Oral transmucosal fentanyl citrate (ACTIQ%o): early experience in Australia -The first 10 patients

Background
Oral transmucosal fentanyl citrate (ACTIQ%o) has been available in Australia via the Special Access Scheme since November 2001. This unique formulation of the opioid fentanyl allows non-invasive transmucosal delivery through oral administration of a palatable lozenge on a stick. Indicated for the management of breakthrough pain in patients already receiving maintenance opioid therapy for chronic pain, a number of patients have received treatment with ACTIQ lozenges.

Design
This paper will present case studies of our first 12 patients treated with ACTlQ in Australia. The discussion will focus on patient selection, background medication, previous breakthrough analgesia, titration, pain relief, patient satisfaction and quality of life outcomes.

Conclusions
The main advantages of the ACTIQ lozenge are convenience and very rapid onset of action. We believe that this medication is the closest thing yet to an ideal "breakthrough" medication. The transmucosal route is effective even in people with unpredictable absorption, such as those with bowel obstruction.

These case studies illustrate situations where ACTIQ makes a difference in the management of breakthrough pain in palliative care, especially in patients not adequately controlled with currently available medications. We found ACTIQ generally well accepted and tolerated with a high degree of patient and carer satisfaction.