Overdose : מינון יתר

4.9     Overdose
Patients should be informed of the signs and symptoms of overdose and to ensure that family and friends are also aware of these signs and to seek immediate medical help if they occur.
Symptoms and signs:
The manifestations of fentanyl overdosage are generally an extension of its pharmacological action. Depending on the individual sensitivity, the clinical picture is determined primarily by the degree of respiratory depression, which varies from bradypnoea to apnoea. Toxic leukoencephalopathy has been observed with fentanyl overdose.


Treatment:
Hypoventilation or apnoea:                O2 administration, assisted or controlled respiration.
Respiratory depression:                   Specific opioid antagonist. This does not preclude the use of immediate countermeasures.
The respiratory depression may last longer than the effect of the antagonist; additional doses of the latter may therefore be required.
Muscular rigidity:                        Intravenous neuromuscular blocking agent to facilitate assisted or controlled respiration.
The patient should be carefully observed; body warmth and adequate fluid intake should be maintained. If hypotension is severe or if it persists, the possibility of hypovolaemia should be considered and, if present, it should be controlled with appropriate parenteral fluid administration.