フェンタニル口腔粘膜吸収剤の使用実態調査  [in Japanese] An audit of transmucosal immediate-release fentanyl prescribing at a university hospital  [in Japanese]

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Abstract

フェンタニル口腔粘膜吸収剤(transmucosal immediate-release fentanyl;以下,TIRF)は突出痛への有効性が期待されるが,不適切な使用による有害事象も懸念されるため,適正使用モニタリングが重要である.当院でTIRFが処方された31例を対象に,TIRF使用の適切性,逸脱の原因,有害事象を評価するために後方視的カルテ調査を実施した.評価のため,持続痛のコントロール,他のオピオイドの使用状況からなる2段階のアルゴリズムを作成した.TIRF使用が適切と判断された症例は6例(19.4%)であった.不適切な症例では,突出痛の評価が不十分で,定時オピオイド鎮痛薬と同一成分という理由のみで処方された症例が19例,他のオピオイドがより適切である症例が12例であった.全例でTIRFが最小用量から開始され,重篤な有害事象はなかった.突出痛の十分な評価に基づく適切な薬剤選択が望まれる.

Transmucosal Immediate-Release Fentanyl(TIRF)can be a key-drug for breakthrough cancer pain. Prescription audit is needed because there are concerns about tolerance or serious adverse events including respiratory suppression and addiction due to inappropriate use of these drugs. The aim of this audit study is to evaluate appropriateness of TIRF prescriptions, reasons of violation, and adverse events in the real-world setting. A retrospective chart review was conducted in 31 patients who had breakthrough cancer pain and were treated with TIRF. A 2-step algorithm was generated:baseline pain and administration situation of other opioid rescues. TIRF was prescribed appropriately in six patients(19.4%). Reasons of violation were as follows:prescriptions only for using same drug with around-the-clock opioids(fentanyl transdermal patches, <i>n</i>=19), and patients could take oral medicines and use of morphine or oxycodone rescues would be preferable(<i>n</i>=12). TIRF was initiated with a minimum dose in all patients and no serious adverse events were observed. Although TIRF was used widely for breakthrough cancer pain, prescription was not necessarily done appropriately. Detailed assessment of breakthrough cancer pain and consideration of the use the other rescue medication would be required.

Journal

  • Palliative Care Research

    Palliative Care Research 10(1), 107-112, 2015

    Japanese Society for Palliative Medicine

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