Actiq® 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 information should be read together with the manufacturer’s patient information leaflet.
What is Actiq®?
Actiq® is a lozenge which contains a drug called fentanyl, which is a strong opioid painkiller. As it is absorbed quickly, it may provide rapid pain relief. You will only be prescribed Actiq® if you are already taking a regular strong opioid painkiller (such as morphine, fentanyl or oxycodone).
How do I take Actiq®?
The lozenge should be placed in the mouth against the cheek and moved around the mouth using the handle which is supplied. If your mouth is dry, you may use water to moisten your mouth.
Do not bite, suck or chew Actiq®. You should consume the lozenge for over 15 mins to get the most relief. If you finish Actiq® too quickly, you will swallow more of the medicine and get less relief. If you begin to feel unwell in any way while taking Actiq®, you should immediately remove the lozenge from your mouth.
What dose of Actiq® is usually prescribed?
You will always start by taking 200 micrograms of Actiq® as required for breakthrough pain. This is because the effects vary from person to person and the dose is increased based on how effective it is at managing your pain. If adequate pain relief is felt within 15 to 30 minutes you will remain on 200 micrograms of Actiq®. If not, the dose will be increased. Your doctor will talk this through with you and make sure the required tablet strengths are prescribed.
You can take up to 4 doses of Actiq® 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 4 hours between doses.
Actiq® titration (dose change) process
Start dosing at 200 micrograms (1 lozenge)
Use the Actiq® lozenge over 15 minutes
Wait for 15 minutes more. If you still have pain, use only one more Actiq® lozenge (same strength as before)
Continue to use this strength lozenge for future episodes of breakthough pain
Was your pain controlled with one Actiq® lozenge?
If yes, continue to take this dose
If no, increase dose to next strength - available dosage strengths include: 200, 400, 600, 800, 1200, and 1600 micrograms. For example, if you needed to take 2 lozenges of 200 micrograms to treat this pain episode, for the next pain episode you use the 400 microgram lozenge.
Can I take Actiq® with my other medications?
All of your medications will be reviewed when you are prescribed Actiq® and you will be advised as to whether you will continue with any medication that you have previously been prescribed for pain.
Actiq® 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 Actiq® 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 Actiq® 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 Actiq® can slow your breathing pattern. If this is not treated, it can be 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 Actiq® addictive?
Most patients do not become addicted when Actiq® is started appropriately and reviewed alongside your pain. However, there have been some reports of addiction to short-acting 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 Actiq® 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 Actiq®?
There are no routine tests required. The healthcare professional managing your pain will want to make sure that your blood tests have been checked prior to starting treatment, to make sure there are no issues with your kidney and liver function.
Can I drive if I am taking Actiq®?
Actiq® 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 Actiq® 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?
Actiq® 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 prescribe Actiq®?
Actiq® will be first prescribed by the supportive care team. It will then be agreed between the supportive care team and your GP or other local service who will issue further prescriptions.
How do I get further prescriptions for Actiq®?
Actiq® is a specialist medicine and is not readily available from your community pharmacy, they will require advance notice to order.
If your GP is willing to prescribe Actiq®, 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, Actiq® 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 Actiq® and are unable to get a further supply, you must contact the supportive care team for advice.
How should Actiq® be stored?
Please keep them 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 advice by calling 999. When taken as directed and under medical supervision, Actiq® is safe for you. However, they are dangerous and potentially fatal, if they are taken by someone they are not prescribed for.
Partially consumed Actiq® may still contain enough medicine to be harmful or life-threatening to a child. Even if there is a little or no medicine left on the handle, the handle itself must be properly disposed of as follows:
if the medicine is totally gone, throw the handle away in a waste container that is out of reach of children and pets
if any medicine remains on the handle, place the lozenge under hot running water to dissolve the remainder and then throw the handle away in a waste container that is out of the reach of children and pets
if you do not finish the entire lozenge and you cannot immediately dissolve the remaining medicine, put the lozenge out of the reach of children and pets until such a time as you can dispose of the partially used lozenge as instructed above
do not flush partially used lozenge, handles, or the blister packaging down the toilet. 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.
Actiq® may be used before or after, but not during, meals. You must not drink or eat anything while taking the medicine.
Actiq® contains glucose and sucrose (types of sugar)
If you have been told by your doctor that you cannot tolerate or digest some sugars, talk to your doctor before using Actiq®.
Each lozenge contains about 2 grams of glucose. If you have diabetes, you need to take this into account.
The glucose in the lozenge may be harmful to the teeth. Always make sure you clean your teeth regularly.
Who should I phone if I need urgent advice about Actiq®?
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