Methoxyflurane (Penthrox®) administered as an inhalation vapour via a hand-held inhaler is approved in Europe for the emergency relief of moderate to severe pain in conscious adults with trauma-associated pain. The time to the onset of meaningful pain relief is 3–4 min. Methoxyflurane provided effective levels of analgesia in patients presenting to the emergency department pain associated with minor trauma, was more effective than intramuscular tramadol when administered by paramedics for acute musculoskeletal pain, and had a more rapid onset of action than tramadol in patients presenting to the emergency department with ankle injuries. When used to relieve trauma pain in the emergency setting, methoxyflurane is generally well tolerated and, unlike when it was used at higher doses as an inhalational anaesthetic, is not associated with a risk of nephrotoxicity. With its non-invasive route of administration, ease of use and/or rapid onset of action, patient-administered inhaled methoxyflurane is a useful option for the management of trauma pain in the pre-hospital or emergency department setting.
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The manuscript was updated from Clinical Drug Investigation 2016;36(12):1067–73 , and was reviewed by: A.D. Dayan, London, UK; E. Griffiths, UK Search and Rescue, North Wales, UK; S. Hartshorn, Emergency Department, Birmingham Children’s Hospital, Birmingham, UK; A. Konkayev, Astana Medical University, Astana, Kazakhstan; J. Mclennan, Emergency Medicine, Royal Stoke University Hospital, Stoke on Trent, UK. During the peer review process, the marketing authorization holder of methoxyflurane was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.
The preparation of this review was not supported by any external funding.
Conflicts of interest
H. A. Blair and J. E. Frampton are employees of Adis/Springer, are responsible for the article content and declare no conflicts of interest.
Additional information about this Adis Drug Review can be found at http://www.medengine.com/Redeem/60E8F0603564A77D.
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Blair, H.A., Frampton, J.E. Methoxyflurane inhalation vapour in trauma pain: a profile of its use in the EU. Drugs Ther Perspect 33, 403–408 (2017). https://doi.org/10.1007/s40267-017-0433-7