Intranasal fentanyl spray (INFS) is a rapid-acting fentanyl formulation used for treatment of breakthrough pain in cancer patients already receiving maintenance opioid therapy for chronic pain. Instanyl is absorbed through the nasal mucosa, and it is shown that is has the same rapid onset of action and the same pain relieving effect as fentanyl given intravenously.
If you can predict breakthrough pain oral morphine should be tried, but the longer duration of working can be a problem. Spontaneous breakthrough pain in hospitalised patients can be treated with intravenous morphine. If cheaper medicine containing morphine can not be used then INFS and the dispersible tablet are rational choices, even though a unblinded study indicates that INFS has a faster onset of meaningful pain relief at 11 minutes compared with fentanyl dispersible tablets, that reliefs pain after 16 minutes.
The price for Instanyl (116Dkr per dose) is in line with the price of fentanyl dispersible tablets, Actiq (117 Dkr per dose). These prices are much higher than normal opioid treatment (0,26-2,89 Dkr / dose).
It is not decided whether Instanyl is under the rules of general reimbursement.
Instanyl was marketed the 21st of September 2009.