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Rapid acting fentanyl formulations in breakthrough pain in cancer. Drug selection by means of the System of Objectified Judgement Analysis
  1. Robert Janknegt1,
  2. Marieke van den Beuken2,
  3. Sjouke Schiere3,
  4. Michael Überall4,
  5. Roger Knaggs5,6,
  6. Jaquie Hanley7,
  7. Morten Thronaes8
  1. 1Department of Clinical Pharmacy and Toxicology, Zuyderland Medical Centre, Sittard, The Netherlands
  2. 2Palliative Care MUMC+, Maastricht, The Netherlands
  3. 3Tjongerschans Hospital, Heerenveen, The Netherlands
  4. 4IFNAP Institute for Neurosciences, Algesiology and Paediatrics, Nürnberg, Germany
  5. 5University of Nottingham, Nottingham, UK
  6. 6Nottingham University Hospitals NHS Trust, Nottingham, UK
  7. 7Antrim Area Hospital, Antrim, UK
  8. 8Faculty of Medicine, Department of Cancer Research and Molecular Medicine, European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology (NTNU) and St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  1. Correspondence to Dr Robert Janknegt, Department of Clinical Pharmacy and Toxicology, Zuyderland Medisch Centrum, PO Box 5500, Sittard 6130 MB, The Netherlands; r.janknegt{at}


Drug selection of rapid acting fentanyl formulations in the treatment of breakthrough pain in patients with cancer is performed by the System of Objectified Judgement Analysis method. All seven available formulations were included in the analysis. The following selection criteria were used: number of available strengths, variability in the rate of absorption, interactions, clinical efficacy, side effects, ease of administration and documentation. No direct double-blind comparative studies between two or more formulations were identified and the clinical documentation of all formulations is limited. The most distinguishing criterion was ease of use. This led to slightly higher scores for Abstral, Instanyl and PecFent than for the other formulations. The pros and cons of each formulation should be discussed with the patient, and the most suitable formulation selected for each individual patient.


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