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arznei-telegramm 2010; 41: 75

 


Overdose with fentanyl nasal spray (INSTANYL): An 86-year-old man with post-herpetic neuralgia uses the opioid analgesic fentanyl as a nasal spray (INSTANYL). Because the nozzle was blocked, he tried to get the nasal spray working again with a heated paper-clip. After application, he subsequently developed dizziness, impaired thinking, nausea and drowsiness as signs of an overdose (NETZWERK-Bericht 15.579). Since September 2009 the spray has been on the market for the management of breakthrough pain in adults who are already receiving maintenance opioid therapy for chronic cancer pain (Nycomed: INSTANYL SPC, as at July 2009). The manufacturer does not have any previous reports of the nozzle getting blocked. The patient leaflet points out that the nozzle should be cleaned thoroughly after every use. However, blockage "can occur in principle, as with all nasally applied medicinal products" (Nycomed: letter dated 2 July 2010). Manipulation of the spray nozzle can cause substantial overdosing. In the directions for use of other nasal sprays, for example the GnRH-analogue nafarelin (SYNARELA), a warning is therefore given to the effect, "under no circumstances is the spray tip to be cleaned with a pointed object" (Pfizer: SYNARELA package leaflet, as at March 2009).





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