The proper dosage for fentanyl OTFC is a first dose of 800 mcg. A second dose may be repeated after 15 minutes if pain is uncontrolled by the first.
As Combat Medics, the oral transmucosal fentanyl citrate (OTFC) lozenges are the formulation of choice for administering fentanyl. Combat Paramedics and providers also have the option for considering IN and IV/IO routes of administration. In the end, the medical director for each unit will need to evaluate which medics are capable of performing each task (safely administering the right medication using the proper route of administration for the tactical situation) and develop unit-specific guidance that either supports the guideline recommendations or explains the rationale behind any alternative courses of action.
The method of administration for OTFC is outlined in the guidelines:
The added safety measure of taping the “lozenge-on-a-stick” or using a safety pin and rubber band works by pulling the lozenge from the casualty’s mouth when they inadvertently absorb a dose that results in somnolence as the supporting arm relaxes or the rubber band pulls the lozenge from the casualty’s relaxed mouth.
It should be noted that administering OTFC in a prehospital setting is an off-label use, as the FDA approval is for use in cancer patients. Nevertheless, several wilderness and austere medicine experts and professional societies also recommend its use in those settings.