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Sublimaze (Fentanyl Citrate)

Sublimaze 50 micrograms/ml solution for injection or infusion

Fentanyl Citrate

1. What Sublimaze is and what it is used for

Sublimaze contains a medicine called fentanyl citrate. It belongs to a group of medicines called ‘opioid analgesics’. Sublimaze is a strong painkiller that works for a short period of time.

Sublimaze is used to prevent or relieve pain during different types of surgery. It can be used for:

•    Short operations, where you go home on the same day

•    Longer operations where you may stay in hospital for a number of days

High doses of Sublimaze are also used to lower your natural breathing rate when you are on a ventilator. During major operations, it is used together with a sedative known as a neuroleptic to put you to sleep. It can also be used to relieve severe pain such as during a heart attack.

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2. Before you are given Sublimaze

Do not have Sublimaze if:

•    You are allergic to anything in Sublimaze

•    You are allergic to other strong medicines for pain called ‘opioid analgesics’

•    You suffer from breathing difficulties called ‘obstructive airways disease’ or ‘respiratory depression’. You may only be able to have Sublimaze if your breathing is helped by a machine called a ventilator

You are in labour or before the cord is clamped during a Caesarean section, Sublimaze may affect the baby’s breathing.

Do not use this medicine if any of the above applies to you. If you are not sure, talk to your doctor or nurse before having Sublimaze.

Take special care with Sublimaze

Check with your doctor or nurse before using this medicine if you have or have ever had:

•    Problems with your lungs, liver or kidneys

•    An underactive thyroid gland

•    Problems with alcohol (alcoholism)

•    A muscle weakness called ‘myasthenia gravis’

•    Long-term treatment with strong painkillers

•    Low blood volume

•    A recent head injury

•    If you are elderly or weak due to ill health

Your doctor will carefully monitor the amount of Sublimaze they give you. If you are not sure if any of the above applies to you, talk to your doctor or nurse before having Sublimaze.

Special monitoring

•    Sublimaze may make you breathe more slowly. Your breathing will be carefully monitored until it returns to normal.

•    Your blood pressure and heart rate may also be monitored

Taking other medicines

Please tell your doctor or nurse if you are taking or have recently taken any other medicines. This includes medicines that you buy without a prescription or herbal medicines.

In particular, do not have this medicine and tell your doctor or nurse if:

•    You have taken medicines for depression called ‘monoamine oxidase inhibitors’ (MAOIs) in the past two weeks

If this applies to you, do not have Sublimaze

The effects of Sublimaze or any of these medicines may be increased when they are taken together

•    Other strong medicines for pain called ‘opioid analgesics’ such as morphine or codeine

•    Medicines for putting you to sleep called ‘anaesthetic agents’

•    Medicines for anxiety or to help you sleep such as tranquillisers or sleeping pills

•    Medicines for HIV infection (called antiviral protease inhibitors) such as ritonavir, indinavir or saquinivir

•    Medicines for treating a fungal infection such as fluconazole or voriconazole

The dose of etomidate and midazolam may need to be reduced if given together with Sublimaze.

Talk to your doctor before having Sublimaze if you are taking any of these medicines. They may have to change the amount of Sublimaze or the other medicines you are given.

  • Pregnancy and breast-feeding

You must tell your doctor before having Sublimaze if you are pregnant, think you may be pregnant or might become pregnant.

You may still be able to have Sublimaze if your doctor thinks you need to.

Sublimaze should not be used during childbirth as it can affect the baby’s breathing.

Sublimaze may get into breast milk. Do not breast-feed for 24 hours after having Sublimaze.

Ask your doctor or pharmacist for advice before taking any medicine if you are pregnant or breast-feeding.

  • Driving and using machines

Do not drive or use any tools or machines for 24 hours after having Sublimaze. You may be less alert than usual.

Important information about an ingredient of Sublimaze

If you need to control your salt intake (controlled sodium diet) be aware that:

•    Each millilitre of Sublimaze contains 3.5 mg of sodium

•    The contents of the ampoule may be diluted in a salt solution before being given to you. This salt solution also contains sodium
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3. How Sublimaze is given

Sublimaze is given by a doctor experienced in using this type of medicine. Check with your doctor or nurse if you are not sure about anything.

How Sublimaze is given

•    Sublimaze is given as a drip (infusion) or injection into a vein or a muscle

•    You may be given an anaesthetic at the same time

•    You may be given other medicines to help with some of the side effects of Sublimaze such as slower heart rate and rigid muscles

How much Sublimaze is given

Your doctor will decide how much Sublimaze you need. This may depend on:

•     Your body weight in kilograms

•     Your general health

•     Your age

•     The reason you are being given it

•     Other medication

Sublimaze given by injection

If you are to breathe by yourself – adults and children aged 12 to 17 years old:

•    You will usually be given an initial dose of 50 – 200 micrograms

•    If necessary, you will be given further injections of 50 micrograms during the operation – children aged 2 to 11 years old:

•    You will usually be given an initial dose of 1 – 3 micrograms per kilogram

•    If necessary, you will be given further injections of 1 -1.25 microgram per kilogram during the operation

When your breathing is helped by a machine (ventilator)

– adults and children aged 12 to 17 years old:

•    The initial dose will be 300 – 3500 micrograms

•    If necessary, further injections of 100 – 200 micrograms will be given during the operation

– children aged 2 to 11 years old:

•    You will usually be given an initial dose of 1 – 3 micrograms per kilogram

•    If necessary, you will be given further injections of 1 -1.25 micrograms per kilogram during the operation

Sublimaze given as a drip (infusion)

•    The dose of Sublimaze is based on body weight in kilograms

•    You may be given an initial dose of 1 microgram per kilogram during each minute for the first 10 minutes

•    If necessary, this may be followed by 0.1 micrograms per kilogram during each minute of your operation

•    The drip will normally be stopped 40 minutes before the end of your operation

Elderly patients

Less Sublimaze may be used in patients that are elderly or weak due to ill health.

If you have too much Sublimaze

It is unlikely that you will be given too much Sublimaze. This will be monitored during your operation.

4. Possible side effects

Like all medicines, Sublimaze can cause side effects, although not everybody gets them. Your doctor will monitor these effects during your operation.

Very common (affects more than 1 in 10 people)

•    Feeling sick (nausea), being sick (vomiting)

•    Muscle stiffness (which may involve your chest muscles)

Common (affects less than 1 in 10 people)

•    Agitation

•    Difficulty with body movements

•    Drowsiness

•    Dizziness

•    Problems with vision

•    Irregular heartbeat (slow or fast)

•    Low or high blood pressure

•    Pain in your veins

•    Choking caused by cramping (spasm) of the muscles in your throat

•    Difficulty in breathing or wheezing

•    Stop breathing for a short period of time. If necessary, your breathing will be helped by a machine (ventilator)

•    Skin rash

•    Confusion after the operation

Uncommon (affects less than 1 in 100 people)

•    Changes in blood pressure

•    Breathing complications

•    Breathing faster than normal

•    Fall in body temperature below normal or chills

•    Headache

•    Swelling and clotting in a vein

•    Hiccups

•    Feeling of extreme happiness

Other side effects (frequency not known):

•    Serious allergic reaction which may cause difficulty in breathing or dizziness, and hives or nettle rash (urticaria)

•    Convulsions (fits or seizures)

•    Loss of consciousness

•    Muscle twitching

•    Stopping of the heart

•    Slow or shallow breathing

•    Itching of the skin

Other side effects when Sublimaze is used together with medicines called neuroleptics, which can be given before or during an operation:

•    Shivering and restlessness

•    Seeing things that aren’t there (hallucinations)

•    Unusual movements, including trembling and shaking of the hands and fingers, twisting movements of the body, shuffling walk and stiffness of the arms and legs

If you notice any other side effects after your operation and they are not listed in this leaflet, please tell your doctor or nurse.

5. How Sublimaze is stored

Sublimaze is kept out of the reach and sight of children. It is stored in a Controlled Drug Store in the hospital pharmacy. Do not store above 30°C. Keep the ampoules in the outer carton to protect from light.

Sublimaze will not be used after the expiry date stated on the label. The expiry date refers to the last day of that month.

6. Further information

The active substance in Sublimaze is fentanyl citrate. Each millilitre (ml) contains 50 micrograms of fentanyl (as the citrate).

The other ingredients are sodium chloride and water.

What Sublimaze looks like and contents of the pack

Sublimaze is supplied in a clear glass ampoule containing 2 ml (packs of 10) or 10 ml (packs of 5) of liquid.

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