Lazanda

Generic Name: fentanyl (nasal) (FEN tan il)
Brand Names: Lazanda

What is Lazanda?

Lazanda Nasal Spray contains fentanyl, an opioid pain medicine. An opioid is sometimes called a narcotic.

Lazanda Nasal Spray is used to treat "breakthrough" cancer pain. Lazanda is taken together with other non-fentanyl narcotic pain medicine that is used around the clock. This medication is not for treating pain that is not cancer-related, such as pain from surgery, dental work, or migraine headaches.

Lazanda Nasal Spray is available only under a special program called Lazanda REMS. You must be registered in the program and sign documents stating that you understand the risks and benefits of using this medication.

Lazanda Nasal Spray may also be used for purposes not listed in this medication guide.

Important information about Lazanda

Do not use Lazanda to replace any other form of fentanyl, such as Abstral, Actiq, Fentora, Onsolis, Duragesic, or generic brands of fentanyl (injection, skin patch, dissolving film, or "lollipop" device). Tell your doctor if there are children living in the home where you will store this medicine. Keep this medicine out of the reach of children. The amount of fentanyl in each bottle of Lazanda can be fatal to a child. Never share Lazanda with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

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There are many other drugs that can interact with fentanyl. Tell your doctor about all medications you use.

Before using Lazanda

Do not use Lazanda Nasal Spray unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant. Do not use Lazanda if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. Tell your doctor if there are children living in the home where you will store this medicine. Keep out of the reach of children. The amount of fentanyl in Lazanda can be fatal to a child.

To make sure you can safely use Lazanda, tell your doctor if you have any of these other conditions:

• a breathing disorder such as wheezing, asthma, or chronic obstructive pulmonary disease (COPD);

• seizures, epilepsy, or a history of head injury or brain tumor;

• low blood pressure, slow heartbeats or other heart rhythm disorder;

• mental illness such as depression, schizophrenia, or hallucinations;

• liver or kidney disease;

• any type of debilitating condition; or

• a history of drug or alcohol addiction.

Lazanda may be habit-forming and should be used only by the person it was prescribed for. Never share Lazanda with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

FDA pregnancy category C. It is not known whether fentanyl will harm an unborn baby. Fentanyl may cause breathing problems, seizure, or addiction and withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using Lazanda. Fentanyl may also cause drowsiness, breathing problems, or addiction and withdrawal symptoms in a nursing infant. Do not breast-feed while you are using Lazanda. Do not give this medication to anyone under 18 years old.

See also: Lazanda pregnancy and breastfeeding warnings (in more detail)

How should I use Lazanda?

Do not use Lazanda to replace any other form of fentanyl, such as Abstral, Actiq, Fentora, Onsolis, Duragesic, or generic brands of fentanyl (injection, skin patch, dissolving film, or "lollipop" device). Use exactly as prescribed. Never use Lazanda in larger amounts, or for longer than recommended by your doctor. Keep using your around-the-clock narcotic pain medicine but never use Lazanda together with a second form of fentanyl.

This medication comes with patient instructions for safe use, and directions for priming and disposal of the nasal spray. Ask your doctor or pharmacist if you have any questions.

If you switch to Lazanda from another form of fentanyl, you will not use the same dose. You must start with the lowest dose (100 micrograms).

The usual starting dose of Lazanda Nasal Spray is 1 single spray into 1 nostril. Your doctor may change your dose to make sure you get the best results. Follow dosing instructions very carefully. Do not use more than one dose for each episode of breakthrough cancer pain.

Call your doctor if you still have pain within 30 minutes after using the nasal spray. Do not use the nasal spray more than 4 times in 24 hours. You must wait at least 2 hours after your last dose of Lazanda before you can treat a new pain episode.

Do not treat more than 4 pain episodes per day with Lazanda. Call your doctor if you have breakthrough pain more than 4 times in one day.

Do not stop using Lazanda or your other narcotic pain medicine without your doctor's advice. Ask your doctor how to avoid withdrawal symptoms when you stop using pain medication. Keep out of the reach of children. The amount of fentanyl in each bottle of Lazanda can be fatal to a child.

Do not use a bottle of Lazanda that has not been used for 5 days or longer. Once you have primed a spray bottle, throw it away after 14 days, even if there is still medicine left in it.

Store at room temperature, away from heat and moisture. Keep the bottle tightly closed and stored in the child-resistant container when not in use.

Keep track of the amount of medicine used from each carton. Fentanyl is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

What happens if I miss a dose?

Since Lazanda is used as needed, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A fentanyl overdose can be fatal, especially to a child.

Overdose symptoms may include extreme drowsiness, weak pulse, fainting, and slow breathing (breathing may stop).

What should I avoid while taking Lazanda?

Avoid using a decongestant nasal spray while you are using Lazanda Nasal Spray.

Fentanyl may impair your thinking or reactions. Avoid driving or operating machinery until you know how Lazanda will affect you. Do not drink alcohol. It can increase drowsiness or breathing problems caused by fentanyl.

Grapefruit and grapefruit juice may interact with fentanyl and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Lazanda side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Lazanda: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using Lazanda and call your doctor at once if you have a serious side effect such as:

• slow heart rate, weak or shallow breathing, sighing;

• confusion, extreme fear, unusual thoughts or behavior; or

• feeling like you might pass out.

Less serious Lazanda side effects may include:

• nausea, vomiting, constipation;

• dizziness, drowsiness, tired feeling; or

• white patches or sores inside your mouth or on your lips.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Lazanda side effects (in more detail)

What other drugs will affect Lazanda?

Do not use Lazanda with any other narcotic pain medications, sedatives, tranquilizers, sleeping pills, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Many drugs can interact with fentanyl. Below is just a partial list. Tell your doctor if you are using:

• aprepitant (Emend);

• modafinil (Progivil);

• pioglitazone (Actos, Actoplus Met, Duetact);

• St. John's wort;

• an antibiotic such as clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), rifabutin (Mycobutin), rifampin (Rifater, Rifadin, Rifamate), telithromycin (Ketek), and others;

• phenobarbital (Solfoton) or other barbiturates;

• antifungal medication such as itraconazole (Sporanox), ketoconazole (Nizoral), miconazole (Oravig), or voriconazole (Vfend);

• heart or blood pressure medication such as diltiazem (Cartia, Cardizem), nicardipine (Cardene), quinidine (Quin-G), verapamil (Calan, Covera, Isoptin, Verelan), and others;

• HIV/AIDS medicine such as delavirdine (Rescriptor), efavirenz (Sustiva, Atripla), fosamprenavir (Lexiva), nevirapine (Viramune), ritonavir (Norvir, Kaletra), and others;

• seizure medication such as carbamazepine (Carbatrol, Tegretol), oxcarbazepine (Trileptal), phenytoin (Dilantin), and others; or

• steroids such as prednisone and others.

This list is not complete and other drugs may interact with Lazanda. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about Lazanda.