Noble-Gresty Jo
Advanced Specialist Pharmacist, Palliative Care, Pembridge Palliative Care Centre, St Charles' Hospital, Exmoor Street, London W10 6DZ, 020 8962 4035.
Rev Pain. 2010 Oct;4(2):2-7. doi: 10.1177/204946371000400202.
The pharmacokinetics of the traditional oral opioids do not match the time course of breakthrough cancer pain, a common and distinct component of cancer pain which has a negative impact on quality of life for the patient.Fentanyl and alfentanil are potent, lipophilic, fast acting opioids with short durations of action and consequently more appropriate for the treatment of breakthrough cancer pain. These agents are ideal for oral transmucosal or nasal transmucosal administration.There are now four licensed preparations of fentanyl in the UK for the treatment of cancer breakthrough pain; lozenge, buccal tablet, sublingual tablet and nasal spray. They are not interchangeable and all require titration using the lowest dose.Alfentanil is available as a buccal or nasal spray. It is an unlicensed product and is available as a special order from Torbay Pharmacy Manufacturing Unit.There is a paucity of comparator studies for these new modes of administration.Further innovative delivery systems of fentanyl are on the horizon.
传统口服阿片类药物的药代动力学与爆发性癌痛的时程不匹配，爆发性癌痛是癌痛常见且独特的组成部分，会对患者的生活质量产生负面影响。芬太尼和阿芬太尼是强效、亲脂性、起效快的阿片类药物，作用持续时间短，因此更适合用于治疗爆发性癌痛。这些药物非常适合口腔黏膜或鼻腔黏膜给药。目前在英国有四种获得许可的芬太尼制剂用于治疗癌痛爆发；含片、颊含片、舌下片和鼻喷雾剂。它们不可互换，且都需要使用最低剂量进行滴定。阿芬太尼有颊用或鼻用喷雾剂。它是一种未获许可的产品，可从托贝药房生产单位特别订购。对于这些新的给药方式，比较研究较少。芬太尼的进一步创新给药系统即将出现。
