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      Asociación del uso crónico del citrato de fentanilo oral con la aparición de caries y pérdida de piezas dentales Translated title: Association between chronic use of oral fentanyl citrate and teeth decay and loss

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          Abstract

          Objetivos: El objetivo de este estudio ha sido conocer si el uso crónico de citrato de fentanilo oral puede guardar relación con la aparición de caries y con la pérdida de piezas dentales, y de ser así, si hubiera forma de evitar o minimizar este efecto, a propósito de la aparición de un caso en nuestra unidad. Pacientes y métodos: Se estudió el caso de un varón de 53 años en tratamiento por nuestra Clínica del Dolor, que tomaba citrato de fentanilo oral para el tratamiento de un dolor crónico en el contexto de un síndrome postlaminectomía cervical y lumbar, y en el que aparecieron varias caries y pérdida de piezas dentales. Se revisaron los 77 pacientes a los que en la actualidad, también tratábamos de forma crónica con este fármaco, para estudiar la frecuencia y magnitud de esta posible asociación. Resultados: La higiene dental de los distintos pacientes no varió durante el tratamiento con citrato de fentanilo oral. La existencia de trastornos odontógenos añadidos con posterioridad al inicio del tratamiento, no apareció en ningún otro caso. Este único paciente presentaba un aseo dental defectuoso. Conclusión: El uso crónico de citrato de fentanilo oral es un factor que puede contribuir, aunque de forma infrecuente, a la aparición de caries y pérdida de piezas dentarias. Una adecuada higiene dental podría evitar, o al menos minimizar, la repercusión del uso crónico de citrato de fentanilo oral sobre la salud dentaria.

          Translated abstract

          Objectives: The aim of this study was to determine whether the use of oral fentanyl citrate can be related to teeth decay and loss, and if so, whether such effect can be prevented or minimized. A case seen in our unit is reported. Patients and methods: We studied the case of a 53-years old male admitted in our Pain Clinic that was taking oral fentanyl citrate for the management of chronic pain caused by cervical and lumbar postlaminectomy syndrome and in which teeth decay and loss occurred. Seventy seven patients that were also receiving chronic treatment with the same drug were reviewed in order to determine the frequency and magnitude of this potential association. Results: Dental hygiene of patients did not changed throughout the treatment with oral fentanyl citrate. No other patient developed odontal disorders after the beginning of the treatment. This single patient had a poor dental hygiene. Conclusion: Chronic use of oral fentanyl citrate is a factor that may contribute, although in rare cases, to teeth decay and loss. An appropriate dental hygiene can prevent or at least minimize the impact of chronic use of oral fentanyl citrate on dental health.

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          Most cited references18

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          Oral transmucosal fentanyl citrate: randomized, double-blinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients.

          Patients with cancer frequently experience episodes of acute pain, i.e., breakthrough pain, superimposed on their chronic pain. Breakthrough pain is usually treated with short-acting oral opioids, most of which provide some relief after 15-20 minutes, with peak effects after 30-45 minutes. Oral transmucosal fentanyl citrate (OTFC), a unique formulation of the opioid fentanyl, has been shown to provide meaningful pain relief within 5 minutes in patients following surgery. We conducted a multicenter, randomized, double-blinded, placebo-controlled trial of OTFC for cancer-related breakthrough pain. Patients who were 18 years of age or older, receiving the equivalent of at least 60 mg oral morphine or at least 50 microg transdermal fentanyl per day for chronic cancer-related pain, and experiencing at least one episode of breakthrough pain per day were studied. After titration to an effective OTFC dose, subjects were given 10 randomly ordered treatment units (seven OTFC units and three placebo units) in the form of identical lozenges. If acceptable pain relief was not achieved within 30 minutes, subjects were instructed to take their previous breakthrough pain medication (i.e., rescue medication). Pain intensity, pain relief, and use of rescue medication were evaluated at 15-minute intervals over a 60-minute period. Eighty-nine of 92 patients who received the randomized treatment were assessable (i.e., treated with at least one unit of OTFC and one unit of placebo). OTFC produced significantly larger changes in pain intensity and better pain relief than placebo at all time points (two-sided P<.0001). Episodes treated with placebo required the use of rescue medication more often than episodes treated with OTFC (34% versus 15%; relative risk = 2.27; 95% confidence interval = 1.51-3.26; two-sided P<.0001). OTFC appears effective in the treatment of cancer-related breakthrough pain.
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            Absorption and bioavailability of oral transmucosal fentanyl citrate.

            Oral transmucosal fentanyl citrate (OTFC) is a novel, noninvasive dosage form of fentanyl used to provide children and adults with sedation, anxiolysis, and analgesia. In order to determine the bioavailability and absorption of fentanyl from OTFC, 12 volunteers were given intravenous fentanyl citrate or OTFC 15 micrograms/kg on each of two occasions. On a third occasion, the authors assessed oral administration (gastrointestinal absorption) by giving eight of the same volunteers the same dose of a solution of fentanyl citrate to swallow. In each study, arterial blood samples were taken over 24 h for analysis of plasma fentanyl. After intravenous (iv) administration of fentanyl, clearance (mean +/- standard deviation) was 0.67 +/- 0.15 l/min; volume of distribution at steady state was 287 +/- 79 l; and the terminal elimination half-life was 425 +/- 102 min. Peak plasma concentrations of fentanyl were higher (3.0 +/- 1.0 vs. 1.6 +/- 0.6 ng/ml, P = 0.01) and occurred sooner (22 +/- 2.5 vs. 101 +/- 48.8 min, P = 0.003) after OTFC than after oral solution administration. Plasma concentrations of fentanyl after OTFC decreased rapidly, to less than 1.0 ng/ml within 75-135 min after the beginning of administration. Peak absorption rate was greater (11.1 +/- 4.3 vs. 3.6 +/- 2.1 micrograms/min, P = 0.004) and occurred much sooner after OTFC than after oral solution administration (19 +/- 2.6 vs. 87.5 +/- 38.1 min, P = 0.001). Systemic bioavailability was greater after OTFC administration than after the oral solution (0.52 +/- 0.1 vs. 0.32 +/- 0.1, P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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              Long-term safety of oral transmucosal fentanyl citrate for breakthrough cancer pain.

              This open-label study evaluated the long-term safety and tolerability of oral transmucosal fentanyl citrate (OTFC) in ambulatory cancer patients with breakthrough pain undergoing cancer care at 32 university- or community-based practices. Patients had participated in a previous short-term titration trial of OTFC, were experiencing at least one episode per day of breakthrough pain, and had achieved relief of their breakthrough pain with an opioid. Patients received OTFC units at a starting dosage strength determined in the short-term trial (200-1600 microg). Outcome measures included number of successfully treated breakthrough pains, global satisfaction rating (0 = poor through 4 = excellent), and side effects. In total, 41,766 units of OTFC were used to treat 38,595 episodes of breakthrough pain in 155 patients. Number of treatment days ranged from 1 to 423 (mean, 91 days). Patients averaged 2.9 breakthrough pain episodes per day. About 92% of episodes were successfully treated with OTFC and there was no trend toward decreased effectiveness over time. Most patients (61%) did not require dose escalation during treatment. Global satisfaction ratings were consistently above 3, indicating very good to excellent relief. Common adverse events associated with OTFC were somnolence (9%), constipation (8%), nausea (8%), dizziness (8%), and vomiting (5%). Six patients (4%) discontinued therapy due to an OTFC-related adverse event. There were no reports of abuse and no concerns about the safety of the drug raised by patients or families. OTFC was used safely and effectively during long-term treatment of breakthrough pain in cancer patients at home.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                April 2005
                : 12
                : 3
                : 154-157
                Affiliations
                [01] Cádiz orgnameHospital Universitario Puerta del Mar orgdiv1Servicio de Anestesiología Reanimación y Unidad del Dolor
                Article
                S1134-80462005000300004
                f39bc146-1da9-4803-809d-25e7929ab4bd

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 02 September 2004
                : 15 January 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 12, Pages: 4
                Product

                SciELO Spain


                Citrato de fentanilo,Piezas dentales,Fentanyl citatre,Dental pieces

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