# Fentanyl (transmucosal, for breakthrough cancer pain)

Source: https://onco.cc/drugs/fentanyl/  
OnCo record `fentanyl` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

These are fast-acting forms of the opioid fentanyl, taken as a tablet against the cheek or as a nasal spray, for sudden flares of pain in people whose cancer pain is otherwise controlled by a regular opioid. They are only for patients already tolerant to opioids.

## Summary

Three centrally authorised fentanyl products are indicated for breakthrough pain in adults who are already receiving maintenance opioid therapy for chronic cancer pain, breakthrough pain being a transitory exacerbation on a background of otherwise controlled persistent pain: Effentora buccal tablets (authorised 4 April 2008; marketing authorisation holder Phoenix Labs Unlimited Company), Instanyl nasal spray (authorised 20 July 2009; Istituto Gentili S.r.l.) and PecFent nasal spray (authorised 31 August 2010; Gruenenthal GmbH). The EMA lists the therapeutic area as pain. This record covers the cancer-pain formulations only.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-22
- Also known as: fentanyl; fentanyl citrate; Effentora; Instanyl; PecFent
- Tags: ema-register; supportive
- Brand: Effentora / Instanyl / PecFent
- Modality: Small-molecule opioid analgesic (buccal tablet and nasal sprays)
- Mechanism: Mu-opioid receptor agonist formulated for fast absorption through the mouth or nose, for breakthrough pain in adults already on maintenance opioid therapy for chronic cancer pain (indication wording, EMA).
- Approvals: EU 2008: Breakthrough pain in adults receiving maintenance opioid therapy for chronic cancer pain

## Sources

- EMA: Effentora (EPAR): https://www.ema.europa.eu/en/medicines/human/EPAR/effentora
- EMA: Instanyl (EPAR): https://www.ema.europa.eu/en/medicines/human/EPAR/instanyl
- EMA: PecFent (EPAR): https://www.ema.europa.eu/en/medicines/human/EPAR/pecfent

## Connected records

- drugs: [Methylnaltrexone](https://onco.cc/drugs/methylnaltrexone/)
- technologies: [Cancer pain management](https://onco.cc/technologies/pain-management/)
- targets: [Mu-opioid receptor](https://onco.cc/targets/oprm1/)
- companies: [Grünenthal](https://onco.cc/companies/gruenenthal/)

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