Transmucosal Fentanyl Preparations

Transmucosal fentanyl preparations are licensed for breakthrough pain in patients receiving opioid therapy for chronic cancer pain.

Such patients should already be receiving a strong opioid for background pain and should have been receiving oral morphine for at least 60mg /24hours (or equivalent dose of an alternative strong opioid) for the previous week before being commenced on an immediate release fentanyl preparation.

Seek specialist palliative care advice before prescribing immediate release fentanyl preparations.

Various transmucosal fentanyl preparations are available with similar onset of action and alternative routes of delivery:

  • buccal tablets
  • intranasal spray
  • sublingual tablets
  • lozenges
  • buccal films

The most appropriate route of administration will depend on the patient’s preference, their manual dexterity and other clinical circumstances. These medications all require careful individual dose titration according to the product literature and patient response.

Transmucosal fentanyl citrate preparations:

Oro-mucosal products:

100, 200, 300, 400, 600 and 800 microgram sublingual tablets

Actiq® lozenges with applicator:
200, 400, 600, 800, 1200, 1600 micrograms buccal lozenges

Breakyl® film (buccal):
200, 400, 800 microgram films

Effentora® buccal/sub-lingual tablets:
100, 200, 400, 600 and 800 microgram tablets

Recivit® sub-lingual tablets:
133, 267, 400, 533, 800 microgram tablets

Nasal Sprays:

PecFent® nasal spray:
100 , 400 microgram metered sprays

Please see

Summary of Product characteristics (SPC) for details of administration for the individual preparations.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.