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Fentanyl, also spelled Fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. It has a rapid onset and its effects generally last less than two hours. Medically, fentanil is used by injection, nasal spray, skin patch, or absorbed through the cheek (transmucosal) as a lozenge or tablet. 

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Common side effects include vomiting, constipation, sedation, confusion, hallucinations, and injuries related to poor coordination. Serious side effects may include decreased breathing (respiratory depression), serotonin syndrome, low blood pressure, addiction, or coma. Fentanyl works primarily by activating μ-opioid receptors. It is around 100 times stronger than morphine, and some analogues such as carfentanil are around 10,000 times stronger. 

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Fentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States in 1968. In 2015, 1,600 kilograms (3,500 lb) were used in healthcare globally. As of 2017, fentanyl was the most widely used synthetic opioid in medicine. Fentanyl patches for cancer pain are on the World Health Organization’s List of Essential Medicines. In 2016, fentanil and analogues were the most common cause of overdose deaths in the United States at more than 20,000, about half of all opioid-related deaths. Most of these overdose deaths were due to illegally made fentanil.

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Intravenous fentanil is often used for anesthesia and to treat pain. To induce anesthesia, it is given with a sedative-hypnotic, like propofol or thiopental, and a muscle relaxant. To maintain anesthesia, inhaled anesthetics and additional fentanyl may be used. These are often given in 15–30 minute intervals throughout procedures such as endoscopy, surgeries, and in emergency rooms. 

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For pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for emergence from anesthesia. Balancing this medication and titrating the drug based on expected stimuli and the person’s responses can result in a stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain. 

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