Comparative Pharmacology
Head-to-head clinical analysis: IONSYS versus STADOL.
Peer-Reviewed Evidence
Head-to-head clinical analysis: IONSYS versus STADOL.
IONSYS vs STADOL
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
IONSYS is an iontophoretic delivery system for fentanyl, a mu-opioid receptor agonist. Fentanyl binds to mu-opioid receptors in the CNS, inhibiting ascending pain pathways and altering pain perception and emotional response.
Partial agonist at mu-opioid receptors and agonist at kappa-opioid receptors in the CNS, altering pain perception and emotional response to pain.
Apply one 40 mcg fentanyl iontophoretic transdermal system to skin on upper arm or chest; delivers 40 mcg per dose on-demand for up to 24 hours or 80 doses, whichever is shorter. Maximum 2 doses per hour, 6 doses per application. Patient must be opioid-tolerant.
Butorphanol tartrate 1-2 mg IV or IM every 3-4 hours as needed for pain; alternatively, 0.5-1 mg IV every 3-4 hours. For nasal spray: 1 mg (one spray) in one nostril, may repeat in 60-90 minutes if needed; then 1 mg every 3-4 hours as needed.
None Documented
None Documented
Terminal elimination half-life: 16.3 ± 9.1 hours for fentanyl released from IONSYS; accounts for prolonged release from depot and is longer than intravenous fentanyl (3-12 hours).
Terminal elimination half-life: 2.5-4 hours; clinically, prolonged in hepatic impairment (up to 10-12 hours) and elderly
Renal: approximately 90% as fentanyl metabolites (mainly norfentanyl) and less than 10% as unchanged drug; fecal: less than 10%.
Renal: 85-90% as unchanged drug and metabolites (primarily as glucuronide conjugates); Fecal: <10%; Biliary: minimal
Category C
Category C
Opioid Analgesic
Opioid Analgesic