Abstral is an opioid analgesic, or narcotic, prescribed in order to help cancer patients when they experience breakthrough pain. Breakthrough pain is sudden, intense pain that occurs despite the other pain medications already present in their system.
Abstral has a powerful pain-relieving effect; it’s meant to stop an agonizing burst of pain for people who are constantly dealing with and battling pain. Due to its high potential for misuse, Abstral can only be obtained by cancer patients who are taking other opioids for pain management, and it can only be accessed through a restricted program via the Food and Drug Administration.
The FDA approved Abstral for breakthrough pain in January 2011.
Due to the high risk for substance misuse, psychological addiction, or overdose, Abstral should only be taken as directed by a doctor. Increasing the amount without medical consent can lead to the psychological disease of addiction. Many doctors warn their patients of the risks associated with Abstral. The opioid should never be taken more than twice during one breakthrough episode.
Abstral is offered as a sublingual tablet, meaning the tablet is placed under the tongue to dissolve, and it should never be chewed or swallowed. Initial doses start around 100 mcg, although a doctor may change this depending on the frequency and intensity of the pain.
It is not recommended to take another dose of Abstral within two hours of the last tablet, as it may cause side effects and overdose if continued.
Common side effects of Abstral include nausea, dizziness, drowsiness, vomiting, constipation, and dry mouth.
Most cancer patients already have a well-developed tolerance to opioid analgesics prior to taking Abstral. Unfortunately, this often increases the risk for the patient to misuse the drug. Misuse occurs when a person taking Abstral begins to increase their dose and take it more frequently without consulting their doctor. This does not mean they are addicted to Abstral, but the risk is far greater.
If someone is struggling with a substance use disorder, they begin to have uncontrollable cravings for Abstral and might start neglecting important aspects of life. Everyday life will begin to feel less important. Sometimes a person struggling with addiction will steal to obtain what they seek; this can cause problems with family members as well as trouble with the law.
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Staying in recovery is difficult, and if someone attempts detox alone, the risk for recurring use is much higher. Finding the best treatment program for you or a loved one can have a drastic impact on the future.
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Follow-up treatment involves closely monitoring the patient for respiratory depression. This is especially critical if the patient is arriving in the emergency room. Individuals arriving through the ER have an unknown variety of risk factors. Patients with a history of chronic pulmonary disease, or who are cachectic or debilitated have a higher chance of life-threatening respiratory depression returning.
Serotonin syndrome is a potentially fatal risk factor when serotonergic drugs are mixed with Abstral. Serotonergic drugs include many common anti-anxiety medications such as SSRIs (selective serotonin reuptake inhibitors). Patients with adrenal insufficiency and a history of hypotension are also at increased risk.
If you or someone you know is struggling with an opioid misuse disorder, The Recovery Village is available to answer any questions you may have.
The amount of Abstral necessary to overdose can be surprisingly low for some patients. Extreme caution must be exercised when introducing Abstral into a patient’s system. Even in opioid-tolerant users, the initial dose of Abstral should be limited to 100 mcg. The one exception is for patients who are switching to Abstral from Actiq. Actiq is pharmacologically similar enough to allow for a low-risk transition.
Individuals with impaired liver function may have an increased risk for overdose. Abstral is metabolized primarily by the liver. A poorly functioning liver can lead to elevated blood plasma levels of the drug and an extended plasma clearance time. As a result, Abstral may linger in the system at higher than therapeutic doses.
Abstral is a narcotic and will show up in a drug test screening, so it’s important to inform your drug test administrator that you are taking or have recently taken this prescription. Abstral will stay in your urine and blood for at least 5 days, but will stay in your hair considerably longer. Drug test on your hair can show traces of Abstral and other medications for up to 90 days after your last dose.
If you feel you or a loved one is suffering from substance use disorder, it’s not too late to stop drugs from taking over your life. The Recovery Village has well-trained staff standing by to answer your questions.
Abstral is a brand-name medication that contains the powerful and often addictive painkiller fentanyl. Abstral is available as a sublingual tablet and classified as an opioid or a narcotic. Abstral is meant to be taken only in very specific circumstances, and it is prescribed for breakthrough pain in opioid tolerant patients who have been receiving continuous opioid therapy for managing pain. For a patient to be considered opioid tolerant, they would need to have been taking at least 60 mg of morphine daily for a week. For someone who isn’t opioid-tolerant or who takes Abstral outside of prescribing guidelines, it can be dangerous and deadly. Abstral, similarly to other opioids, slows the central nervous system and the respiratory system. Breathing can slow to the point that someone overdoses or dies as a result.
While Abstral has rigid prescribing guidelines, as with other opioids, it is sometimes diverted from medical use and sold on the black market. Abstral and other drugs containing fentanyl are in high-demand because of the opioid epidemic. Since fentanyl is so potent, people seek it out. It’s also included in other drugs sold on the black market. If people do not realize they’re taking it, they may die. Abstral is a Schedule II controlled substance in the U.S. It’s available only through a program from the Food and Drug Administration called a Risk Evaluation and Mitigation Strategy (REMS). In this program, healthcare professionals who prescribe medicines to outpatients and pharmacies must enroll.
Is it safe to take Abstral while pregnant? The answer is no. The FDA’s data sheet on Abstral warns that it can cause fetal harm and it’s not recommended to be taken by women who are breastfeeding, either. There are two different scenarios where a person may wonder if it’s safe to take Abstral while pregnant. The first would be if they were misusing opioids and became pregnant. The second scenario is during labor and delivery. If a woman is treated with epidural or intravenous fentanyl during labor and delivery, then the management of the medication is up to the treating physicians. In terms of someone who is misusing or addicted to Abstral or fentanyl and becomes pregnant, it’s not safe, and the woman should speak with her physician openly and honestly to try and determine what options may be available.
Since Abstral is an opioid, it can affect a fetus in a way similar to other drugs in this class. Other opioids include prescription pain medicines like hydrocodone and oxycodone, as well as heroin. Abstral can increase the risk of miscarriage and preterm labor and premature birth. Taking opioids during pregnancy is associated with an increased risk of birth defects like spina bifida and heart defects as well as low birthweight and fetal growth restriction.
However, if a woman is dependent on Abstral or another opioid when she becomes pregnant, stopping suddenly can also be dangerous. Abruptly stopping opioids while pregnant can increase the risk of preterm labor, premature birth or placental abruption. Placental abruption can cause heavy bleeding that can be deadly for a woman and the child. Also possible is a stillbirth, which is the death of a baby in the womb anytime after the 20th week of pregnancy. Instead of trying to stop treatment on your own, it’s important to speak with your healthcare provider about the safest route to take.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.