291:1333-1341.
26. Viscusi ER, Siccardi M, Damaraju CV, et al. The safety and efficacy of fentanyl iontophoretic transdermal system compared with morphine intravenous patient-controlled analgesia for postoperative pain management: an analysis of pooled data from three randomized, active-controlled clinical studies. Anesth Analg. 2007;105:1428-1436.
27. Anderson DT, Muto JJ. Duragesic® transdermal patch: postmortem tissue distribution of fentanyl in 25 cases. J Anal Toxicol. 2000;24:627-634.
28. Low JA, Chye R. A pitfall to avoid when starting a patient on transdermal fentanyl. Aust Fam Physician. 2000;29: 1173-1175.
29. Coopman V, Cordonnier J, Pien K, et al. LC-MS/MS analysis of fentanyl and norfentanyl in a fatality due to application of multiple Durogesic transdermal therapeutic systems. Forensic Sci Int. 2007;169:223-227.
30. Klockegether-Radke A, Hildebrandt J. Opioid intoxication: inappropriate administration of transdermal fentanyl. Anaesthesist. 1997;46:428-429.
31. National Institute of Drug Abuse, Community Epidemiology Working Group [webpage on the Internet]. Epidemiologic trends in drug abuse. Advanced report: Prescription drug abuse [updated June 2004; cited 1 March 2008]. NIH Publication No. 04-5363A. Available from: http://www.drugabuse.gov/PDF/CEWG/AdvReport604.pdf
32. Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2006. DAWN Series D-28, DHHS Publication No. (SMA) 06-4143.
33. Henderson GL. Designer drugs: past history and future prospects. J Forensic Sci. 1998;33:569-575.
34. Jerrard DA. Designer drugs-a current perspective. J Emerg Med. 1990;8:733-741.
35. Kuhlman JJ, McCaulley R, Valouch TJ, et al. Fentanyl use, misuse, and abuse: a summary of 23 postmortem cases. J Anal Toxicol. 2003;27:499-504.
36. Edinboro LE, Poklis A, Trautman D, et al. Fatal fentanyl intoxication following excessive transdermal application. J Forensic Sci. 1997;42:741-743.
37. Lehmann KA, Zech D. Transdermal fentanyl: clinical pharmacology. J Pain Symptom Manage. 1992;7:S8-S16.
38. Janssen Pharmaceutical [webpage on the Internet]. Duragesic® approved package insert. Titusville, NJ. [updated April 2007; cited 1 March 1, 2008]. Available from: http://www. duragesic.com/duragesic/shared/pi/duragesic.pdf
39. Sebel PS, Barrett CW, Kirk CJ, et al. Transdermal absorption of fentanyl and sufentanil in man. Eur J Clin Pharmacol. 1987;32:529-531.
40. Sandler A. Transdermal fentanyl: acute analgesic clinical studies. J Pain Symptom Manage. 1992;7:S27-S35.
41. Solassol I, Bressolle F, Caumette L, et al. Interand intraindividual variabilities in pharmacokinetics of fentanyl after repeated 72-hour transdermal applications in cancer pain patients. Ther Drug Monit. 2005;27:491-498.
42. Gupta SK, Southam M, Gale R, et al. System functionality and physiochemical model of fentanyl transdermal system. J Pain Symptom Manage. 1992;7:S17-S26.
43. Karst M, Fink M, Wagner T, et al. Transdermal fentanyl: little absorption in two patients with systemic sclerosis? Pain Medicine. 2001;2:225-227.
44. Larsen RH, Nielsen F, Sørensen JA, et al. Dermal penetration of fentanyl: inter- and intraindividual variations. Pharmacol Toxicol. 2003;93:244-248.
45. Roy SD, Flynn GL. Transdermal delivery of narcotic analgesics: pH, anatomical and subject influences on cutaneous permeability of fentanyl and sufentanil. Pharm Res. 1990;7:842-847.
46. Cephalon, Inc. [webpage on the Internet]. Fentora prescribing information. Frazer, PA [updated October 2007; cited 1 March 2008]. Available from: http://www.fentora.com/ HCP/pi.pdf
47. Kramer C, Tawney M. A fatal overdose of transdermally administered fentanyl. J Am Osteopath Assoc. 1998;98:385-386.
48. Arvanitis ML, Satonik RC. Transdermal fentanyl abuse and misuse. Am J Emerg Med. 2002;20:58-59.
49. Liappas IA, Dimopoulos NP, Mellos E et al. Oral transmucosal abuse of transdermal fentanyl. J Psychopharmacol. 2004;18:277-280.
50. Roberge RJ, Krenzelok EP, Mrvos R. Transdermal drug delivery system exposure outcomes. J Emerg Med. 2000;18:147-151.
51. Newshan G. Heat-related toxicity with the fentanyl transdermal patch. J Pain Symptom Manage. 1998;16:277-278.
52. Ashburn MA, Ogden LL, Zhang J, et al. The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain. 2003;4:291-297.
53. Shomaker TS, Zhang J, Ashburn MA. Assessing the impact of heat on the systemic delivery of fentanyl through the transdermal fentanyl delivery system. Pain Med. 2000;1: 225-230.
54. Song CW, Chelstrom LM, Levitt SH, et al. Effects of temperature on blood circulation with laser Doppler method. Int J Radiat Oncol Biol Phys. 1989;17:1041-1047.
55. Rose PG, Macfee MS, Boswell MV. Fentanyl transdermal system overdose secondary to cutaneous hyperthermia. Anesth Analg. 1993;77:390-391.
56. Frolich M, Giannotti A, Modell JH. Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg. 2001;93:647-648.
57. Mylan Laboratories, Inc. [webpage on the Internet]. Citizens petition (2006P-0123) FDA. [16 March 2006]. Available from: http://www.fda.gov/ohrms/dockets/dockets/06p0123/06p-0123-cp00001-01-vol1.pdf
58. Jeal W, Benfield P. Transdermal fentanyl: a review of its pharmacological properties and therapeutic efficacy in pain control. Drugs. 1997;53:109-138.
59. Cephalon, Inc. [webpage on the Internet]. Salt Lake City, UT. Actiq prescribing information [updated Feb 2007; cited 1 March 2008]. Available from: http://www.actiq.com/pdf/actiq_package_insert_4_5_07.pdf
60. Stevens RA, Ghazi SM. Routes of opioid analgesic therapy in the management of cancer pain. Cancer Control. 2000;7: 132-141.
61. Varvel JR, Shafer SL, Hwang SS, et al. Absorption characteristics of transdermally administered fentanyl. Anesthesiology. 1989;70:928-934.
62. Grond S, Radbruch L, Lehman KA. Clinical pharmacokinetics of transdermal opioids: focus on transdermal fentanyl. Clin Pharmacokinet. 2000;38:59-89.
63. Mystakidou K, Katsouda E, Tsilika E, et al. Transdermal therapeutic fentanyl-system (TTS-F). In Vivo. 2004;18:633-642.
64. Freynhagen R, Jürgen von Giesen H, Busche P, et al. Switching from reservoir to matrix systems for the transdermal delivery of fentanyl: a prospective, multicenter pilot study in outpatients with chronic pain. J Pain Symp Manage. 2005;30: 289-297.
65. Mylan Pharmaceuticals Inc. [webpage on the Internet]. Morgantown, WV. Mylan® Fentanyl Transdermal System, approved prescribing information [updated December 2006; 1 March 2008]. Available from: http://www.mylanpharms.com/ pdfs/07-04-27_fentanyl_v14.pdf
66. Mylan Technologies [webpage on the Internet]. Comments of Mylan Technologies Inc. on Docket No. 2004P-0506: To require comprehensive risk minimization programs for fentanyl matrix systems and to treat fentanyl matrix systems as different dosage forms than fentanyl reservoir systems [updated XXXX; cited 1 March 2008]. Available from: http://www.fda.gov/ ohrms/DOCKETS/dockets/04p0506/04p-0506-c000001-01-vol1.pdf
67. Alza Corporation [webpage on the Internet]. Re: Docket No. 2004P-0506 (fentanyl transdermal products), dated January 12, 2005 [updated 12 January 2005; cited 1 March 2008]. Available from: http://www.fda.gov/ohrms/dockets/dockets/04p0506/ 04p-0506-rc00001-01-vol2.pdf
68. Food and Drug Administration, Center for Drug Evaluation and Research [webpage on the Internet]. Approved Drug Products with Therapeutic Equivalence Evaluations. 28th Edition. Washington, DC [updated XXXX; cited 1 March 2008]. Available from: http://www.fda.gov/cder/ob/docs/preface/ ecpreface.htm#Therapeutic%20Equivalence-Related%20Terms
69. Fiset P, Cohane C, Browne S, et al. Biopharmaceutics of a new transdermal fentanyl device. Anesthesiology. 1995;83:459-469.
70. Marier JF, Lor M, Potvin D, et al. Pharmacokinetics, tolerability, and performance of a novel matrix transdermal delivery system of fentanyl relative to the commercially available reservoir formulation in healthy subjects. J Clin Pharmacol. 2006;46:642-653.
71. Ross JR, Quigley C. Transdermal fentanyl: informed prescribing is essential. Eur J Pain. 2003;7:481-483.
72. Holley FO, Van Steennis C. Postoperative analgesia with fentanyl: pharmacokinetics and pharmacodynamics of constant-rate IV and transdermal delivery. Br J Anaesth. 1988;60:608-613.
73. Portenoy RK, Southam MA, Gupta SK, et al. Transdermal fentanyl for cancer pain: repeated dose pharmacokinetics. Anesthesiology. 1993;78:36-43.
74. Fung DL, Eisele JH. Fentanyl pharmacokinetics in awake volunteers. J Clin Pharmacol. 1980;20:652-658.
75. Hwang SS, Nichols KC, Southam MA. Transdermal permeation: physiological and physicochemical aspects. In: Lehmann KA, Zech D, eds. Transdermal fentanyl. Berlin: Springer 1991:1-7.
76. Roy SD, Hou SYE, Witham SL, et al. Transdermal delivery of narcotic analgesics: comparative metabolism and permeability of human cadaver skin and hairless mouse skin. J Pharm Sci. 1994;83:1723-1728.
77. Thompson JP, Bower S, Liddle AM, et al. Perioperative pharmacokinetics of transdermal fentanyl in elderly and young adult patients. Br J Anaesth. 1998;81:152-154.
78. Zernikow B, Michel E, Anderson B. Transdermal fentanyl in childhood and adolescence: a comprehensive literature review. J Pain. 2007;8:187-207.
79. Cartwright P, Prys-Roberts C, Gill K, et al. Ventilatory depression related to plasma fentanyl concentrations during and after anesthesia in humans. Anesth Analg. 1983;62: 966-974.
80. Shibutani K, Inchiosa MA Jr, Sawada K, et al,. Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients. Br J Anaesth. 2005;95(3):377-383.
81. Shibutani K, Katoh T, Sakai T, et al. Clinical applications of fentanyl pharmacokinetics and pharmacodynamics: roles of fentanyl in anesthesia. J Anesth. 1999;13(4):209-216.
82. Sabatowski R, Petzke F, Brunsch-Radbruch A, et al. Transdermal fentanyl for the management of cancer pain: a survey of 1005 patients. Palliat Med. 2001;15:309-321.
83. Streisand JB, Bailey PL, LeMaire L, et al. Fentanyl-induced rigidity and unconsciousness in human volunteers: incidence, duration, and plasma concentrations. Anesthesiology. 1993;78: 629-634.
84. Vielvoye-Kerkmeer AP, Mattern C, Uitendaal MP. Transdermal fentanyl in opioid-naive cancer pain patients: an open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naïve patients and a group using codeine. J Pain Symptom Manage. 2000;19:185-192.
85. Tawfik MO. Use of transdermal fentanyl without prior opioid stabilization in patients with cancer pain. Curr Med Res Opin. 2004;20:259-267.
86. Welsh J, Reid A, Graham J, et al. Physicians' knowledge of transdermal fentanyl. Palliat Med. 2005;19:9-16.
87. Booth JV, Grossman D, Moore J, et al. Substance abuse among physicians: A survey of academic anesthesiology programs. Anesth Analg. 2002;95:1024-1030.
88. Kram TC, Cooper DA, Allen AC. Behind the identification of china white. Anal Chem. 1981;53:1379A-1386A.
89. LaBarbera M, Wolfe T. Characteristics, attitudes and implications of fentanyl use based on reports from self-identified fentanyl users. J Psychoactive Drugs. 1983;15:293-301.
90. Jost U, Wolter E, Bohrer H. Repeated improper intravenous injection of fentanyl from a transdermal system. Dtsch Med Wochenschr. 2004;129:313-314.
91. Reeves MD, Ginifer C. Fatal intravenous misuse of transdermal fentanyl. Med J Aust. 2002;18:552-553.
92. Purucker M, Swann W. Potential for duragesic patch abuse (letter). Ann Emerg Med. 2000;35:314.
93. Tharp AM, Winecker RE, Winston DC. Fatal intravenous fentanyl abuse: four cases involving extraction from transdermal patches. Am J Forensic Med Pathol. 2004;25:178-181.
94. Lilleng PK, Mehlum LI, Bachs L, et al. Deaths after intravenous misuse of transdermal fentanyl. J Forensic Sci. 2004;49:1-3.
95. Sellers EM, Schuller R, Romach MK, et al. Relative abuse potential of opioid formulations in Canada: a structured field study. J Opioid Manag. 2006;2:219-227.
96. Marquardt KA, Tharratt RS. Inhalational abuse of fentanyl patch. Clin Toxicol. 1994;32:75-78.
97. Barrueto F, Howland MA, Hoffman RS, et al. The fentanyl tea bag. Vet Human Toxicol. 2004;46:30-31.
98. Coon TP, Miller M, Kaylor D, et al. Rectal insertion of fentanyl patches: a new route of toxicity (letter). Ann Emerg Med. 2005;46:473.
99. van Rijswijk R, van Guldener C. A delirious patient with opioid intoxication after chewing a fentanyl patch. J Am Geriatr Soc. 2006;54:1298-1299.
100. Teske J, Weller JP, Larsch K, et al. Fatal outcome in a child after ingestion of a transdermal fentanyl patch. Int J Legal Med. 2007;121:147-151.
101. Cephalan, Inc. [webpage on the Internet]. Important Safety Information for Fentora (Dear Doctor letter). Frazer, PA [updated 10 September 2007; 1 March 2008]. Available from: http://www.fentora.com/pdf/fentora_ddl.pdf.
102. Marquardt KA, Tharratt RS, Musallam NA. Fentanyl remaining in a transdermal system following three days of continuous use. Ann Pharmacother. 1995;29:969-971.
103. Flannagan LM, Butts JD, Anderson WH. Fentanyl patches left on dead bodies: potential source of drug abusers. J Forensic Sci. 1996;41:320-321.
104. Gardner-Nix J. Caregiver toxicity from transdermal fentanyl. J Pain Symptom Manage. 2001;21:447-448.
105. Hardwick WE, King WD. Respiratory depression in a child unintentionally exposed to transdermal fentanyl patch. South Med J. 1997;90:962-965.
106. Janssen Pharmaceuticals [webpage on the Internet]. Urgent product recall. 75 mcg/hr Duragesic patches. Titusville, NJ [updated 17 February 2004; cited 1 March 2008]. Available from: http://www.fda.gov/medwatch/SAFETY/2004/duragesic_ recall.pdf
107. Janssen Pharmaceuticals [webpage on the Internet]. Urgent expanded product recall. 75 mcg/hr Duragesic patches. Titusville, NJ [updated 7 April 2004; cited 1 March 2008]. Available from: http://www.fda.gov/cder/drug/shortages/duragesicLetter.pdf
108. US Food and Drug Administration [webpage on the Internet]. Actavis Recalls Certain Fentanyl Patches in the US as Precaution. Washington, DC [updated 19 February 2008; 1 March 2008]. Available from: http://www.fda.gov/oc/po/firmrecalls/actavis02_08.html
109. US Food and Drug Administration [webpage on the Internet]. Pricara recalls 25 mcg/hr Duragesic (fentanyl transdermal system) CII pain patches. Washington, DC [updated 12 February 2008; 1 March 2008]. Available from: http://www.fda.gov/oc/ po/firmrecalls/pricara02_08.html.
110. Henderson GL. Fentanyl-related deaths: demographics, circumstances, and toxicology of 112 cases. J Forensic Sci. 1991;36(2):422-433.
111. Rainey PM. Laboratry Principles. In: Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, Lewin N, Nelson LS, eds. Goldfrank's Toxicologic Emergencies. 8th ed. McGraw-Hill: New York; 2006:88-108.
112. Thomasy SM, Mama KR, Stanley SD. Comparison of liquid chromatography-mass spectrometry and radioimmunoassay for measurement of fentanyl and determination of pharmacokinetics in equine plasma. J Anal Toxicol. 2008;39:754-759.
113. Thompson JG, Baker AM, Bracey AH, et al. Fentanyl concentrations in 23 postmortem cases from the Hennepin County medical eexaminer's office. J Forensic Sci. 2007;52: 978-981.
114. Pizon AF, Brooks DE. Fentanyl patch abuse: naloxone complications and extracorporeal membrane oxygenation rescue. Vet Human Toxicol. 2004;46:256-257.