Oral transmucosal fentanyl citrate: a novel agent for breakthrough pain related to cancer.

Pain is problematic for many cancer patients. As more experience has been gained in treating cancer pain, breakthrough pain has been recognized as a phenomenon that occurs frequently in this population. Breakthrough pain is generally treated with a variety of short-acting opioids via a number of routes. Actiq (oral transmucosal fentanyl citrate) is a formulation of fentanyl citrate delivered via the transmucosal route in a sucrose base. Patients using this agent are instructed to paint the unit on the buccal mucosa in order to achieve relief. The onset of Actiq is reported to be equal to intravenous morphine. There are a wide variety of dosage forms available, allowing 74% of patients involved in clinical studies of the agent to titrate to an appropriate dose. The proper use, side effect profile and advantages/disadvantages will be reviewed for this agent.