Comparative Pharmacology
Head-to-head clinical analysis: OPANA versus SUBSYS.
Peer-Reviewed Evidence
Head-to-head clinical analysis: OPANA versus SUBSYS.
OPANA vs SUBSYS
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Mu-opioid receptor agonist; produces analgesia by binding to opioid receptors in the CNS, inhibiting ascending pain pathways and altering pain perception.
SUBSYS (fentanyl) is a mu-opioid receptor agonist that produces analgesia by mimicking endogenous opioids, increasing potassium efflux and reducing calcium influx, thereby inhibiting neuronal transmission of pain signals.
5-20 mg orally every 4-6 hours as needed for pain; extended-release tablets: 5 mg orally every 12 hours, titrated up to 20 mg every 12 hours.
SUBSYS (fentanyl buccal soluble film) is indicated for breakthrough pain in opioid-tolerant patients. Initial dose: 100 mcg (one 100 mcg film) placed on the inner cheek, allowed to dissolve over 15-25 minutes; may repeat once after 30 minutes if pain not relieved. Titrate to effective dose (200, 400, 600, 800, 1200, 1600 mcg). Maximum: 4 doses per day. No more than 2 doses per breakthrough pain episode. Wait at least 2 hours before treating next episode.
None Documented
None Documented
Terminal elimination half-life is 11-16 hours (mean 14 hours) in adults; prolonged in hepatic impairment (up to 30 hours) and elderly.
Terminal half-life 2–4 hours (single dose); prolonged to 7–15 hours in hepatic/renal impairment; clinical context: necessitates q4–6h dosing for chronic pain.
Primarily renal (approximately 90% as conjugated metabolites, 10% unchanged); biliary/fecal elimination accounts for <10%.
Primarily renal (~75% as metabolites, <10% unchanged); biliary/fecal excretion of conjugates; ~9% in feces.
Category C
Category C
Opioid Analgesic
Opioid Analgesic