Lazanda (fentanyl) is a strong pain medication used to treat breakthrough cancer pain in people who already take around-the-clock opioid pain medications. It's a nasal spray that can be used by adults over the age of 18, but it requires special monitoring because of the risk of abuse, addiction, and overdose.
Breakthrough cancer pain in adults 18 years and older
Lazanda (fentanyl) belongs to a group of pain medications, known as opioids. It works directly on opioid receptors in your brain to relieve pain.
Lazanda (fentanyl) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: First 1 to 3 days of starting Lazanda (fentanyl) | Dose changes | High doses | Switching between fentanyl-containing medications | Opioid-intolerance | Accidental overdose | Children | Age 65 years or older | Severe lung conditions | History of sleep apnea | Taking other medications that cause respiratory depression
Lazanda (fentanyl) can cause serious,
life-threatening slowed breathing (respiratory depression) and death, even at normal doses. Your risk is greatest during the first 24 to 72 hours of starting Lazanda (fentanyl) and after your dose is raised. If you're opioid-intolerant, meaning you aren't taking opioids around-the-clock, don't take Lazanda (fentanyl).
For your safety, use Lazanda (fentanyl) exactly as prescribed by your healthcare provider, and don't adjust your dose or switch between products without discussing with your provider first. Lazanda (fentanyl) is NOT equal to other forms of fentanyl, such as the patch, pills, or lozenge. Don't convert, switch, or substitute Lazanda (fentanyl) with any other fentanyl-containing medications without proper guidance from your healthcare provider. Make sure to discuss your entire medical history with your provider, since some conditions put you at a higher risk for respiratory depression.
Accidental ingestion of even one dose, especially by children, can lead to severe breathing problems and death. Respiratory depression is a medical emergency that must be managed and treated right away. Alcohol and other medications, like benzodiazepines, sedatives, anxiety medications, and certain muscle relaxants, can slow down your breathing even more and you should avoid taking them together with Lazanda (fentanyl). If you have shortness of breath, wheezing, slowed breathing, tiredness or sleepiness during the day, anxiety, or confusion, call for emergency medical help right away.
Risk factors: Children | Using more Lazanda (fentanyl) than prescribed
Overdose can happen at recommended doses of Lazanda (fentanyl), or if it's accidentally taken by a child or a loved one. Accidental ingestion of even one dose in a child can cause overdose and death. It can also happen if you take higher doses or take the medication more often than prescribed. If you live in a home with children or if children frequently visit your home, store both used and unused medication in a secure place. For questions about proper storage or disposal of Lazanda (fentanyl), refer to the medication guide that came with your medication or ask your pharmacist.
Symptoms of an overdose include slowed breathing, sleepiness, muscle weakness, small pupils, cold or clammy skin, abnormal snoring, low blood pressure, slow heart rate, or unresponsiveness. If you, your child, or anyone around you accidentally overdoses on Lazanda (fentanyl), get emergency medical help right away. If you're at a high risk for overdose, have a history of opioid overdose, or live with children or other family members at high risk, your provider might prescribe naloxone (Narcan). Naloxone (Narcan) can be used in emergency situations for Lazanda (fentanyl) overdose. It's important for you and your caregiver to know how to use naloxone (Narcan) in case an accidental overdose happens. Even if you use naloxone (Narcan) for an overdose, you'll still have to call for emergency medical help because it's effects are temporary and only last for a few minutes.
Using Lazanda (fentanyl) with certain medications or suddenly stopping some medications can raise or lower levels of Lazanda (fentanyl) in your body. For example, taking erythromycin (Ery-Tab), ketoconazole, or ritonavir (Norvir) raises Lazanda (fentanyl) levels, leading to greater side effects, such as slowed breathing. Other medications like phenytoin (Dilantin), carbamazepine (Tegretol), or rifampin (Rifadin) can lower Lazanda (fentanyl) levels in your body, leading to withdrawal symptoms or lessened pain relief. In these situations, your provider might need to adjust your medications or dosage. If you start or stop any medications, ask your pharmacist or healthcare provider if it's safe to continue using Lazanda (fentanyl).
Risk factors: Age 65 years or older | Alcohol use | Taking other medications that make you less alert | High doses
Using Lazanda (fentanyl) with alcohol or other medications, like benzodiazepines, sleep medications, antipsychotics, muscle relaxers, or other opioids, can slow down brain activity and lead to severe sleepiness, slowed breathing, coma, and even death. If you currently take or start taking any of these medications, work with your healthcare provider to take the lowest dose for the shortest amount of time. Because of the risk of excessive drowsiness, make sure you know how this medication affects you before driving a car or doing activities that require concentration. For your safety, let your provider know if you have a history of substance abuse. Call for emergency medical help right away if you experience severe sleepiness, dizziness, low heart rate, slowed breathing, muscle weakness, headache, slurred speech, blurred vision, or confusion.
Risk factors: Personal or family history of substance or alcohol abuse | History of mental health conditions | Using more Lazanda (fentanyl) than prescribed | Long-term use of Lazanda (fentanyl) | Improper storage or disposal of Lazanda (fentanyl)
Using Lazanda (fentanyl) can lead to abuse, misuse (using it for reasons other than prescribed), or addiction, even if you use it at the recommended dose. This can cause serious problems, such as overdose and death. Your risk is greater if you have a history of substance or alcohol abuse or mental health conditions, such as depression. To lower this risk, your healthcare provider will prescribe the lowest amount of Lazanda (fentanyl) that's necessary for you for the shortest period of time possible. It's important to properly store and dispose of used and unused medication to prevent it from coming into contact with anyone else.
Because of the risk of abuse, misuse, addiction, and overdose, the U.S. Food and Drug Administration (FDA) requires this medication to be under a restricted program called the Transmucosal Immediate Release Fentanyl Risk Evaluation and Mitigation Strategy (TIRF REMS). This means that Lazanda (fentanyl) is only available at certified pharmacies, and healthcare providers must complete special training before prescribing this medication. Under this program, your provider or pharmacist is required to provide you with a medication guide and talk to you about the proper use, serious risks, and appropriate storage and disposal of this medication in order to keep you and your loved ones safe. It's important that you read the medication guide every time to familiarize yourself with safe use of this medication. To learn more about the TIRF REMS program or for a list of certified pharmacies, visit the website or call 1-866-822-1483.
Risk factors: Long-term use of Lazanda (fentanyl) during pregnancy
Long-term use of Lazanda (fentanyl) during pregnancy can cause your unborn baby to become dependent on opioids the same way that you can. Once your baby is born, they can experience withdrawal symptoms just like if you were to stop the medication suddenly. Withdrawal symptoms in your newborn can include high-pitched crying, poor feeding and sucking behavior, trembling, irritability, abnormal sleep patterns, and seizures. This condition is called neonatal opioid withdrawal syndrome and can be life-threatening if not recognized and treated in time. Let your healthcare provider know if you've used Lazanda (fentanyl) during pregnancy or if you notice these symptoms in your baby.
Risk factors: Using Lazanda (fentanyl) with serotonergic medications
Using Lazanda (fentanyl) with other medications that raise serotonin levels in your brain, known as serotonergic medications, can cause a life-threatening condition called serotonin syndrome. Some examples of serotonergic medications include fluoxetine (Prozac), duloxetine (Cymbalta), amitriptyline (Elavil), sumatriptan (Imitrex), and trazodone (Desyrel). Serotonin syndrome generally occurs within a few hours or a few days of combining these medications, but might occur later. Let your healthcare provider or pharmacist know if you start a new medication to make sure it's safe to combine with Lazanda (fentanyl). Call for emergency medical help right away and stop using Lazanda (fentanyl) if you experience nausea, vomiting, diarrhea, fever, agitation, hallucinations (seeing things that aren't there), shivering, restlessness, sweating, fast heart rate, or stiff muscles.
Risk factors: Using opioids for greater than 1 month | History of low cortisol levels
Using opioids like Lazanda (fentanyl), especially for longer than 1 month, can lead to low levels of cortisol hormone (adrenal insufficiency). Cortisol helps control your mood, stress, blood pressure, and blood sugar levels. If you have symptoms such as nausea, vomiting, loss of appetite, tiredness, weakness, dizziness, or low blood pressure, let your healthcare provider know so that tests can be performed. If your cortisol levels are too low, your provider will treat you with corticosteroids and you might slowly be weaned off of Lazanda (fentanyl) or switched to another medication if necessary.
Risk factors: Age 65 years or older | Taking other medications that lower blood pressure | Dehydration | History of low blood pressure | Taking certain antipsychotics | Starting Lazanda (fentanyl) | Dose adjustments | History of slow heart rate | Heart problems
Lazanda (fentanyl) can cause severe low blood pressure, including a drop in blood pressure when you stand from a sitting or lying position. This can lead to dizziness and fainting. Your risk is greater if you take medications for high blood pressure or if you take certain antipsychotics, known as phenothiazines. Be careful as you stand up after sitting for an extended period of time and make sure to sit back down if you feel faint or dizzy. The chances of low blood pressure are higher when you first start using Lazanda (fentanyl) or with dose changes. Lazanda (fentanyl) can also cause slowed heart rate. Make sure to let your provider know if you have a history of heart problems, like abnormal heart rate (arrhythmias). If dizziness or lightheadedness doesn't go away, talk to your healthcare provider.
Risk factors: History of seizures | Taking other medications or having health conditions that raise your risk of seizures
Lazanda (fentanyl) can raise your risk of seizures if you have a history of seizures. If your seizures have worsened or become harder to control after starting Lazanda (fentanyl), let your healthcare provider know right away.
Source:Â DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Less common
Abdominal or stomach pain
black, tarry stools
bladder pain
bloating or swelling of the face, arms, hands, lower legs, or feet
bloody nose
bloody or cloudy urine
blurred vision
body aches or pain
chills
clay-colored stools
confusion
cough producing mucus
dark urine
decreased urination
decreased weight
difficult or labored breathing
difficult, burning, or painful urination
difficulty with breathing
dizziness or lightheadedness
ear congestion
fainting
frequent urge to urinate
headache
hoarseness
increase in heart rate
increased sweating
irritation
joint pain, stiffness, or swelling
loss of appetite
loss of voice
lower back or side pain
nervousness
pain, redness, or swelling in the arm or leg
pale skin
pounding in the ears
rapid breathing
rapid weight gain
rash
redness of the skin
runny or stuffy nose
shortness of breath
slow or fast heartbeat
sudden shortness of breath or troubled breathing
sunken eyes
swelling of the eyelids, face, lips, hands, or feet
thirst
tightness in the chest
tingling of the hands or feet
troubled breathing or swallowing
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
vomiting of blood
wrinkled skin
yellow eyes or skin
Incidence not known
Irregular, fast or slow, or shallow breathing
pale or blue lips, fingernails, or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Difficulty having a bowel movement (stool)
sleepiness or unusual drowsiness
vomiting
Less common
Acid or sour stomach
back pain
belching
burning feeling in the chest or stomach
change in taste
confusion about identity, place, and time
decreased appetite
difficulty with moving
drooping upper eyelids
flushed, dry skin
fruit-like breath odor
hyperventilation
increased hunger
increased thirst
increased urination
indigestion
irregular heartbeats
irritability
irritation or soreness of the mouth
lack or loss of strength
loss of taste
muscle aches
muscle pain or stiffness
pain in the arms or legs
pain in the rectum
restlessness
shaking
stomach discomfort or upset
stomach bloating
sweating
tenderness in the stomach area
trouble with sleeping
troubled breathing
unable to sleep
unexplained weight loss
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Available in multiple dosage strengths
Works in about 7 minutes to relieve breakthrough cancer pain
Good alternative if you have trouble swallowing pills
Comes with a child-resistant container and pouch for safe storage and disposal
Brand only, so it might be expensive
Can only be used if you already take opioids around-the-clock (opioid-tolerance)
Has undesirable side effects, such as nausea, vomiting, fever, and constipation
Not for short-term pain, such as dental pain, headaches or migraines, or pain after surgery
Can't be used in children younger than 18 years old
Before using Lazanda (fentanyl), refer to the instructions and make sure you know how to prepare and use it.
You'll need to prime (or prepare) the bottle the first time you use Lazanda (fentanyl) so that you get a proper dose. To prime your bottle, remove the cap from the nozzle (tip) and place the tip into the opening of the disposal pouch. A new and unused bottle will show 2 thin red lines in the white plastic top ("window") of the bottle. Press and release the grips 4 times until you see a green bar in the window. Once the green bar appears, your bottle is primed and ready to use.
If you don't use Lazanda (fentanyl) for more than 5 days, you'll need to re-prime your bottle by spraying once into the pouch.
To use Lazanda (fentanyl), remove the cap from the tip. Sit with your head upright and hold the spray bottle with your thumb on the bottom of the bottle and your first and middle fingers on the grips around the tip. Place the tip into your nose (about ½ inch) and point the tip towards the bridge of your nose by slightly tilting your bottle. Use one finger to close your other nostril. Press down on the grip and breathe in through your nose and out through your mouth one time after spraying. Don't sniff.
It's okay if you don't feel the spray going into your nose. You'll hear a "click" sound and the number in the window of the bottle will go up by 1, which tells you that you received your dose.
If you have a runny nose or feel like blowing your nose, do so before your dose of Lazanda (fentanyl). Avoid blowing your nose for at least 30 minutes after your dose because you might accidentally remove medication from your nose, leading to a lower dose.
If your provider prescribed multiple sprays, be sure to alternate nostrils for each dose. This will ensure that you get the proper amount of medication. Continue sitting down for at least 1 minute after each spray.
Each bottle of Lazanda (fentanyl) contains 8 sprays. The counting window will show a red "8" when your bottle no longer has any doses left. Once you've used 8 sprays or it's been longer than 60 days since you first used your bottle, throw the bottle away and use a new one.
If there's any medication left in the bottle, squeeze it out into the disposal pouch before throwing the bottle away. This ensures that no one, especially children, can come into contact with the medication. If you don't have an empty pouch, call 1-844-452-9263 to request one in the mail.
Place the empty spray bottle and the sealed pouch into the child-resistant container and throw it away in a trash can. Wash your hands with soap and water after handling the medication.
Lazanda (fentanyl) can cause excessive sleepiness, dizziness, and lightheadedness. Don't drive, use any heavy machinery, or perform any activities that require you to be alert until you know how the medication affects you.
Talk to your pharmacist or healthcare provider about naloxone (Narcan), which is a medication that can be used in emergency situations for accidental overdose of Lazanda (fentanyl). Make sure to tell your family and close friends where you keep your naloxone (Narcan) in the event of an emergency, and read the patient information material before an emergency situation occurs. Symptoms of an overdose include slowed breathing, sleepiness, muscle weakness, small pupils, cold or clammy skin, abnormal snoring, low blood pressure, slow heart rate, or unresponsiveness. If you use naloxone (Narcan) for an overdose situation, you should still call for emergency medical help because its effects are temporary.
Don't lower your dose or stop taking Lazanda (fentanyl) suddenly without talking to your healthcare provider. Doing so might lead to withdrawal symptoms, including nausea, sweating, yawning, and trouble sleeping.
Store Lazanda (fentanyl) at room temperature in a secure place protected from light and out of reach from children, pets, and guests at all times. Your medication will come with a child-resistant container where the spray bottle should be stored after each use. Lazanda (fentanyl) has a risk of life-threatening overdose, especially in children. If your child accidentally comes into contact with Lazanda (fentanyl), get emergency medical help right away.
Your provider will work with you to prescribe the right dose of Lazanda (fentanyl) for your individual needs. It's recommended to use the lowest dose possible for the shortest duration of time to manage your pain.
The typical starting dose is one spray (100 mcg) in one nostril for one episode of breakthrough pain.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Not taking around-the-clock opioids (opioid non-tolerance)
Short-term pain, such as headache or migraine, dental pain, or pain after surgery
Slowed breathing (respiratory depression)
Severe asthma
Stomach or intestinal blockage (paralytic ileus)
Breakthrough cancer pain in adults 18 years and older
Breakthrough cancer pain in people 16 years and older
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