Skip Navigation

Search Knowledgebase

fentanyl (sublingual)

Pronunciation: FEN tan il sub LIN gwal

Brand: Abstral, Subsys

What is the most important information I should know about fentanyl?

Multum donot

Do not use this medication to replace any other form of fentanyl, such as Actiq, Fentora, Onsolis, Duragesic, Lazanda, or generic brands of fentanyl (injection, skin patch, dissolving film, or "lollipop" device).

Before taking fentanyl, tell your doctor if you have a breathing disorder (asthma, wheezing, COPD), slow heartbeats, seizures, mental illness, low blood pressure, liver or kidney disease, a debilitating condition, or a history of head injury, brain tumor, or addiction to drugs or alcohol.

Multum emt

Tell your doctor if there are children living in the home where you will store this medicine. Keep fentanyl out of the reach of children. The amount of fentanyl in each Abstral tablet or Subsys spray unit can be fatal to a child.

Multum habit

Never share fentanyl with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

What is fentanyl sublingual?

Fentanyl sublingual (under the tongue) is an opioid pain medication. An opioid is sometimes called a narcotic.

Fentanyl sublingual tablets (Abstral) and sublingual spray (Subsys) are used to treat "breakthrough" cancer pain. Fentanyl sublingual is taken together with other non-fentanyl narcotic pain medicine that is used around the clock. This medication is not for treating pain that is not cancer-related, such as pain from surgery or dental work, migraine headaches, or back pain.

Fentanyl sublingual may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking fentanyl?

Multum donot

Do not take fentanyl unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant.

Multum donot

Do not take fentanyl if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days.

Multum emt

Tell your doctor if there are children living in the home where you will store this medicine. Keep fentanyl out of the reach of children. The amount of fentanyl in each Abstral tablet or Subsys spray unit can be fatal to a child.

To make sure you can safely take fentanyl sublingual, tell your doctor if you have any of these other conditions:

  • a breathing disorder such as wheezing, asthma, or chronic obstructive pulmonary disease (COPD);
  • seizures, epilepsy, or a history of head injury or brain tumor;
  • low blood pressure, slow heartbeats or other heart rhythm disorder;
  • mental illness such as depression, schizophrenia, or hallucinations;
  • liver or kidney disease; or
  • a personal or family history of drug or alcohol addiction.
Multum habit

Fentanyl may be habit-forming and should be used only by the person it was prescribed for. Never share fentanyl with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Multum nopreg

FDA pregnancy category C. It is not known whether fentanyl will harm an unborn baby. Fentanyl may cause breathing problems, seizure, or addiction and withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using fentanyl sublingual.

Multum nobrfeed

Fentanyl may also cause drowsiness, breathing problems, or addiction and withdrawal symptoms in a nursing infant. Do not breast-feed while you are taking fentanyl sublingual.

How should I take fentanyl sublingual?

Multum emt

Use exactly as prescribed. Never use fentanyl in larger amounts, or for longer than recommended by your doctor. Keep using your around-the-clock narcotic pain medicine but never take Abstral or Subsys together with a second form of fentanyl.

Multum donot

Do not use Abstral or Subsys to replace any other form of fentanyl, such as Actiq, Fentora, Onsolis, Duragesic, Lazanda, or generic brands of fentanyl (injection, skin patch, dissolving film, or "lollipop" device).

Multum emt

If you switch to Abstral or Subsys from another form of fentanyl, you will not use the same dose. You must start with the lowest dose (100 micrograms). Your doctor may change your dose to make sure you get the best results.

Place the Abstral tablet under your tongue, as far back as you can. Do not break, chew, suck, or swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Do not drink or eat anything during this time.

You may use a second Abstral tablet 30 minutes after the first. Use only the same strength and amount you used for the first dose. Call your doctor if you still have pain after taking the second tablet. Do not take more than 2 tablets for each episode of breakthrough cancer pain. You must wait at least 2 hours after your last dose of Abstral before you can treat a new pain episode.

Point the Subsys spray nozzle into your mouth, lift your tongue, and spray the medicine under your tongue. Hold the liquid under the tongue for 30 to 60 seconds. Do not spit, swallow, or rinse your mouth during this time.

You may use a second Subsys spray unit 30 minutes after the first. Use only the same strength and amount you used for the first dose. Call your doctor if you still have pain after using the second spray. Do not use more than 2 sprays for each episode of breakthrough cancer pain. You must wait at least 4 hours after your last dose of Subsys before you can treat a new pain episode.

Do not treat more than 4 pain episodes per day with fentanyl sublingual. Call your doctor if you have breakthrough pain more than 4 times in one day.

Multum donot

Do not stop taking fentanyl or your other narcotic pain medicine without your doctor's advice. Ask your doctor how to avoid withdrawal symptoms when you stop using pain medication.

Multum rt

Store in the original carton at room temperature, away from heat and moisture. Keep track of the amount of medicine used from each carton. Fentanyl is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Multum emt

Keep out of the reach of children. The amount of fentanyl in each Abstral tablet or Subsys spray unit can be fatal to a child.

Multum finish

Carefully follow the instructions for disposing of this medicine when it is no longer needed. Throw away any unused Abstral tablets by removing them from the blister pack and flushing them down a toilet. Dispose of used Subsys spray units in the disposal bags provided with this medication. Empty any unused spray units into the disposal bottle provided.

What happens if I miss a dose?

Since fentanyl sublingual is used as needed, you are not likely to miss a dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Multum emt

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A fentanyl overdose can be fatal. Overdose symptoms may include extreme drowsiness, weak pulse, fainting, and slow breathing (breathing may stop).

What should I avoid while taking fentanyl?

Multum dizzy

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how fentanyl will affect you.

Multum noalcohol

Do not drink alcohol. It can increase your risk of a dangerous side effect while taking fentanyl.

Grapefruit and grapefruit juice may interact with fentanyl and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

What are the possible side effects of fentanyl?

Multum emt

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Multum donot

Stop using fentanyl and call your doctor at once if you have a serious side effect such as:

  • slow heart rate, weak or shallow breathing, sighing, severe drowsiness;
  • confusion, extreme fear, unusual thoughts or behavior; or
  • feeling like you might pass out.

Less serious side effects may include:

  • dry mouth, nausea, vomiting, constipation;
  • headache, drowsiness, tired feeling; or
  • white patches or sores inside your mouth or on your lips.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect fentanyl?

Multum dizzy

Cold or allergy medicine, sedatives, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety can add to sleepiness caused by fentanyl. Tell your doctor if you regularly use any of these medicines.

Many drugs can interact with fentanyl. Below is just a partial list. Tell your doctor if you are using:

  • phenobarbital (Solfoton) or other barbiturates;
  • pioglitazone (Actos, Actoplus Met, Duetact);
  • an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifabutin (Mycobutin), rifampin (Rifater, Rifadin, Rifamate), telithromycin (Ketek), and others;
  • antifungal medication such as itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);
  • heart or blood pressure medication such as diltiazem (Cartia, Cardizem), nicardipine (Cardene), quinidine (Quin-G), verapamil (Calan, Covera, Isoptin, Verelan), and others;
  • HIV/AIDS medicine such as delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), fosamprenavir (Lexiva), nevirapine (Viramune), ritonavir (Norvir, Kaletra), and others;
  • seizure medication such as carbamazepine (Carbatrol, Equetro, Tegretol), oxcarbazepine (Trileptal), phenytoin (Dilantin), and others; or
  • steroids such as prednisone and others.

This list is not complete and there are many other drugs that can interact with fentanyl sublingual. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about fentanyl sublingual.


Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2013 Cerner Multum, Inc. Version: 3.04. Revision date: 3/30/2012.

Your use of the content provided in this service indicates that you have read, understood and agree to the End-User License Agreement, which can be accessed by clicking on this link.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.