Name of the medicine:

Alfentanil 5 mg/5 ml sublingual spray

What is it for?

Alfentanil is a strong pain reliever that works very quickly. It is used to treat the kind of moderate to severe pain that comes on suddenly without warning (sometimes called breakthrough pain). It is also used to treat pain that is brought on by movement or something like changing a dressing (called incident pain). These kinds of pains usually last for a short time so a pain reliever like alfentanil can help. If you know what brings your pain on, you can use the spray in advance to prevent pain.

Most medicines available in the UK have a licence. The licence describes the conditions the medicine can be used to treat, and how the medicine can be given. The manufacturer of the medicine has to show that the medicine is safe and made to a high standard before the medicine is licenced.

Alfentanil is a licensed pain medication, but the nasal spray does not have a license for use.

The information in this leaflet is not included in the information leaflet supplied with the medicine.

We are giving you this extra leaflet to tell you about the reason(s) why you are taking this medicine and to highlight other information. You should read both leaflets. 

What form(s) of this medicine are there and how is it usually taken?

 The spray comes in several parts:

(1)    A brown glass bottle containing the alfentanil liquid

(2)    A pump mechanism that screws into the bottle

 (3)   A spray head with a 10-cm long tube used to spray the medicine under your tongue

(4)    A short spray head with a clear plastic cover used to spray the medicine inside your nostril. Your doctor or nurse will explain which head to use.

·      Wash your hands before putting the spray together on a clean surface like a kitchen worktop

·      Open the plastic bag and push the spray head (3 or 4) onto the shorter of the two plastic tubes of the pump mechanism (2)

·      Open the glass bottle (1). Remove the rubber insert and screw the pump mechanism, with the spray head attached, onto the bottle. Then throw the original cap and rubber insert away.                                         

Before you use the spray for the first time, press the button fully twice to fill the tubes (prime the spray). This only needs to be done when you first set up the spray pump and NOT each time you use it. After using your spray, put it back inside the resealable plastic bag to keep it clean.

How to use the nasal spray:

·      Use the shorter spray nozzle – item (4) pictured in the image above 

·      Blow your nose if you feel you need to

·      Sit down or lie down with your head upright

·      Place the short spray nozzle a short way into your nostril and tilt it towards the wall of the nostril

·      Close the other nostril using the fingertip of your other hand

·      Press the spray, with fingers on either side of the spray

·      Breathe in gently through your nose and out through your mouth

·      If you have been prescribed more than one spray, repeat this using the other nostril

How to use under the tongue:

·      Use the longer spray nozzle – item (3) pictured in the image above

·      Place the end of the nozzle under your tongue and press down on the nozzle head

·      If you are prescribed more than one spray, repeat 

What are the most common side effects I might experience?

Sleepiness

Some people feel drowsy while the alfentanil is working, but this should wear off quickly. This is more likely to happen when you first take alfentanil or when your dose is increased.  It should improve after a few days. You MUST NOT drive whilst you are experiencing this. Please refer to our leaflet on driving and the use of strong opioids.

Sickness

Some people may feel a bit sick when they start using alfentanil, l but this soon settles.  Your health professional may give you an anti-sickness medicine to take for a few days.

Dry mouth

Alfentanil may make your mouth dry. Make sure that you keep your teeth and mouth clean.

·       Brush your teeth regularly.

·       Keeping your lips moistened with lip salve, or an oral spray or gel may help. Speak to your doctor or nurse if this side effect is a problem for you.

·       Regular small sips of water and sucking crushed ice or ice lollies can help too. 

Constipation

Alfentanil can cause constipation, but this is not common and can usually be avoided by eating a high-fibre diet and drinking fluids. If you are prescribed a laxative, it is important to take it regularly, as prescribed, if you require this.  The dose of laxative can be increased or reduced to make sure you pass a soft motion regularly.  Speak to your doctor or nurse if these side effects are a problem for you.

What other information should I know about this medicine?

Please remember to order your repeat prescription with a few days spare, to allow it to be processed.  

Alfentanil nasal spray is not kept in stock by most community pharmacies. It may take a few working days for your local pharmacist to obtain Alfentanil nasal spray. At least a few days before running out of Alfentanil nasal spray, make sure you get a prescription from your GP and ask your local pharmacist to order more for you. This ensures that there are no gaps in you taking your medication. You or your representative may be asked to sign for collecting this medicine at the community pharmacy. 

It is important not to order more medication than you need. Even if you return them to the pharmacy in future, they cannot be reused after they have been labelled for your use and must be disposed of. 

Your medication needs to be kept in a safe place out of the reach of children.  

It is important to store your medication in the original container.  

Return ALL unused medication to a pharmacy.  

If for any reason a you or your carer are UNABLE to go to the pharmacy, medication can be disposed of at home. However, it is important NOT to flush it down the toilet as this pollutes the water. Medication can be disposed of in a general waste bin, ensuring that cannot be accessed by children or animals, although disposal at a pharmacy is preferable.

What dose will I use?

The dose prescribed for you will depend on your pain. You may start with 1 or 2 sprays for an episode of pain. The dose can be increased if your doctor or nurse tells you to do that.

When do I take it?

Your doctor or nurse will explain how to use the spray and when to take it.   This will depend on the pain that you are having. The spray will work best if you take it as soon as the pain starts to come on or just before you do something that gives you pain.

Some people only need to use the spray occasionally. Others may need to use it more often. It is important to follow the advice given by your doctor or nurse. There should be at least 1 hour between using the alfentanil spray and taking a further dose. If you are using the alfentanil spray more than 4 times a day, then please consult with your doctor.

How long will it take to work?

Alfentanil passes quickly through moist skin in the mouth and nose into the bloodstream. Most people get pain relief within 5–10 minutes and the effect lasts for about 30 minutes.

It is useful to keep a note of when you take a spray and how well it works.

Will alfentanil always relieve my pain completely?

Although alfentanil is a very good pain reliever, it is not helpful for all types of pain. Your doctor may prescribe an additional quick-acting pain reliever that you can take if you are still having pain despite having taken the alfentanil.

Can I drive?

You may be able to drive but you must discuss this with your doctor. You must not drive if you feel drowsy or unwell.

https://www.nhsinform.scot/care-support-and-rights/palliative-care/practical-help-and-advice/driving-when-taking-strong-painkillers

Can I drink alcohol?

Alfentanil spray can make you drowsy so you should not take alcohol when you are using this medicine.

What happens if I swallow or inhale the spray?

It is not dangerous to breathe in some drops of the spray through your nose or to swallow the spray, but it will not work for your pain. The medicine needs to be in direct contact with the moist areas in your mouth or nose to reach your bloodstream to work.

How long will the spray bottle last?

It contains enough liquid for about 30 sprays. Once a bottle has been opened it can be used for up to 28 days (4 weeks). If you write the date you opened the bottle on the bottle label it will help you remember to ask for a new bottle in time. It can take a few days for the alfentanil spray to arrive at your local pharmacy so please allow time for this when asking for a repeat prescription.

Discuss the leaflet with your doctor, nurse or pharmacist who will answer any questions you may have.