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Fentanyl chemical structure

IUPAC name
CAS number
ATC code

N01AH01 .

Chemical formula {{{chemical_formula}}}
Molecular weight 336.471 g/mol
Bioavailability 92% (transdermal)
50% (buccal)
33% (ingestion)
Metabolism hepatic, primarily by CYP3A4
Elimination half-life 7 hours (range 3–12 h)
Pregnancy category {{{pregnancy_category}}}
Legal status {{{legal_status}}}
Routes of administration TD, IM, IV, oral, sublingual, buccal

Fentanyl is an odorless, rapid-acting opioid (or synthetic opiate), which depresses central nervous system and respiratory function, and alleviates pain without causing a loss of consciousness. It is one of the most powerful opioid analgesics, with a potency approximately 80 times that of heroin and hundreds of times that of morphine.[1] Fentanyl has an LD50 of 3.1 milligrams per kilogram in rats and 0.03 milligrams per kilogram in monkeys. The LD50 in humans, by intravenous injection in an opiate-naive individual (without tolerance), is approximated to be 0.5-1 milligrams. It is classified as a Schedule II drug in the United States due to its high abuse rate. In October 2002, the Russian military reportedly used "a fentanyl derivative" against terrorists holding hostages in a Moscow theater.[1]


Fentanyl was first synthesized by Paul Janssen under the label of his relatively newly formed Janssen Pharmaceutica in 1959. In the 1960s, fentanyl was introduced as an intravenous anesthetic under the trade name of Sublimaze.

In the mid-1990s, Janssen Pharmaceutica developed and introduced into clinical trials the Duragesic patch, which is a formation of an inert alcohol gel infused with select fentanyl doses which are worn to provide constant administration of the opioid over a period of 48 to 72 hours. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into the medical practice, eventually reaching record profits of over a billion dollars gross sales in 2004, following prescription practices extending beyond chronic cancer and non-cancer malignant pain.

Following the patch, a flavored lollipop of fentanyl citrate mixed with inert fillers was introduced under the brand name of Actiq, becoming the first quick-acting formation of fentanyl for use with breakthrough chronic pain.

More recently, fentanyl has been developed into an effervescent tab for buccal absorption much like the Actiq lollipop, followed by a buccal spray device for fast-acting relief and other delivery methods currently in development.



The synthesis of fentanyl (N-phenyl-N-(1-phenethyl-4-piperidinyl)propanamide) by Janssen Pharmaceutica was achieved in four steps, starting from 4-piperidinone hydrochloride. The 4-piperidinone hydrochloride was first reacted with phenethyl bromide to give N-phenethyl-4-piperidinone (NPP). Treatment of the NPP intermediate with aniline followed by reduction with sodium borohydride affording 4-anilino-N-phenethyl-piperidine (ANPP). Finally ANPP and propionic anhydride are reacted to form the amide product.


The pharmaceutical industry has developed several analogues of fentanyl:

  • Alfentanil (trade name Alfenta), an ultra-short acting (5–10 minutes) analgesic,
  • Sufentanil (trade name Sufenta), a potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery.
  • Remifentanil (trade name Ultiva), currently the shortest acting opioid, has the benefit of rapid offset, even after prolonged infusions.
  • Carfentanil (trade name Wildnil) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals such as elephants.

Therapeutic use

Fentanyl is extensively used for anesthesia and analgesia, most often in the operating room and intensive care unit. Additionally, Fentanyl is often used in cancer therapy and other chronic pain management due to its effectiveness in relieving pain.

File:Fentanyl Transdermal System 50 mcg Patch.jpg

Fentanyl Transdermal System patch (50 µg/h).

Fentanyl transdermal patch (Durogesic/Duragesic) is used in chronic pain management. The patches work by releasing fentanyl into body fats, which then slowly release the drug into the blood stream over 48 to 72 hours, allowing for long lasting relief from pain. The patches are available in generic form and are available for lower costs. Fentanyl patches are manufactured in five patch sizes: 12.5 micrograms/hour, 25 µg/h, 50 µg/h, 75 µg/h, and 100 µg/h. Dosage is based on the size of the patch, since the transdermal absorption rate is generally constant at a constant skin temperature. Rate of absorption is dependent on a number of factors. Body temperature, skin type, amount of body fat, and placement of the patch can have major effects. The different delivery systems used by different makers will also affect individual rates of absorption. The typical patch will take effect under normal circumstances usually within 8-12 hours, thus fentanyl patches are often prescribed with another opiate (such as morphine sulfate) to handle breakthrough pain.

Fentanyl lozenges (Actiq) are a solid formulation of fentanyl citrate on a stick in the form of a lollipop that dissolves slowly in the mouth for transmucosal absorption. These lozenges are intended for opioid-tolerant individuals and are effective in treating breakthrough cancer pain. It is also useful for breakthrough pain for those suffering bone injuries, severe back pain, neuropathy, arthritis, and some other examples of chronic nonmalignant pain. The unit is a berry-flavored lozenge on a stick which is swabbed on the mucosal surfaces inside the mouth—inside of the cheeks, under and on the tongue and gums—to release the fentanyl quickly into the system. It is most effective when the lozenge is consumed in 15 minutes. The drug is less effective if swallowed, as despite good absorbance from the small intestine there is extensive first pass metabolism, leading to an oral bioavailability of 33%. Fentanyl lozenges are available in six dosages, from 200 to 1600 µg in 200 µg increments (excluding 1000 µg and 1400 µg). These are now available in the United states in generic form,[2] through an FTC consent agreement.[3]
However, most patients find it takes 10-15 minutes to use all of one lozenge, and those with a dry mouth cannot use this route. In addition, nurses are unable to document how much of a lozenge has been used by a patient, making drug records inaccurate.

Over 2008/9 a wide range of fentanyl preparations will become available, including buccal tablets or patches, nasal sprays, inhalers and active transdermal patches (heat or electrical). High quality evidence for their superiority over existing preparations is currently lacking. Some preparations such as nasal sprays and inhalers may result in a rapid response, but the fast onset of high blood levels may compromise safety (see below). In addition the expense of some of these appliances may greatly reduce their cost-effectiveness.

In palliative care transdermal fentanyl has a definite, but limited, role for:

  • Patients already stabilized on other opioids who have persistent swallowing problem and cannot tolerate other parenteral routes such as subcutaneous administration.
  • Patients with moderate to severe renal failure
  • Troublesome adverse effects on morphine, hydromorphone or oxycodone.

Fentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural anesthesia and analgesia. Because of fentanyl's high lipid solubility its effects are more localised than morphine and some clinicians prefer to use the morphine to get a wider spread of analgesia.

Adverse events

Fentanyl's major side effects (more than 10% of patients) include diarrhea, nausea, constipation, dry mouth, somnolence, confusion, asthenia (weakness), and sweating; and, less frequently (3 to 10% of patients), abdominal pain, headache, fatigue, anorexia and weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia (indigestion), dyspnea (shortness of breath), hypoventilation, apnea, and urinary retention. Fentanyl use has also been associated with aphasia.[4]Fentanyl patch has been associated with altered mental state leading to aggression in an anecdotal case report.[5]

Adverse effects

Like other lipid soluble drugs, the pharmacodynamics of fentanyl are poorly understood. The manufacturers acknowledge there is no data on the pharmacodynamics of fentanyl in elderly, cachectic or debilitated patients, frequently the type of patient for which transdermal fentanyl is being used. This may explain the increasing number of reports of respiratory depression events since the late 1970s.[6][7][8][9][10][11][12] In 2006 the U.S. Food and Drug Administration started investigating several respiratory deaths, but doctors in the UK had to wait until September 2008 before being warned of the risks with fentanyl.[13]

The precise reason for sudden respiratory depression is unclear, but there are several hypotheses:

  • Saturation of the body fat compartment in patients with rapid and profound body fat loss (patients with cancer, cardiac or infection-induced cachexia can lose 80% of their body fat).
  • Early carbon dioxide retention causing cutaneous vasodilatation (releasing more fentanyl), together with acidosis which reduces protein binding of fentanyl (releasing yet more fentanyl).
  • Reduced sedation, losing a useful early warning sign of opioid toxicity, and resulting in levels closer to respiratory depressant levels.

Fentanyl has a therapeutic index of 270.[14]

Illicit use


Fentanyl powder seized by a Lake County Deputy Sheriff in Painesville, Ohio, where a male subject had been discovered unresponsive and struggling to breathe

Illicit use of pharmaceutical fentanyls first appeared in the mid-1970s in the medical community and continues in the present. United States authorities classify fentanyl as a narcotic. To date, over 12 different analogues of fentanyl have been produced clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are similar to those of heroin, with the exception that many users report a noticeably less euphoric 'high' associated with the drug and stronger sedative and analgesic effects. Because the effects of fentanyl last for only a very short time, it is even more addictive than heroin, and regular users may become addicted very quickly. Additionally, fentanyl may be hundreds of times more potent than street heroin, and tends to produce significantly worse respiratory depression, making it somewhat more dangerous than heroin to users — though in some places, it is sold as heroin, often leading to overdoses. Fentanyl is most commonly used orally, but like heroin, can also be smoked, snorted or injected. Many fentanyl overdoses are initially classified as heroin overdoses.[15]

Fentanyl is normally sold on the black market in the form of transdermal fentanyl patches such as Duragesic, diverted from legitimate medical supplies. The patches may be cut up and eaten, or the gel from inside the patch smoked. To prevent the removal of the fentanyl base, Janssen-Cilag, the inventor of the Fentanyl patch designed the Durogesic patch. The Durogesic patches contain their Fentanyl throughout the plastic matrix instead of gel incorporated into a reservoir on the patch. Manufacturers such as Mylan have also produced Durogesic style fentanyl patches that contain the chemical in a silicone matrix, preventing the removal of the fentanyl-containing gel present in other products.[1] Another dosage form of fentanyl which has appeared on the streets are the fentanyl lollipops Actiq, which are sold under the street name of "percopop". The pharmacy retail price ranges from US$10 to US$30 per unit (based on strength of lozenge), with the black market cost anywhere from US$15 to US$40 per unit, depending on the strength. Non-medical use of fentanyl by individuals without opiate tolerance can be very dangerous and has resulted in numerous deaths.[2] Even those with opiate tolerances are at high risk for overdoses. Once the fentanyl is in the user's system it is extremely difficult to stop its course because of the nature of absorption. Illicitly synthesized fentanyl powder has also appeared on the US market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and consequently very dangerous. Some heroin dealers mix fentanyl powder with larger amounts of heroin in order to increase potency or compensate for low-quality heroin, and to increase the volume of their product. As of December 2006, a mix of fentanyl and either cocaine or heroin has caused an outbreak in overdose deaths in the United States, heavily concentrated in the cities of Detroit, Philadelphia, Pittsburgh, St. Louis, Milwaukee, Camden, Chicago,[16] Little Rock, and Dallas.[17] The mixture of fentanyl and heroin is known as "magic" or "the bomb", among other names, on the street.[18]

Several large quantities of illicitly-produced fentanyl have been seized by U.S. law enforcement agencies. In June 2006, 945 grams of 83% pure fentanyl powder were seized by Border Patrol agents in California from a vehicle which had entered from Mexico.[19] Mexico is the source of much of the illicit fentanyl for sale in the U.S. However, there has been one domestic fentanyl lab discovered by law enforcement, in April 2006 in Azusa, California. The lab was a source of counterfeit 80 mg OxyContin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs.[20][21]

The "china white" form of fentanyl refers to the clandestinely produced analogue α-methylfentanyl (AMF)[22], which is classified as a Schedule I drug in the United States. Although AMF is described as having a short duration of action (90 minutes), the main bonus of inserting the α-Me can be thought analogously to phenethylamines and amphetamines.

Thus, the motivation for AMF is that despite the extra difficulty from a synthetic stand-point, the resultant drug is relatively more resistant to metabolic degradation resulting in a drug with an increased duration.[23] This is particularly noteworthy since an article in JPET reported that the main metabolite for fentanyl in vivo is the N-dealkylated metabolite.[How to reference and link to summary or text] Additionally, AMF is reported to be at least three times more potent than fentanyl.[How to reference and link to summary or text]

Overdoses, recalls and legal action

A number of fatal fentanyl overdoses have been directly tied to the drug over the past several years. In particular, manufacturers of time-release fentanyl patches have come under scrutiny for defective products. While the fentanyl contained in the patches was safe, a malfunction of the patches caused an excessive amount of fentanyl to leak and to be absorbed by patients, resulting in life-threatening side effects and even death.

Manufacturers of fentanyl transdermal pain patches have voluntarily recalled numerous lots of their patches and the FDA has issued Public Health Advisories related to the fentanyl patch dangers. Manufacturers affected include Janssen Pharmaceutica Products, L.P.; Alza Corporation; Actavis South Atlantic, LLC; Sandoz; and Cephalon, Inc..

On June 19, 2007, a $5.5 million jury verdict was awarded in a case against Johnson & Johnson subsidiaries, Alza Corporation and Janssen Pharmaceutica Products, the manufacturers of the Duragesic fentanyl transdermal pain patch. This case, the first Federal trial involving a fentanyl patch, was tried in the Federal District Court for the Southern District of Florida, West Palm Beach Division. Led by attorney Jim Orr, Dallas, Texas-based law firm, Heygood, Orr, Reyes, Pearson & Bartolomei, achieved the verdict for the family of a 28-year-old Florida man (Adam Hendelson) who died while wearing a fentanyl transdermal pain patch. On November 17, 2008, lead attorneys Jim Orr and Michael Heygood won a case against Johnson & Johnson subsidiaries Alza Corporation and Janssen Pharmaceutica Products in a Cook County Circuit Court, achieving a $16.5M jury verdict for the family of 38-year-old Janice DiCosolo, mother of three, who died while wearing the patch in 2004.

See also



  1. 1.0 1.1 Fentanyl: Incapacitating Agent. National Institute for Occupational Safety and Health. Emergency Response Database. August 22, 2008. Retrieved December 31, 2008.
  2. Barr Pharmaceuticals (2006-09-27). Barr Launches Generic ACTIQ(R) Cancer Pain Management Product. Press release. Retrieved on 2006-09-30.
  3. FTC (2004-08-09). With Conditions, FTC Allows Cephalon’s Purchase of CIMA, Protecting Competition for Breakthrough Cancer Pain Drugs. Press release. Retrieved on 2006-09-30.
  4. Fentanyl Transdermal Official FDA information, side effects and uses
  6. Smydo J. Delayed respiratory depression with fentanyl. Anesthesia Progress. 26(2):47-8, 1979
  7. van Leeuwen L. Deen L. Helmers JH. A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression. Anaesthesist. 30(8):397-9, 1981
  8. Brown DL. Postoperative analgesia following thoracotomy. Danger of delayed respiratory depression. Chest. 88(5):779-80, 1985.
  9. Bulow HH. Linnemann M. Berg H. Lang-Jensen T. LaCour S. Jonsson T. Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl. Acta Anaesthesiologica Scandinavica, 1995; 39(6): 835-9.
  10. Nilsson C. Rosberg B. Recurrence of respiratory depression following neurolept analgesia. Acta Anaesthesiologica Scandinavica. 26(3):240-1, 1982
  11. McLoughlin R. McQuillan R. Transdermal fentanyl and respiratory depression. Palliative Medicine, 1997; 11(5):419.
  12. Regnard C, Pelham A. Severe respiratory depression and sedation with transdermal fentanyl: four case studies. Palliative Medicine, 2003; 17: 714-716.
  13. Drug Safety Update, vol 2(2) September 2008 p2. Available online on
  14. New Anesthetic Agents, Devices, and Monitoring Techniques. URL accessed on 2007-10-20.
  15. [Boddiger, D. (2006, August 12). Fentanyl-laced street drugs “kill hundreds”. In in EBSCOhost. Retrieved March 7, 2007, from pdf?vid=8&hid=8&sid=e6bcbd34-2854-4beb-bfca-35460dd686e6%40sessionmgr7 ]
  16. Press Release by the Chicago Police Department Police report about a death linked to heroin/fentanyl mixture August 24, 2006
  17. SMU student's death blamed on rare drug
  18. Fentanyl probe nets 3 suspects by Norman Sinclair and Ronald J. Hansen, The Detroit News, June 23, 2006, retrieved June 25, 2006.
  22. Behind the Identification of China White Analytical Chemistry, 53(12), 1379A-1386A (1981)
  23. Van Bever W, Niemegeers C, Janssen P (1974). Synthetic analgesics. Synthesis and pharmacology of the diastereoisomers of N-(3-methyl-1-(2-phenylethyl)-4-piperidyl)-N-phenylpropanamide and N-(3-methyl-1-(1-methyl-2-phenylethyl)-4-piperidyl)-N-phenylpropanamide. J Med Chem 17 (10): 1047–51.

Further reading


  • Lehman, K. A., and D. Zech (eds) Transdermal Fentanyl: a new Approach to Prolonged Pain Control, Berlin; New York: Springer-Verlag (1991) ISBN 038754440


Agarwal, S., Polydefkis, M., Block, B., Haythornthwaite, J., & Raja, S. N. (2007). Transdermal fentanyl reduces pain and improves functional activity in neuropathic pain states: Pain Medicine Vol 8(7) Oct 2007, 554-562.

  • Ailawadhi, S., Sung, K. W., Carlson, L. A., & Baer, M. R. (2007). Serotonin syndrome caused by interaction between citalopram and fentanyl: Journal of Clinical Pharmacy and Therapeutics Vol 32(2) Apr 2007, 199-202.
  • Allan, L., Hays, H., Jensen, N.-H., Le Polain de Waroux, B., Bolt, M., Donald, R., et al. (2001). Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain: BMJ: British Medical Journal Vol 322(7295) May 2001, 1154.
  • Angst, M. S., & Clark, J. D. (2007). Comment on Koltzenburg et al.: Differential sensitivity of three experimental pain models in detecting the analgesic effects of transdermal fentanyl and buprenorphine. Pain 2006;126:165-74: Pain Vol 128(3) Apr 2007, 292-294.
  • Ayesta, F. J., Ableitner, A., Emmett-Oglesby, M. W., Herz, A., & et al. (1992). Paradoxical effect of chronic fentanyl treatment on naltrexone-induced supersensitivity and upregulation: Journal of Pharmacology and Experimental Therapeutics Vol 260(1) Jan 1992, 168-174.
  • Baad-Hansen, L., Juhl, G. I., Jensen, T. S., Brandsborg, B., & Svensson, P. (2007). Differential effect of intravenous S-ketamine and fentanyl on atypical odontalgia and capsaicin-evoked pain: Pain Vol 129(1-2) May 2007, 46-54.
  • Backonja, M.-M., & Gosnell, B. A. (1996). Analgesia and oral opioid consumption: Strengths and shortcomings of methods: Pain Vol 64(2) Feb 1996, 398-399.
  • Baker, M. L., Brockunier, L. L., Bagley, J. R., France, C. P., & et al. (1995). Fentanyl-related 4-heteroanilido piperidine OHM3295 augments splenic natural killer activity and induces analgesia through opioid receptor pathways: Journal of Pharmacology and Experimental Therapeutics Vol 274(3) Sep 1995, 1285-1292.
  • Bantutova, I., & Yakimova, K. (1991). Effect of narcotic analgesic agents on the central nervous system as an indicator of their toxicomanic potential: Farmakologiya i Toksikologiya Vol 54(1) Jan-Feb 1991, 21-23.
  • Barke, K. E., & Hough, L. B. (1993). Simultaneous measurement of opiate-induced histamine release in the periaqueductal gray and opiate antinociception: An in vivo microdialysis study: Journal of Pharmacology and Experimental Therapeutics Vol 266(2) Aug 1993, 934-942.
  • Baylon, G. J., Kaplan, H. L., Somer, G., Busto, U. E., & Sellers, E. M. (2000). Comparative abuse liability of intravenously administered remifentanil and fentanyl: Journal of Clinical Psychopharmacology Vol 20(6) Dec 2000, 597-606.
  • Beck, J., & Morgan, P. A. (1986). Designer drug confusion: A focus on MDMA: Journal of Drug Education Vol 16(3) 1986, 287-302.
  • Berliner, M. N., Giesecke, T., & Bornhovd, K. D. (2007). Impact of transdermal fentanyl on quality of life in rheumatoid arthritis: Clinical Journal of Pain Vol 23(6) Jul-Aug 2007, 530-534.
  • Bhimji, K. (2005). Opioid Rotation from Methadone: Fraught with Difficulties: Journal of Pain and Symptom Management Vol 29(4) Apr 2005, 334-335.
  • Borszcz, G. S., Johnson, C. P., & Fahey, K. A. (1994). Comparison of motor reflex and vocalization thresholds following systemically administered morphine, fentanyl, and diazepam in the rat: Assessment of sensory and performance variables: Pharmacology, Biochemistry and Behavior Vol 49(4) Dec 1994, 827-834.
  • Botschev, C., & Muller, N. (1991). Opiate receptor antagonists for delusions of parasitosis: Biological Psychiatry Vol 30(5) Sep 1991, 530-531.
  • Broadbear, J. H., Winger, G., & Woods, J. H. (2004). Self-administration of fentanyl, cocaine and ketamine: Effects on the pituitary-adrenal axis in rhesus monkeys: Psychopharmacology Vol 176(3-4) 2004, 398-406.
  • Broqua, P., Wettstein, J. G., Rocher, M.-N., Riviere, P. J. M., & Dahl, S. G. (1998). The discriminative stimulus properties of U50,488 and morphine are not shared by fedotozine: European Neuropsychopharmacology Vol 8(4) Dec 1998, 261-266.
  • Bruera, E., & Pereira, J. (1997). Acute neuropsychiatric findings in a patient receiving fentanyl for cancer pain: Pain Vol 69(1-2) Jan 1997, 199-201.
  • Bruijnzeel, A. W., Lewis, B., Bajpai, L. K., Morey, T. E., Dennis, D. M., & Gold, M. (2006). Severe deficit in brain reward function associated with fentanyl withdrawal in rats: Biological Psychiatry Vol 59(5) Mar 2006, 477-480.
  • Bruijnzeel, A. W., Marcinkiewcz, C., Isaac, S., Booth, M. M., Dennis, D. M., & Gold, M. S. (2007). The effects of buprenorphine on fentanyl withdrawal in rats: Psychopharmacology Vol 191(4) May 2007, 931-941.
  • Burton, A. W., Driver, L. C., Mendoza, T. R., & Syed, G. (2004). Oral Transmucosal Fentanyl Citrate in the Outpatient Management of Severe Cancer Pain Crises: Clinical Journal of Pain Vol 20(3) May-Jun 2004, 195-197.
  • Butelman, E. R., Harris, T. J., & Kreek, M. J. (2004). Antiallodynic Effects of Loperamide and Fentanyl against Topical Capsaicin-Induced Allodynia in Unanesthetized Primates: Journal of Pharmacology and Experimental Therapeutics Vol 311(1) Oct 2004, 155-163.
  • Butelman, E. R., Reed, B., Chait, B. T., Mandau, M., Yuferov, V., & Kreek, M. J. (2008). Limited effects of beta -endorphin compared to loperamide or fentanyl in a neuroendocrine biomarker assay in non-human primates: Psychoneuroendocrinology Vol 33(3) Apr 2008, 292-304.
  • Carter, B. L., Tiffany, S. T., & Conklin, C. A. (2000). Associative and non-associative fentanyl tolerance in the rat: Evaluation of cross tolerance with mu- and kappa-specific opioids: Psychopharmacology Vol 148(4) Mar 2000, 384-392.
  • Casey, K. L., Svensson, P., Morrow, T. J., Raz, J., Jone, C., & Minoshima, S. (2000). Selective opiate modulation of nociceptive processing in the human brain: Journal of Neurophysiology Vol 84(1) Jul 2000, 525-533.
  • Celerier, E., Laulin, J.-P., Larcher, A., Le Moal, M., & Simonnet, G. (1999). Evidence for opiate-activated NMDA processes masking opiate analgesia in rats: Brain Research Vol 847(1) Nov 1999, 18-25.
  • Cicero, T. J., Inciardi, J. A., & Surratt, H. (2007). Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States: Drug and Alcohol Dependence Vol 91(2-3) Dec 2007, 115-120.
  • Clarke, R. W., Parry-Baggott, C., Houghton, A. K., & Ogilvie, J. (1998). The involvement of bulbospinal pathways in fentanyl-induced inhibition of spinal withdrawal reflexes in the decerebrated rabbit: Pain Vol 78(3) Dec 1998, 197-207.
  • Clarke, R. W., & Ward, R. E. (2000). The role of 5-HT-sub(1A)-receptors in fentanyl-induced bulbospinal inhibition of a spinal withdrawal reflex in the rabbit: Pain Vol 85(1-2) Mar 2000, 239-245.
  • Cohen, P. J. (2006). Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis: Comments by Peter J. Cohen: Journal of Addictive Diseases Vol 25(4) 2006, 135-136.
  • Colpaert, F. C., Tarayre, J. P., Alliaga, M., Slot, L. A. B., Attal, N., & Koek, W. (2001). Opiate self-administration as a measure of chronic nociceptive pain in arthritic rats: Pain Vol 91(1-2) Mar 2001, 33-45.
  • Coluzzi, P. H., Schwartzberg, L., Conroy, J. D., Jr., Charapata, S., Gay, M., Busch, M. A., et al. (2001). Breakthrough cancer pain: A randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR): Pain Vol 91(1-2) Mar 2001, 123-130.
  • Comer, S. D., Burke, T. F., Lewis, J. W., & Woods, J. H. (1992). Clocinnamox: A novel, systemically-active, irreversible opioid antagonist: Journal of Pharmacology and Experimental Therapeutics Vol 262(3) Sep 1992, 1051-1056.
  • Coyne, P. J., Viswanathan, R., & Smith, T. J. (2002). Nebulized fentanyl citrate improves patients' perception of breathing, respiratory rate, and oxygen saturation in dyspnea: Journal of Pain and Symptom Management Vol 23(2) Feb 2002, 157-160.
  • Czirr, S. A., Hubbell, C. L., Milano, W. C., Frank, J. M., & et al. (1987). Selected opioids modify intake of sweetened ethanol solution among female rats: Alcohol Vol 4(3) May-Jun 1987, 157-160.
  • Davies, A. N., & Vriens, J. (2005). Oral Transmucosal Fentanyl Citrate and Xerostomia: Journal of Pain and Symptom Management Vol 30(6) Dec 2005, 496-497.
  • de Azevedo Focchi, G. R., & Scivoletto, S. (2000). Designer drugs: New drugs of abuse? : Jornal Brasileiro de Psiquiatria Vol 49(10-12) Oct-Dec 2000, 383-386.
  • de Vry, J., Koek, W., & Slangen, J. L. (1984). Effects of drug-induced differences in reinforcement frequency on discriminative stimulus properties of fentanyl: Psychopharmacology Vol 83(3) 1984, 257-261.
  • Dellemijn, P. L. I. (2001). Commentary: Tolerance to high dose transdermal fentanyl in a patient with neuropathic pain, a case report: European Journal of Pain Vol 5(3) 2001, 329-331.
  • Dellemijn, P. L. I. (2001). Opioids in non-cancer pain: A life-time sentence? : European Journal of Pain Vol 5(3) 2001, 333-339.
  • Dellemijn, P. L. I., van Duijn, H., & Vanneste, J. A. L. (1998). Prolonged treatment with transdermal fentanyl in neuropathic pain: Journal of Pain and Symptom Management Vol 16(4) Oct 1998, 220-229.
  • Denisco, R. A. (2006). Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis: Comments by Richard A. Denisco: Journal of Addictive Diseases Vol 25(4) 2006, 137.
  • Dickenson, A. H., Sullivan, A. F., & McQuay, H. J. (1990). Intrathecal etorphine, fentanyl and buprenorphine on spinal nociceptive neurones in the rat: Pain Vol 42(2) Aug 1990, 227-234.
  • Donner, B., Zenz, M., Strumpf, M., & Raber, M. (1998). Long-term treatment of cancer pain with transdermal fentanyl: Journal of Pain and Symptom Management Vol 15(3) Apr 1998, 168-175.
  • Donner, B., Zenz, M., Tryba, M., & Strumpf, M. (1996). Direct conversion from oral morphine to transdermal fentanyl: A multicenter study in patients with cancer pain: Pain Vol 64(3) Mar 1996, 527-534.
  • El Mouedden, M., & Meert, T. F. (2005). Evaluation of pain-related behavior, bone destruction and effectiveness of fentanyl, sufentanil, and morphine in a murine model of cancer pain: Pharmacology, Biochemistry and Behavior Vol 82(1) Sep 2005, 109-119.
  • Ellershaw, J. E., Kinder, C., Aldridge, J., Allison, M., & Smith, J. C. (2002). Care of the dying: Is pain control compromised or enhanced by continuation of the fentanyl transdermal patch in the dying phase: Journal of Pain and Symptom Management Vol 24(4) Oct 2002, 398-403.
  • Elsharrawy, E. A., & Elbaghdady, Y. M. (2007). A Double-Blind Comparison of a Supplemental Interligamentary Injection of Fentanyl and Mepivacaine with 1:200,000 Epinephrine for Irreversible Pulpitis: Journal of Pain and Symptom Management Vol 33(2) Feb 2007, 203-207.
  • Emmett-Oglesby, M. W., Shippenberg, T. S., & Herz, A. (1989). Fentanyl and morphine discrimination in rats continuously infused with fentanyl: Behavioural Pharmacology Vol 1(1) Fal 1989, 3-11.
  • Farrar, J. T., Portenoy, R. K., Berlin, J. A., Kinman, J. L., & Strom, B. L. (2000). Defining the clinically important difference in pain outcome measures: Pain Vol 88(3) Dec 2000, 287-294.
  • Fine, P. G., & Streisand, J. B. (1998). A Review of Oral Transmucosal Fentanyl Citrate: Potent, Rapid and Noninvasive Opioid Analgesia: Journal of Palliative Medicine Vol 1(1) Mar 1998, 55-63.
  • Finlay, J. M., Jakubovic, A., Phillips, A. G., & Fibiger, H. C. (1988). Fentanyl-induced conditional place preference: Lack of associated conditional neurochemical events: Psychopharmacology Vol 96(4) Dec 1988, 534-540.
  • France, C. P., Ahn, S. C., Brockunier, L. L., Bagley, J. R., Brandt, M. R., Winsauer, P. J., et al. (1998). Behavioral effects and binding affinities of the fentanyl derivative OHM3507: Pharmacology, Biochemistry and Behavior Vol 59(2) Feb 1998, 295-303.
  • France, C. P., Gerak, L. R., Flynn, D., Winger, G. D., & et al. (1995). Behavioral effects and receptor binding affinities of fentanyl derivatives in rhesus monkeys: Journal of Pharmacology and Experimental Therapeutics Vol 274(1) Jul 1995, 17-28.
  • France, C. P., Winger, G., Medzihradsky, F., Seggel, M. R., & et al. (1991). Mirfentanil: Pharmacological profile of a novel fentanyl derivative with opioid and nonopioid effects: Journal of Pharmacology and Experimental Therapeutics Vol 258(2) Aug 1991, 502-510.
  • Franchi, S., Panerai, A. E., & Sacerdote, P. (2007). Buprenorphine ameliorates the effect of surgery on hypothalamus--pituitary--adrenal axis, natural killer cell activity and metastatic colonization in rats in comparison with morphine or fentanyl treatment: Brain, Behavior, and Immunity Vol 21(6) August 2007, 767-774.
  • Frecska, E., Arato, M., Banki, C. M., Mohari, K., & et al. (1989). Prolactin response to fentanyl in depression: Biological Psychiatry Vol 25(6) Mar 1989, 692-696.
  • Frecska, E., Perenyi, A., & Arato, M. (2003). Blunted prolactin response to fentanyl in depression. Normalizing effect of partial sleep deprivation: Psychiatry Research Vol 118(2) May 2003, 155-164.
  • Gaitan, G., & Herrero, J. F. (2005). Subanalgesic doses of dexketoprofen and HCT-2037 (nitrodexketoprofen) enhance fentanyl antinociception in monoarthritic rats: Pharmacology, Biochemistry and Behavior Vol 80(2) Feb 2005, 327-332.
  • Gardner-Nix, J. (2001). Caregiver toxicity from transdermal fentanyl: Journal of Pain and Symptom Management Vol 21(6) Jun 2001, 447-448.
  • Gardner-Nix, J. (2001). Oral transmucosal fentanyl and sufentanil for incident pain: Journal of Pain and Symptom Management Vol 22(2) Aug 2001, 627-630.
  • Gauthier, C. A., Gerak, L. R., Bagley, J. R., Brockunier, L. L., & France, C. P. (1998). The rate-decreasing effects of fentanyl derivatives in pigeons before, during and after chronic morphine treatment: Psychopharmacology Vol 137(1) May 1998, 67-73.
  • Gentle, M. J., Hocking, P. M., Bernard, R., & Dunn, L. N. (1999). Evaluation of intraarticular opioid analgesia for the relief of articular pain in the domestic fowl: Pharmacology, Biochemistry and Behavior Vol 63(2) Jun 1999, 339-343.
  • Ginsberg, B., Gil, K. M., Muir, M., Sullivan, F., & et al. (1995). The influence of lockout intervals and drug selection on patient-controlled analgesia following gynecological surgery: Pain Vol 62(1) Jul 1995, 95-100.
  • Giron, R., Abalo, R., Goicoechea, C., Martin, M. I., Callado, L. F., Cano, C., et al. (2002). Synthesis and opioid activity of new fentanyl analogs: Life Sciences Vol 71(9) Jul 2002, 1023-1034.
  • Gold, M. S., Kolodner, D., Logan, D., & Goldberger, B. A. (2006). Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis: Response by Mark Gold et al: Journal of Addictive Diseases Vol 25(4) 2006, 141-144.
  • Gold, M. S., Melker, R. J., Dennis, D. M., Morey, T. E., Bajpai, L. K., Pomm, R., et al. (2006). Fentanyl Abuse and Dependence: Further Evidence for Second Hand Exposure Hypothesis: Journal of Addictive Diseases Vol 25(1) 2006, 15-21.
  • Gorman, E. (2006). Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis: Comments by Eugene Gorman: Journal of Addictive Diseases Vol 25(4) 2006, 139-140.
  • Gracely, R. H., & Dubner, R. (1987). Reliability and validity of verbal descriptor scales of painfulness: Pain Vol 29(2) May 1987, 175-185.
  • Grass, J. A. (1992). Fentanyl: Clinical use as postoperative analgesic: Epidural/intrathecal route: Journal of Pain and Symptom Management Vol 7(7) Oct 1992, 419-430.
  • Greenwald, M. K., & Roehrs, T. A. (2005). Mu-opioid Self-Administration vs Passive Administration in Heroin Abusers Produces Differential EEG Activation: Neuropsychopharmacology Vol 30(1) Jan 2005, 212-221.
  • Greiner, W., Lehmann, K., Earnshaw, S., Bug, C., & Sabatowski, R. (2006). Economic evaluation of durogesic in moderate to severe, nonmalignant, chronic pain in Germany: The European Journal of Health Economics Vol 7(4) Dec 2006, 290-296.
  • Grond, S., Zech, D., Lehmann, K. A., Radbruch, L., & et al. (1997). 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 Vol 69(1-2) Jan 1997, 191-198.
  • Haazen, L., Noorduin, H., Megens, A., & Meert, T. (1999). The constipation-inducing potential of morphine and transdermal fentanyl: European Journal of Pain Vol 3(Suppl1) 1999, 9-15.
  • Haeseler, G., Foadi, N., Ahrens, J., Dengler, R., Hecker, H., & Leuwer, M. (2006). Tramadol, fentanyl and sufentanil but not morphine block voltage-operated sodium channels: Pain Vol 126(1-3) Dec 2006, 234-244.
  • Hashimoto, M., Johkura, K., Ichikawa, T., Kojima, A., Nishimura, S., & Shinonaga, M. (2008). Conservative treatment of ruptured vertebrobasilar dissecting aneurysm: Neurological Sciences Vol 29(4) Sep 2008, 241-244.
  • Heapy, A., Sellinger, J., Higgins, D., Chatkoff, D., Bennett, T. C., & Kerns, R. D. (2007). Using interactive voice response to measure pain and quality of life: Pain Medicine Vol 8(Suppl 3) Oct 2007, S145-S154.
  • Herbst, L. H., & Strause, L. G. (1992). Transdermal fentanyl use in hospice home-care patients with chronic cancer pain: Journal of Pain and Symptom Management Vol 7(3, Suppl) Apr 1992, S54-S57.
  • Heurich, M., Mousa, S. A., Lenzner, M., Morciniec, P., Kopf, A., Welte, M., et al. (2007). Influence of pain treatment by epidural fentanyl and bupivacaine on homing of opioid-containing leukocytes to surgical wounds: Brain, Behavior, and Immunity Vol 21(5) Jul 2007, 544-552.
  • Hoehe, M. R. (1988). Influence of the menstrual cycle on neuroendocrine and behavioral responses to an opiate agonist in humans: Preliminary results: Psychoneuroendocrinology Vol 13(4) 1988, 339-344.
  • Hoehe, M. R., & Doenicke, A. (1988). Human studies on the !m opiate receptor agonist Fentanyl: Neuroendocrine and behavioral responses: Psychoneuroendocrinology Vol 13(5) 1988, 397-408.
  • Hoehe, M. R., & Duka, T. (1993). Opiates increase plasma catecholamines in humans: Psychoneuroendocrinology Vol 18(2) 1993, 141-148.
  • Hoffmann, V. L. H., Baker, A. K., Vercauteren, M. P., Adriaensen, H. F., & Meert, T. F. (2003). Epidural ketamine potentiates epidural morphine but not fentanyl in acute nociception in rats: European Journal of Pain Vol 7(2) Apr 2003, 121-130.
  • Horvath, G., Szikszay, M., Rubicsek, G., & Benedek, G. (1992). An isobolographic analysis of the hypnotic effects of combinations of dexmedetomidine with fentanyl or diazepam in rats: Life Sciences Vol 50(23) 1992, PL215-PL220.
  • Inoue, M., Ates, N., Vossen, J. M. H., & Coenen, A. M. L. (1994). Effects of the neuroleptanalgesic fentanyl-fluanisone (hypnorm) on spike-wave discharges in epileptic rats: Pharmacology, Biochemistry and Behavior Vol 48(2) Jun 1994, 547-551.
  • Jaakola, M.-L., Salonen, M., Lehtinen, R., & Scheinin, H. (1991). The analgesic action of dexmedetomidine--a novel !a-sub-2-adrenoceptor agonist--in healthy volunteers: Pain Vol 46(3) Sep 1991, 281-285.
  • Jacobson, L., Chabal, C., Brody, M. C., Mariano, A. J., & et al. (1990). A comparison of the effects of intrathecal fentanyl and lidocaine on established postamputation stump pain: Pain Vol 40(2) Feb 1990, 137-141.
  • Johnson, S., & Faull, C. (1997). The absence of "cross-tolerance" when switching from oral morphine to transdermal fentanyl: Palliative Medicine Vol 11(6) Nov 1997, 494-495.
  • Johnson, S., & Faull, C. (1998). "The absence of 'cross-tolerance' when switching from oral morphine to transdermal fentanyl": Erratum: Palliative Medicine Vol 12(2) Mar 1998, 74.
  • Katz, J., Kavanagh, B. P., & Sandler, A. N. (1992). Does pre-operative fentanyl administration influence postoperative analgesia? : Pain Vol 51(1) Oct 1992, 123-124.
  • Kayser, V., Gobeaux, D., Lombard, M. C., Guilbaud, G., & et al. (1990). Potent and long lasting antinociceptive effects after injection of low doses of a mu-opioid receptor agonist, fentanyl, into the brachial plexus sheath of the rat: Pain Vol 42(2) Aug 1990, 215-225.
  • Khantzian, E. J. (1995). Alcoholics Anonymous--Cult or corrective: A case study: Journal of Substance Abuse Treatment Vol 12(3) May-Jun 1995, 157-165.
  • Kiss, I. E., & Kilian, M. (1992). "Does pre-operative fentanyl administration influence postoperative analgesia?": Reply: Pain Vol 51(1) Oct 1992, 124.
  • Klein, L. C. (2001). Effects of adolescent nicotine exposure on opioid consumption and neuroendocrine response in adult male and female rats: Experimental and Clinical Psychopharmacology Vol 9(3) Aug 2001, 251-261.
  • Klein, L. C., Popke, E. J., & Grunberg, N. E. (1997). Sex differences in effects of predictable and unpredictable footshock on fentanyl self-administration in rats: Experimental and Clinical Psychopharmacology Vol 5(2) May 1997, 99-106.
  • Koek, W., Colpaert, F. C., & Vignon, J. (1993). Effects of phencyclidine-type drugs in rats discriminating fentanyl from saline: Pharmacological and behavioral characterization of intermediate levels of drug lever selection: Journal of Pharmacology and Experimental Therapeutics Vol 264(2) Feb 1993, 746-756.
  • Koltzenburg, M., Pokorny, R., Gasser, U. E., & Richarz, U. (2006). Differential sensitivity of three experimental pain models in detecting the analgesic effects of transdermal fentanyl and buprenorphine: Pain Vol 126(1-3) Dec 2006, 165-174.
  • Komurcu, S., Turhal, S., Altundag, K., Atahan, L., Turna, H. S., Manavoglu, O., et al. (2007). Safety and efficacy of transdermal fentanyl in patients with cancer pain: Phase IV, Turkish oncology group trial: European Journal of Cancer Care Vol 16(1) Jan 2007, 67-73.
  • Kongsgaard, U. E., & Poulain, P. (1998). Transdermal fentanyl for pain control in adults with chronic cancer pain: European Journal of Pain Vol 2(1) 1998, 53-62.
  • Korte, W. (1996). Day-to-day titration to initiate transdermal fentanyl in patients with cancer pain: Short- and long-term experiences in a prospective study of 39 patients: Journal of Pain and Symptom Management Vol 11(3) Apr 1996, 139-146.
  • Kouvaras, E., Asprodini, E. K., Asouchidou, I., Vasilaki, A., Kilindris, T., Michaloudis, D., et al. (2008). Fentanyl treatment reduces GABAergic inhibition in the CA1 area of the hippocampus 24 h after acute exposure to the drug: Neuropharmacology Vol 55(7) Dec 2008, 1172-1182.
  • Krivan, M., Szabo, G., Sarnyai, Z., Kovacs, G. L., & et al. (1995). Oxytocin blocks the development of heroin-fentanyl cross-tolerance in mice: Pharmacology, Biochemistry and Behavior Vol 52(3) Nov 1995, 591-594.
  • Kupers, R., & Gybels, J. (1995). The consumption of fentanyl is increase in rats with nociceptive but not with neuropathic pain: Pain Vol 60(2) Feb 1995, 137-141.
  • Kupers, R. C., & Gybels, J. M. (1996). On "strengths and shortcomings": Reply to the letter by Backonja and Gosnell: Pain Vol 64(2) Feb 1996, 399-401.
  • Larson, M. D. (2008). Mechanism of opioid-induced pupillary effects: Clinical Neurophysiology Vol 119(6) Jun 2008, 1358-1364.
  • Lawrie, l., Lloyd-Williams, M., & Waterhouse, E. (2003). Breakthrough strong opioid analgesia prescription in patients using transdermal fentanyl admitted to a hospice: American Journal of Hospice & Palliative Care Vol 20(3) May-Jun 2003, 229-230.
  • Lembo, T., Naliboff, B. D., Matin, K., Munakata, J., Parker, R. A., Gracely, R. H., et al. (2000). Irritable bowel syndrome patients show altered sensitivity to exogenous opioids: Pain Vol 87(2) Aug 2000, 137-147.
  • Liappas, I. A., Dimopoulos, N. P., Mellos, E., Gitsa, O. E., Liappas, A. I., & Rabavilas, A. D. (2004). Oral transmucosal abuse of transdermal fentanyl: Journal of Psychopharmacology Vol 18(2) Jun 2004, 277-280.
  • Lin, K.-C., Chou, W.-Y., Wang, C.-H., Concejero, A., Yang, C. H., Cheng, K.-W., et al. (2006). A comparison of the relative effectiveness of intravenous patient controlled-analgesia delivered morphine and morphine with fentanyl: The Pain Clinic Vol 18(3) 2006, 213-217.
  • Luks, A. M., Zwass, M. S., Brown, R. C., Lau, M., Chari, G., & Fisher, D. M. (1998). Opioid-induced analgesia in neonatal dogs: Pharmacodynamic differences between morphine and fentanyl: Journal of Pharmacology and Experimental Therapeutics Vol 284(1) Jan 1998, 136-141.
  • MacDonald, N. (1993). "The use of transdermal fentanyl in a six-year-old patient with neuroblastoma and diffuse abdominal pain": Commentary: Journal of Pain and Symptom Management Vol 8(5) Jul 1993, 320-321.
  • Marinangeli, F., Ciccozzi, A., Aloisio, L., Colangeli, A., Paladini, A., Bajocco, C., et al. (2007). Improved cancer pain treatment using combined fentanyl-TTS and tramadol: Pain Practice Vol 7(4) Dec 2007, 307-312.
  • Matsuura, N., Shibukawa, Y., Kato, M., Ichinohe, T., Suzuki, T., & Kaneko, Y. (2008). Ketamine, not fentanyl, suppresses pain-related magnetic fields associated with trigeminally innervated area following CO-sub-2 laser: Neuroscience Research Vol 62(2) Oct 2008, 105-111.
  • Matussek, N., & Hoehe, M. (1989). Investigations with the specific !m-opiate receptor agonist fentanyl in depressive patients: Growth hormone, prolactin, cortisol, noradrenaline and euphoric responses: Neuropsychobiology Vol 21(1) Sep 1989, 1-8.
  • Maves, T. J., & Barcellos, W. A. (1992). Management of cancer pain with transdermal fentanyl: Phase IV trial, University of Iowa: Journal of Pain and Symptom Management Vol 7(3, Suppl) Apr 1992, S58-S62.
  • McDaid, C. M., Lewis, S. A., McMurray, T., & Phillips, S. A. (1994). Heart surgery: What are the neuropsychological consequences? : Irish Journal of Psychology Vol 15(1) 1994, 110-125.
  • McNamara, P. (2002). Opioid switching from morphine to transdermal fentanyl for toxicity reduction in palliative care: Palliative Medicine Vol 16(5) Sep 2002, 425-434.
  • Meert, T. F., Awouters, F., Niemegeers, C. J., Schellekens, K. H., & et al. (1991). Ritanserin reduces abuse of alcohol, cocaine, and fentanyl in rats: Pharmacopsychiatry Vol 24(5) Sep 1991, 159-163.
  • Meijer, J. H., Ruijs, A. C. J., Albus, H., van de Geest, B., Duindam, H., Zwinderman, A. H., et al. (2000). Fentanyl, a upsilon -opioid receptor agonist, phase shifts the hamster cicadian pacemaker: Brain Research Vol 868(1) Jun 2000, 135-140.
  • Menefee, L. A., Frank, E. D., Crerand, C., Jalali, S., Park, J., Sanschagrin, K., et al. (2004). The Effects of Transdermal Fentanyl on Driving, Cognitive Performance, and Balance in Patients with Chronic Nonmalignant Pain Conditions: Pain Medicine Vol 5(1) Mar 2004, 42-49.
  • Mercadante, S., Porzio, G., Ferrera, P., Fulfaro, F., Aielli, F., Verna, L., et al. (2008). Sustained-release oral morphine versus transdermal fentanyl and oral methadone in cancer pain management: European Journal of Pain Vol 12(8) Nov 2008, 1040-1046.
  • Mercadante, S., & Villari, P. (2001). Clinical problems with transdermal fentanyl titration from 25 to 50 mu g/hr: Journal of Pain and Symptom Management Vol 21(6) Jun 2001, 448-449.
  • Milligan, K., Lanteri-Minet, M., Borchert, K., Helmers, H., Donald, R., Kress, H.-G., et al. (2001). Evaluation of long-term efficacy and safety of transdermal fentanyl in the treatment of chronic noncancer pain: The Journal of Pain Vol 2(4) Aug 2001, 197-204.
  • Milligan, K. A. (2002). "Evaluation of long-term safety and efficacy of transdermal fentanyl in the treatment of chronic noncancer pain": Reply: The Journal of Pain Vol 3(1) Feb 2002, 66.
  • Minkowitz, H. S., Rathmell, J. P., Vallow, S., Gargiulo, K., Damaraju, C. V., & Hewitt, D. J. (2007). Efficacy and safety of the fentanyl iontophoretic transdermal system (ITS) and intravenous patient-controlled analgesia (IV PCA) with morphine for pain management following abdominal or pelvic surgery: Pain Medicine Vol 8(8) Nov 2007, 657-668.
  • Morgan, A. D., Campbell, U. C., Fons, R. D., & Carroll, M. E. (2002). Effects of agmatine on the escalation of intravenous cocaine and fentanyl self-administration in rats: Pharmacology, Biochemistry and Behavior Vol 72(4) Jul 2002, 873-880.
  • Morii, H., Chiba, M., Konishi, H., Endo, Y., & Yamaji, A. (2007). Failure of Pain Control Using Transdermal Fentanyl During Rifampicin Treatment: Journal of Pain and Symptom Management Vol 33(1) Jan 2007, 5-6.
  • Morita, T., Shishido, H., Tei, Y., Inoue, S., & Nagayama, K. (2004). Neuroleptic Malignant Syndrome after Haloperidol and Fentanyl Infusion in a Patient with Cancer with Severe Mineral Imbalance: Journal of Palliative Medicine Vol 7(6) Dec 2004, 861-864.
  • Morita, T., Takigawa, C., Onishi, H., Tajima, T., Tani, K., Matsubara, T., et al. (2005). Opioid Rotation from Morphine to Fentanyl in Delirious Cancer Patients: An Open-Label Trial: Journal of Pain and Symptom Management Vol 30(1) Jul 2005, 96-103.
  • Mystakidou, K., Parpa, E., Tsilika, E., Katsouda, E., Kouloulias, V., Kouvaris, J., et al. (2004). Pain management of cancer patients with transdermal Fentanyl: A study of 1828 Step I, II, & III transfers: The Journal of Pain Vol 5(2) Mar 2004, 119-132.
  • Mystakidou, K., Parpa, E., Tsilika, E., Katsouda, E., Kouloulias, V., Kouvaris, J., et al. (2004). "Pain Management of Cancer Patients with Transdermal Fentanyl: A Study of 1828 Step I, II, and III Transfers" : Erratum: The Journal of Pain Vol 5(9) Nov 2004, 528.
  • Narita, M., Imai, S., Itou, Y., Yajima, Y., & Suzuki, T. (2002). Possible involvement of mu -sub-1-opioid receptors in the fentanyl- or morphine-induced antinociception at supraspinal and spinal sites: Life Sciences Vol 70(20) Apr 2002, 2341-2354.
  • Negus, S. S., Morgan, D., Cook, C. D., & Picker, M. J. (1996). Effects of the delta opioid agonist BW373U86 in pigeons trained to discriminate fentanyl, bremazocine and water in a three-choice drug discrimination procedure: Psychopharmacology Vol 126(3) Aug 1996, 199-205.
  • Newshan, G., & Lefkowitz, M. (2001). Transdermal fentanyl for chronic pain in AIDS: A pilot study: Journal of Pain and Symptom Management Vol 21(1) Jan 2001, 69-77.
  • Nugent, M., Davis, C., Brooks, D., & Ahmedzai, S. H. (2001). Long-term observations of patients receiving transdermal fentanyl after a randomized trial: Journal of Pain and Symptom Management Vol 21(5) May 2001, 385-391.
  • Okon, T. R., & George, M. L. (2008). Fentanyl-induced neurotoxicity and paradoxic pain: Journal of Pain and Symptom Management Vol 35(3) Mar 2008, 327-333.
  • Pain, L., Oberling, P., Mainsongeon, M., Moulinoux, J.-P., & Simonnet, G. (2008). Delayed aversive effects of high-dose fentanyl prevention by a polyamine-deficient diet: Behavioural Brain Research Vol 190(1) Jun 2008, 119-123.
  • Paix, A., Coleman, A., Lees, J., Grigson, J., & et al. (1995). Subcutaneous fentanyl and sufentanil infusion substitution for morphine intolerance in cancer pain management: Pain Vol 63(2) Nov 1995, 263-269.
  • Patt, R. B. (1993). "The use of transdermal fentanyl in a six-year-old patient with neuroblastoma and diffuse abdominal pain": Response: Journal of Pain and Symptom Management Vol 8(5) Jul 1993, 322-323.
  • Patt, R. B., Lustik, S., & Litman, R. S. (1993). The use of transdermal fentanyl in a six-year-old patient with neuroblastoma and diffuse abdominal pain: Journal of Pain and Symptom Management Vol 8(5) Jul 1993, 317-319.
  • Perez, J., Jimenez, M.-J., Fita, G., Rovira, I., Catalan, M., & Gomar, C. (2007). Epidural methadone for acute post-thoracotomy pain: An alternative to a ropivacaine plus fentanyl-based patient-controlled epidural regimen: Acute Pain Vol 9(4) Dec 2007, 193-199.
  • Picker, M. J., Negus, S. S., & Dykstra, L. A. (1989). Opioid-like discriminative stimulus properties of benzomorphans in the pigeon: Stereospecificity and differential substitution patterns: Life Sciences Vol 45(18) 1989, 1637-1645.
  • Picker, M. J., Smith, M. A., & Morgan, D. (1994). Assessment of the relative intrinsic efficacy of profadol and meperidine in a pigeon drug discrimination procedure: Relevance to partial substitution patterns: Behavioural Pharmacology Vol 5(1) Feb 1994, 61-70.
  • Portenoy, R. K., Taylor, D., Messina, J., & Tremmel, L. (2006). A Randomized, Placebo-controlled Study of Fentanyl Buccal Tablet for Breakthrough Pain in Opioid-treated Patients with Cancer: Clinical Journal of Pain Vol 22(9) Nov-Dec 2006, 805-811.
  • Price, D. D., Harkins, S. W., Rafii, A., & Price, C. (1986). Simultaneous comparison of fentanyl's analgesic effects on experimental and clinical pain: Pain Vol 24(2) Feb 1986, 197-205.
  • Radbruch, L., Sabatowski, R., Petzke, F., Brunsch-Radbruch, A., Grond, S., & Lehmann, K. A. (2001). Transdermal fentanyl for the management of cancer pain: A survey of 1005 patients: Palliative Medicine Vol 15(4) Jul 2001, 309-321.
  • Redwine, K., & Trujillo, K. A. (2003). Effects of NMDA receptor antagonists on acute mu -opioid analgesia in the rat: Pharmacology, Biochemistry and Behavior Vol 76(2) Sep 2003, 361-372.
  • Regnard, C., & Pelham, A. (2003). Severe respiratory depression and sedation with transdermal fentanyl: Four case studies: Palliative Medicine Vol 17(8) Nov 2003, 714-716.
  • Rodrigues, A. R. A., Castro, M. S. A., Francischi, J. N., Perez, A. C., & Duarte, l. D. G. (2005). Participation of ATP-sensitive K-super(+) channels in the peripheral antinociceptive effect of fentanyl in rats: Brazilian Journal of Medical and Biological Research Vol 38(1) Jan 2005, 91-97.
  • Roerig, S. C., Hoffman, R. G., Takemori, A. E., Wilcox, G. L., & et al. (1991). Isobolographic analysis of analgesic interactions between intrathecally and intracerebroventricularly administered fentanyl, morphine and D-Ala-2-D-Leu-5-enkephalin in morphine-tolerant and nontolerant mice: Journal of Pharmacology and Experimental Therapeutics Vol 257(3) Jun 1991, 1091-1099.
  • Sandler, A. N. (1997). Transdermal fentanyl for pain relief: Guidelines for appropriate use: CNS Drugs Vol 7(6) Jun 1997, 442-451.
  • Sansom, A. J., Smith, P. F., & Darlington, C. L. (1996). Fentazin anesthesia for labyrinthine surgery in guinea pigs: Journal of Vestibular Research: Equilibrium & Orientation Vol 6(1) Jan-Feb 1996, 49-52.
  • Schneider, U., Bevilacqua, C., Jacobs, R., Karst, M., Dietrich, D. E., Becker, H., et al. (1999). Effects of fentanyl and low doses of alcohol on neuropsychological performance in healthy subjects: Neuropsychobiology Vol 39(1) Jan 1999, 38-43.
  • Schofferman, J. (2002). "Evaluation of long-term efficacy and safety of transdermal fentanyl in the treatment of chronic noncancer pain": Comment: The Journal of Pain Vol 3(1) Feb 2002, 65.
  • Shaham, Y. (1993). Immobilization stress-induced oral opioid self-administration and withdrawal in rats: Role of conditioning factors and the effect of stress on "relapse" to opioid drugs: Psychopharmacology Vol 111(4) Jul 1993, 477-485.
  • Shaham, Y., Alvares, K., Nespor, S. M., & Grunberg, N. E. (1992). Effect of stress on oral morphine and fentanyl self-administration in rats: Pharmacology, Biochemistry and Behavior Vol 41(3) Mar 1992, 615-619.
  • Shaham, Y., Klein, L. C., Alvares, K., & Grunberg, N. E. (1993). Effect of stress on oral fentanyl consumption in rats in an operant self-administration paradigm: Pharmacology, Biochemistry and Behavior Vol 46(2) Oct 1993, 315-322.
  • Shippenberg, T. S., Emmett-Oglesby, M. W., Ayesta, F. J., & Herz, A. (1988). Tolerance and selective cross-tolerance to the motivational effects of opioids: Psychopharmacology Vol 96(1) Sep 1988, 110-115.
  • Shomaker, T. S., Zhang, J., & Ashburn, M. A. (2000). Assessing the impact of heat on the systemic delivery of fentanyl through the Transdermal Fentanyl Delivery System: Pain Medicine Vol 1(3) Sep 2000, 225-230.
  • Siegel, S., & Kim, J. A. (2000). Absence of cross-tolerance and the situational specificity of tolerance: Palliative Medicine Vol 14(1) Jan 2000, 75-77.
  • Silsby, H. D., Kruzich, D. J., & Hawkins, M. R. (1984). Fentanyl citrate abuse among health care professionals: Military Medicine Vol 149(4) Apr 1984, 227-228.
  • Simpson, D. M., Messina, J., Xie, F., & Hale, M. (2007). Fentanyl buccal tablet for the relief of breakthrough pain in opioid-tolerant adult patients with chronic neuropathic pain: A multicenter, randomized, double-blind, placebo-controlled study: Clinical Therapeutics: The International Peer-Reviewed Journal of Drug Therapy Vol 29(4) Apr 2007, 588-601.
  • Singer, M., & Noonan, K. R. (1993). Continuous intravenous infusion of fentanyl: Case reports of use in patients with advanced cancer and intractable pain: Journal of Pain and Symptom Management Vol 8(4) May 1993, 215-220.
  • Sirohi, S., Dighe, S. V., Walker, E. A., & Yoburn, B. C. (2008). The analgesic efficacy of fentanyl: Relationship to tolerance and mu -opioid receptor regulation: Pharmacology, Biochemistry and Behavior Vol 91(1) Nov 2008, 115-120.
  • Sloan, P. A., Moulin, D. E., & Hays, H. (1998). A clinical evaluation of transdermal therapeutic system fentanyl for the treatment of cancer pain: Journal of Pain and Symptom Management Vol 16(2) Aug 1998, 102-111.
  • Slover, R. (1992). Transdermal fentanyl: Clinical trial at the University of Colorado Health Sciences Center: Journal of Pain and Symptom Management Vol 7(3, Suppl) Apr 1992, S45-S47.
  • Soares, L. G. L., Martins, M., & Uchoa, R. (2003). Intravenous Fentanyl for Cancer Pain: A "Fast Titration" Protocol for the Emergency Room: Journal of Pain and Symptom Management Vol 26(3) Sep 2003, 876-881.
  • Stimmel, B. (2006). Editor's Note: Journal of Addictive Diseases Vol 25(4) 2006, 133.
  • Sutters, K. A., Levine, J. D., Dibble, S., Savedra, M., & et al. (1995). Analgesic efficacy and safety of single-dose intramuscular ketorolac for postoperative pain management in children following tonsillectomy: Pain Vol 61(1) Apr 1995, 145-153.
  • Tang, Q.-p., Ma, X., Liao, Q., & Cheng, Y.-h. (2008). The correlation between COMT polymorphisms, preoperative anxiety and postoperative fentanyl dose: Chinese Journal of Clinical Psychology Vol 16(3) Jun 2008, 321-323.
  • Taylor, D. R., Webster, L. R., Chun, S. Y., Reinking, J., Stegman, M., Shoemaker, S., et al. (2007). Impact of Breakthrough Pain on Quality of Life in Patients with Chronic, Noncancer Pain: Patient Perceptions and Effect of Treatment with Oral Transmucosal Fentanyl Citrate (OTFCReg., ACTIQReg.): Pain Medicine Vol 8(3) Apr 2007, 281-288.
  • Tennant, F., & Hermann, L. (2002). Self-treatment with oral transmucosal fentanyl citrate to prevent emergency room visits for pain crises: Patient self-reports of efficacy and utility: Journal of Pain & Palliative Care Pharmacotherapy Vol 16(3) 2002, 37-44.
  • Theiler, R., Alon, E., Brugger, S., Ljutow, A., Mietzsch, T., Muller, D., et al. (2007). Evaluation of a standardized Internet-based and telephone-based patient monitoring system for pain therapy with transdermal fentanyl: Clinical Journal of Pain Vol 23(9) Nov-Dec 2007, 804-811.
  • Thornton, S. R., Lohmann, A. B., Nicholson, R. A., & Smith, F. L. (2000). Fentanyl self-administration in juvenile rats that were tolerant and dependent to fentanyl as infants: Pharmacology, Biochemistry and Behavior Vol 65(3) Mar 2000, 563-570.
  • Twersky, R. S., Lebovits, A., Williams, C., & Sexton, T. R. (1995). Ketorolac versus fentanyl for postoperative pain management in outpatients: Clinical Journal of Pain Vol 11(2) Jun 1995, 127-133.
  • Twycross, R. G. (1999). Palliative care in the past decade and today: European Journal of Pain Vol 3(Suppl1) 1999, 23-29.
  • van Rijswijk, R., & van Guldener, C. (2006). A Delirious Patient with Opioid Intoxication After Chewing a Fentanyl Patch: Journal of the American Geriatrics Society Vol 54(8) Aug 2006, 1298-1299.
  • Vielvoye-Kerkmeer, A. P. E., Mattern, C., & Uitendaal, M. P. (2000). Transdermal fentanyl in opioid-naive cancer pain patients: An open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naive patients and a group using codeine: Journal of Pain and Symptom Management Vol 19(3) Mar 2000, 185-192.
  • Vielvoye-Kerkmeer, A. P. E., & van der Weide, M. (2001). Reversible delirium during opioid switching: Journal of Pain and Symptom Management Vol 22(2) Aug 2001, 635-636.
  • Viscusi, E. R., Reynolds, L., Chung, F., Atkinson, L. E., & Khanna, S. (2004). Patient-Controlled Transdermal Fentanyl Hydrochloride vs Intravenous Morphine Pump for Postoperative Pain: A Randomized Controlled Trial: JAMA: Journal of the American Medical Association Vol 291(11) Mar 2004, 1333-1341.
  • Vitale, M. A., Chen, D., & Kanarek, R. B. (2003). Chronic access to a sucrose solution enhances the development of conditioned place preferences for fentanyl and amphetamine in male Long-Evans rats: Pharmacology, Biochemistry and Behavior Vol 74(3) Feb 2003, 529-539.
  • Wang, C., Chakrabarti, M. K., & Whitwam, J. G. (1993). Synergism between the antinociceptive effects of intrathecal midazolam and fentanyl on both A !d and C somatosympathetic reflexes: Neuropharmacology Vol 32(3) Mar 1993, 303-305.
  • Welsh, J., Reid, A., Graham, J., Curto, J., MacLeod, K., & O'Neill, C. (2005). Physicians' knowledge of transdermal fentanyl: Palliative Medicine Vol 19(1) Jan 2005, 9-16.
  • Wettstein, J. G., & Martin, W. R. (1985). An analysis of naltrexone and naloxone's possible agonistic actions in the dog: Drug and Alcohol Dependence Vol 15(4) Aug 1985, 353-360.
  • Wilson, K. M., Schneider, J. J., & Ravenscroft, P. J. (1998). Stability of midazolam and fentanyl in infusion solutions: Journal of Pain and Symptom Management Vol 16(1) Jul 1998, 52-58.
  • Womer, D. E., & Shannon, H. E. (2000). Pharmacologic reversal of pertussis toxin-induced thermal allodynia in mice: Neuropharmacology Vol 39(10) Jul 2000, 1732-1739.
  • Worrich, S., Schuler, G., & Janicki, P. K. (2007). Effect of Local Administration of Transdermal Fentanyl on Peripheral Opioid Analgesia: Pain Medicine Vol 8(1) Jan 2007, 41-47.
  • Yeo, W., Lam, K. K., Chan, A. T. C., Leung, T. W. T., Nip, S. Y. W., & Johnson, P. J. (1997). Transdermal fentanyl for severe cancer-related pain: Palliative Medicine Vol 11(3) May 1997, 233-239.
  • Zacny, J. P., Coalson, D. W., Klafta, J. M., & Klock, P. A. (1996). Midazolam does not influence intravenous fentanyl-induced analgesia in healthy volunteers: Pharmacology, Biochemistry and Behavior Vol 55(2) Oct 1996, 275-280.
  • Zacny, J. P., Lichtor, J. L., Zaragoza, J. G., & de Wit, H. (1992). Effects of fasting on responses to intravenous fentanyl in healthy volunteers: Journal of Substance Abuse Vol 4(2) 1992, 197-207.
  • Zacny, J. P., Lichtor, J. L., Zaragoza, J. G., & de Wit, H. (1992). Subjective and behavioral responses to intravenous fentanyl in healthy volunteers: Psychopharmacology Vol 107(2-3) Jun 1992, 319-326.
  • Zacny, J. P., McKay, M. A., Toledano, A. Y., & Marks, S. (1996). The effects of a cold-water immersion stressor on the reinforcing and subjective effects of fentanyl in healthy volunteers: Drug and Alcohol Dependence Vol 42(2) Oct 1996, 133-142.
  • Zech, D. F., Grond, S. U., Lynch, J., Dauer, H. G., & et al. (1992). Transdermal fentanyl and initial dose-finding with patient-controlled analgesia in cancer pain: A pilot study with 20 terminally ill cancer patients: Pain Vol 50(3) Sep 1992, 293-301.
  • Zenz, M., Donner, B., & Strumpf, M. (1994). Withdrawal symptoms during therapy with transdermal fentanyl (fentanyl TTS)? : Journal of Pain and Symptom Management Vol 9(1) Jan 1994, 54-55.
  • Zeppetella, G. (2000). Nebulized and intranasal fentanyl in the management of cancer-related breakthrough pain: Palliative Medicine Vol 14(1) Jan 2000, 57-58.
  • Zeppetella, G. (2001). Sublingual fentanyl citrate for cancer-related breakthrough pain: A pilot study: Palliative Medicine Vol 15(4) Jul 2001, 323-328.
  • Zernig, G., Issaevitch, T., Broadbear, J. H., Burke, T. F., & et al. (1995). Receptor reserve and affinity of mu opioid agonists in mouse antinociception: Correlation with receptor binding: Life Sciences Vol 57(23) Oct 1995, 2113-2125.
  • Zernikow, B., Michel, E., & Anderson, B. (2007). Transdermal Fentanyl in Childhood and Adolescence: A Comprehensive Literature Review: The Journal of Pain Vol 8(3) Mar 2007, 187-207.
  • Zhang, L. J., Han, N. L., & Han, J. S. (1994). Regulation by lithium of the antagonistic effect of cholecystokinin octapeptide on ohmefentayl-induced antinociception: Neuropharmacology Vol 33(1) Jan 1994, 123-126.


  • Frecska, E. (2005). Investigation of endogenous opioid reactivity with fentanyl challenge in major depression and self-injurious behavior. Dissertation Abstracts International: Section B: The Sciences and Engineering.
  • Klein, L. C. (1998). Sex differences and the effects of stress on subsequent opioid consumption in adult rats following adolescent nicotine exposure: A psychopharmacologic examination of the gateway hypothesis. Dissertation Abstracts International: Section B: The Sciences and Engineering.
  • Shaham, Y. (1994). Conditioning factors in the relationship between stress and opioid self-administration in rats. Dissertation Abstracts International: Section B: The Sciences and Engineering.

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