Supportive Care in Cancer

, Volume 21, Issue 8, pp 2335–2339 | Cite as

The use of fentanyl buccal tablets for breakthrough pain by using doses proportional to opioid basal regimen in a home care setting

  • Sebastiano MercadanteEmail author
  • Giampiero Porzio
  • Federica Aielli
  • Lucilla Averna
  • Corrado Ficorella
  • Alessandra Casuccio
Original Article


The dose of rapid onset opioids to be given for breakthrough cancer pain (BTcP) is controversial. Dose proportional to the basal opioid regimen seem to be safe and effective in hospital units. However, data in other less protected settings, like home care, are lacking. The aim of this open-label study was to assess the efficacy and safety in a group of patients with BTcP followed at home, after giving a dose of fentanyl buccal tablets (FBT) proportional to the opioid basal regimen, skipping the steps for dose titration. Consecutive patients admitted to a home care program presenting BTcP episodes and receiving stable doses of opioids for background pain were selected. Data from four consecutive episodes of BTcP were collected. For each episode, patients were instructed to routinely collect changes in pain intensity and severe adverse effects when pain got severe (T0) and to reassess the same items 15 min after FBT, given as a rescue medication in doses proportional to the daily opioid doses used for background pain (T15). One hundred twenty episodes of BTcP were recorded in 30 patients. One hundred eight episodes were defined as successfully treated, while 12 episodes required a further administration of opioids. Pain intensity significantly decreased at T15 (p < 0.001). In 95.5 and 90.8 % of episodes treated, there was a reduction in pain intensity of more than 33 and 50 %, respectively. No relevant adverse effects were recorded, even in older patients. This study suggests that FBT given in doses proportional to the basal opioid regimen for the management of BTcP is very effective and safe in clinical practice in the home care setting.


Cancer pain Breakthrough–episodic pain Fentanyl buccal tablet Opioids Home care 



We wish to thank the patients, relatives, and the nursing staff of L' Aquila per la Vita for the support provided in recording the data.

No conflict of interest declared.

No funding


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    • 2
    Email author
  • Giampiero Porzio
    • 3
  • Federica Aielli
    • 3
  • Lucilla Averna
    • 3
  • Corrado Ficorella
    • 3
  • Alessandra Casuccio
    • 4
  1. 1.Anesthesia and Intensive Care Unit & Pain Relief and Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Department of Anesthesiology, Intensive care and Emergency, Palliative Medicine TeachingUniversity of PalermoPalermoItaly
  3. 3.Department of OncologyUniversity of L’Aquila and L’Aquila per la vita—home careL’AquilaItaly
  4. 4.Department of Experimental Biomedicine and Clinical NeuroscienceUniversity of PalermoPalermoItaly

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