April 24, 2018

Topical Long-Acting Fentanyl is Available For Your Patients

Elanco has done a great job of marketing their product to make us all aware of the new topical Fentanyl.  You apply it safely, hold the dog until it dries, then put a t-shirt on the dog for 72 hours to be safe.  And of course any time you touch the dog you should wash your hands before sucking on your fingers. This miracle formulation gives extended pain relief in dogs for four days with a few milliliters of solution applied dorsally, much like frontline.

RecuvyraThis new technology is based on a fast- drying, small volume of fentanyl-containing liquid, that contains penetration enhancers, that when applied topically, deposit drug into the pet’s skin for long acting transdermal delivery to its bloodstream. It is certainly a much better and more consistent option than the fentanyl patches.

Fentanyl is a potent mu opioid receptor agonist that was discovered to identify an improved human health analgesic over morphine, an opioid frequently associated with histamine-release, bradycardia, hyper- or hypotension, and prolonged postoperative respiratory depression. In conscious dogs, fentanyl has a wide margin of safety, possesses minimum effects on the cardiovascular and respiratory systems, and is readily reversible. Other pharmacological features include sedation, mild reductions in body temperature, and dose-dependent reduction in food intake.  The recent approval of long-acting transdermal fentanyl solution for dogs provides a new approach for sustained delivery of fentanyl for the control of postoperative pain in dogs. It has a rapid onset of action, prolonged duration, and mitigates the disadvantages of oral, parenteral, and patch-delivered opioids.

There are several advantages to transdermal fentanyl solution (TFS) for use in dogs. It is approved for use in dogs and thus there have been extensive studies to demonstrate safety and effectiveness; it is readily available commercially; there is no concern for the legal implications of extra-label drug use as with nonapproved drugs; there is regulatory oversight in its manufacturing process unlike compounded drugs, and up-to-date adverse events information is mandated through pharmacovigilance. TFS is not delivered via a device and therefore there is no need for hair clipping, concern for adhesion of a device to the skin, or adverse clinical consequences because of temperature-induced altered fentanyl flux. As a concentrated liquid, only a small volume (50 lL⁄kg) of TFS applied to the skin of the dorsal scapular area is necessary and is readily applied with the aid of an applicator designed for dogs. Once applied, the dose is dried within 2–5 min where fentanyl is deposited into the stratum corneum for prolonged systemic absorption. As a professional, in-hospital only product, there is no need for owner handling or re-administration; thus, compliance issues are eliminated. A single dose applied prior to surgery delivers fentanyl at therapeutic concentrations with an onset of action of 2–4 h and duration of at least 96 h (4 days). These characteristics allow for both preemptive analgesia and sustained opioid-level analgesia for 4 days postoperatively delivered to conscious ambulatory dogs.

DogIn order to have this product on hand, your practice must go through a quick online orientation, get a DEA 222 form and order it.  The bottles are roughly $300 in cost, and can be used on ten 50 pound dogs within 30 days.  Once the bottle is opened it expires in 30 days.  It is also only approved for orthopedic surgeries in dogs.  This potential overhead, and waste of unused portions of the bottle have many veterinarians who want to use the drug, not buying it.

However, with the recent passing of the Veterinary Mobility Act by Congress, Gateway Veterinary Surgery will be offering this topical medication to our clinics that have been through the online training course! Simply have two people do the online training, and download the owner consent forms for the owner before you book your next orthopedic surgery.  We will bring the Recuvyra to you and help apply it before surgery. Please ask us about this program via email or next time we are in your clinic.  It’s just another way we are bringing top level care to your patients, in the convenience of your practice.