As a premedicant, 1-2 ml fentanyl may be given intramuscularly 45 minutes before induction of anesthesia. Doses in excess of 200mcg are for use in anesthesia only.The dose of fentanyl should be individualized according to age, body weight, physical status, underlying pathological condition, use of other drugs and type of surgery and anesthesia. Fentanyl injection can be administered intravenously either as a bolus or by infusion & by intramuscular route also.Dosage Adjustment: Generally, the dose of Fentanyl should be increased when patients require more than one dose per breakthrough pain episode for several consecutive episodes.To reduce the risk of overdose during titration, patients should have only one strength of Fentanyl tablet available at any one time. Titrate above 400 mcg by 200 mcg increments bearing in mind using more than 4 tablets simultaneously has not been studied and it is important to minimize the number of strengths available to patients at any time to prevent confusion and possible overdose. If this dose is not successful in controlling the breakthrough pain episode, the patient may be instructed to place two 100 mcg tablets on each side of the mouth in the buccal cavity (total of four 100 mcg tablets). Patients require to titrate above 100 mcg can be instructed to use two 100 mcg tablets (one on each side of the mouth in the buccal cavity). Increasing the dose: Titration should be initiated using multiples of the 100 mcg Fentanyl tablet.Re-dosing may occur 30 minutes after the start of administration of Fentanyl and the same dosage strength should be used. Re-dosing patients within a single episode: Dosing may be repeated once during a single episode of breakthrough pain if pain is not adequately relieved by one Fentanyl dose.Starting Dose: The initial dose of Fentanyl should be 100 mcg.

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