Abstral® SL tablets

Abstral® is used to treat breakthrough pain (a temporary flare in pain) related to cancer. The possible benefits of treatment vary; your doctor, nurse, or pharmacist will be happy to answer any questions you have about your treatment.

This leaflet should be read together with the manufacturer’s patient information leaflet.

What is Abstral®?

Abstral® is a tablet which contains a drug called fentanyl, a strong opioid painkiller. As it is absorbed quickly, it may provide rapid pain relief. You will only be prescribed Abstral® if you are already prescribed a regular strong opioid painkiller (such as morphine, fentanyl, and oxycodone).

How do I take Abstral®?

Peel back the foil in the blister pack and remove 1 tablet. Do not try to push the tablet through the foil or split it. Place the Abstral® tablet underneath your tongue (sublingual). The tablets should not be swallowed but allowed to dissolve completely without chewing or sucking. If your mouth is dry, use water to moisten your mouth prior to taking Abstral® to allow the tablet to dissolve.

Do not eat or drink until the tablet has completely dissolved. Most people get pain relief within 5 to 10 minutes and the effect lasts for about 30 to 60 minutes.

What dose of Abstral® is usually prescribed?

The starting dose is 100 micrograms of Abstral® which will be adjusted as required for each breakthrough pain episode. The effects vary from person to person and the dose is increased based on how effective it is at managing your pain. If pain relief is felt within 15 to 30 minutes you will remain on 100 micrograms of Abstral®. If not, the dose would be increased as described in the table overleaf. The prescriber will talk this through with you and write a prescription of the required strength.

You can take up to 4 doses of Abstral® in a 24 hour period. Sometimes, this may differ but the maximum number of doses will be agreed between you and the healthcare professional managing your pain. You must leave at least 2 hours between doses.

Abstral® titration (dose change) process

• Starting dose 100 micrograms

• Pain relief achieved within 15 to 30 minutes?

  • If yes, use this dose for subsequent breakthrough pain episodes

  • If no, take a second tablet (see table below to determine strength of second tablet) then increase first tablet to next higher strength for next breakthrough pain episode

Can I take Abstral® with my other medications?

All of your medications will be reviewed when you are prescribed Abstral® and you will be advised if you can continue with any medication that you have previously been prescribed for pain.

Abstral® may interact with some medications (including certain antifungal drugs such as fluconazole, and the antibiotics clarithromycin and erythromycin) and with certain foods and drink such as grapefruit and grapefruit juice while you are prescribed this medicine.

Use of Abstral® and sedative medicines such as benzodiazepines or related drugs increases the risk of drowsiness, and difficulties in breathing (respiratory depression). If you are taking any sedative medicines, you will be carefully monitored for side-effects.

If you have any queries or concerns about Abstral® and other medicines you are taking, you can discuss with your doctor, specialist nurse or pharmacist. Further information is available in the manufacturer’s patient information leaflet which is supplied with the medication.

What are the possible risks/side-effects?

Side effects may include; tiredness, sleepiness, sickness, constipation and confusion.

If you take too much, please seek medical attention urgently because Abstral® can slow your breathing pattern. If this is not treated, it can be potentially fatal. Signs of overdose include; slow or shallow breathing, loss of consciousness, extreme drowsiness, and feeling very dizzy or confused. Phone 999 if you experience these symptoms.

Is Abstral® addictive?

Most patients do not become addicted when Abstral® is started appropriately and reviewed alongside your pain. However, there have been some reports of addiction to these fentanyl preparations. Risk of addiction is lower when the medication is used as discussed with the prescriber, at the correct dose and time. Please discuss this with your doctor, specialist nurse or pharmacist if you would like further information.

What is the length of treatment and plan for follow up?

The length of treatment will depend on your symptoms. You will be regularly reviewed to assess whether the Abstral® needs to continue or the dose needs to be altered. We will agree together who will continue to review your pain. You will be either be reviewed by The Christie supportive care team or a local service if this is available.

Do I need to have any tests or special monitoring when taking Abstral®?

There are no routine tests required. The healthcare professional managing your pain will want to make sure that your blood tests have been checked before starting treatment to make sure there are no issues with your kidney and liver function.

Can I drive if I am taking Abstral®?

Abstral® may affect your mental and/or physical ability to perform potentially hazardous tasks such as driving or operating machinery. It may be an offence to drive if your ability to drive safely is affected by taking this medicine. You should not drive after starting Abstral® or after a dose change until you have had a discussion with your doctor regarding whether this is advisable and safe.

Can I drink alcohol?

Abstral® can make you feel sleepy, and alcohol will add to this. We advise that you avoid alcohol. If you would like any further information about this please discuss this with your doctor, specialist nurse or pharmacist.

Who will first prescribe Abstral®?

Abstral® will be prescribed by the supportive care team. It will be agreed between the supportive care team and your GP or other local service who will issue more prescriptions.

How do I get further prescriptions for Abstral®?

Abstral® is a specialist medicine and is not readily available from your community pharmacy; who require advance notice to order.

If your GP is willing to prescribe Abstral®, please do not leave it too late to request a prescription. You must request a prescription at least 72 hours in advance of you running out of medication to give your GP and community pharmacist time to arrange. Please allow extra time at weekends and bank holidays.

If you are attending The Christie supportive care or pain clinic for follow up, Abstral® may be dispensed by The Christie Pharmacy. You should be given enough supply to last you until your next review.

If you run out of Abstral® and are unable to get a further supply, you must contact the supportive care team for advice.

How should Abstral® be stored?

Please keep the tablets in their original packaging out of the reach of children or anyone else who might take them by mistake, and if they are consumed seek urgent medical attention by calling 999. When taken as directed and under medical supervision, Abstral® is safe for you. However, it is dangerous and potentially fatal if they are taken by someone they are not prescribed for. Any unused medication can be returned to any pharmacy for safe disposal.

Other useful information

See the patient information leaflet inside the product box for picture instructions of how to use.

Who should I phone if I need urgent advice about Abstral®?

Monday to Friday, 8am to 4pm, contact the supportive care team on 0161 446 3072 or 0161 446 3639. For urgent advice out of these hours or at weekends and bank holidays, contact The Christie Hotline on 0161 446 3658 (24 hours a day, 7 days a week).

Useful contacts

• The Christie Pharmacy: 0161 446 3433