Mercadante, S., Ferrera, P., & Arcuri, E. (2011). The use of fentanyl buccal tablets as breakthrough medication in patients receiving chronic methadone therapy: An open label preliminary study. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 19(3), 435–438.

To assess the efficacy of fentanyl buccal tablets (FBTs) for the treatment of breakthrough cancer pain in patients who receive methadone as a background analgesic

Palliative care inpatients receiving 12 mg morphine received 100 mcg FBTs. Proportionally higher doses of FBTs were given according to background methadone dose. Patients requested pain medication from the nurse for breakthrough episodes. Nurses graded pain scores when called and after 15 minutes.

• The sample was composed of 13 patients.
• Mean patient age was 58.1 years (SD = 9.9 years). The age range of the sample was 43–75 years.
• Of the 13 patients, 4 were female and 9 were male.
• Seven patients had lung cancer, two had pancreas cancer, one had kidney cancer, one had breast cancer, one had prostate cancer, and one had ovarian cancer.
• All patients were receiving stable doses of oral methadone.
• All patients were inpatients receiving palliative care.

• Single site
• Inpatient
• Italy

Prospective trial

• Numeric pain scale, 0–10
• Numeric pain intensity scale, 0–10, to measure changes of pain intensity

In the majority of events, 15 minutes after administration of an FBT, evidence showed a decrease in pain intensity greater than 33% and greater than 50% (n = 20, 31.5% and n = 26, 40.6%, respectively). Nine events (14%) were unsuccessfully treated and required IV methadone injection. In all patients, the level of adverse effects after FBT administration was mild and indistinguishable from the level of adverse effects associated with baseline opioid analgesia.

Patients who receive methadone can achieve analgesic effect when FBT is administered for breakthrough cancer pain.

The study had a small sample size, with fewer than 30 patients.

An FBT lozenge must be rubbed gently against the buccal mucosa until it dissolves completely. For FBT treatment to be effective, patients must be instructed how to do this and they must have the ability to do it. For patients receiving methadone, FBTs may be an effective alternative for treating breakthrough cancer pain.