Related Experiment Video
Updated: Jan 7, 2026
Author Spotlight: An Efficient Methodology to Confidently Differentiate and Characterize Fentanyl Analogs
Published on: November 8, 2024
Prevalence and Patterns of Off-Label Transmucosal Immediate-Release Fentanyl Use in French General Practice: A
Virginie Guastella1,2, Emeline Gueganno3, Célian Bertin4
1Université Clermont Auvergne, INSERM U1107, Neuro-Dol, CHU Clermont-Ferrand, Palliative Care Center, 63118, Cebazat, France. vguastella@chu-clermontferrand.fr.
Introduction:
Prescriptions of transmucosal immediate-release fentanyl (TIRF) have increased in recent years, driven by their rapid onset and ease of administration compared to other opioids like morphine and oxycodone, especially for breakthrough pain. A 2022 study reported high rates of off-label TIRF use, particularly among general practitioners (GPs). This study aimed to assess the prevalence and patterns of off-label TIRF use by GPs, and perceived efficacy for predictable pain associated with medical procedures. Secondary objectives included evaluating its use in other specific contexts such as swallowing or alertness disorders, acute pain, and overall tolerability.
Methods:
A mixed-methods study was designed to combine qualitative interviews exploring clinical contexts with a quantitative cross-sectional survey assessing the prevalence of off-label use of TIRF among French GPs. Data were collected through a national online survey.
Results:
A total of 682 completed questionnaires were analyzed. The study focused exclusively on off-label prescribing of TIRFs. Off-label use was reported by 46% of GPs across a variety of clinical indications. Specifically, 244 GPs (36%; 95% CI 32-40) reported prescribing TIRFs for procedural pain. Other off-label indications were also reported, including use for alertness disorders (24%; 95% CI 21-27), swallowing disorders (32%; 95% CI 28-35), and acute rheumatological pain (12%; 95% CI 9-14). These findings highlight a substantial level of off-label prescribing, with varying perceptions of efficacy and tolerability across different clinical contexts.
Conclusions:
This study confirms widespread off-label TIRF use in well-defined clinical situations. While many GPs report positive outcomes, important concerns remain, including limited training, difficulty with dose titration, and the risk of use disorder. Targeted education and clearer prescribing guidelines could help ensure a safer and more appropriate use of TIRF in GPs practice.
More Related Videos
Related Concept Videos
01:22Drug Delivery: Miscellaneous Routes
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs...
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:02Prescription, Nonprescription and Orphan Drugs
The misuse and addiction to prescription drugs is a growing problem that can affect people of all age groups, specifically teenagers. This can happen when prescription medications are used in ways not intended by the prescriber, such as taking someone else's prescription or using medication for...
01:15Non-Oral Extravascular Drug Absorption Routes
Lipophilic drugs that are stable at salivary pH (6) and exhibit minimal binding to the oral mucosa are absorbed more...
01:19Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
01:18Drug Delivery: Enteral Route