Considerations in Selecting Transmucosal Immediate-Release Fentanyl Formulations for the Management of Breakthrough Cancer Pain

Program Overview

Breakthrough pain (BTP) occurs in many cancer patients. Often, short-acting opioids do not have the pharmacokinetic profile to match the rapid and unpredictable onset of BTP. With their rapid onset of action, transmucosal immediate-release fentanyl (TIRF) formulations offer distinct advantages in the treatment of BTP; however, the availability of a variety of TIRF delivery mechanisms complicates treatment decisions. To provide patients with optimal care, the characteristics of the patient and the unique properties of the individual TIRFs should be considered.

Target Audience

This activity has been designed to meet the educational needs of pain specialists, oncologists, physician assistants, and other health care professionals involved in the care of patients with breakthrough cancer pain.

Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Differentiate among available TIRF formulations for breakthrough cancer pain
  2. Describe components of TIRF REMS


Lynn R. Webster, MD, FACPM, FASAM
Medical Director
CRI Lifetree
Salt Lake City, Utah
The American Academy of Pain Medicine (AAPM)

Jeffrey Gudin, MD
Director, Pain and Palliative Care
Englewood Hospital and Medical Center
Englewood, New Jersey

Disclosure Statements

Elsevier Office of CME assesses conflict of interest with its instructors, planners, managers and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by Elsevier Office of CME for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. Elsevier Office of CME is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

FacultyRelationship Identified With
Lynn R. Webster, MD, FACPM, FASAM

Consultant/Advisor:  AcelRx Pharmaceuticals, AstraZeneca, BioDelivery Sciences International, Boehringer Ingelheim, Collegium Pharmaceuticals, CVS Caremark, Inspirion Pharmaceuticals, LLC, Jazz Pharmaceuticals, Mallinckrodt Pharmaceuticals, Neura Theraeutik, Nevro Corporation, Orexo AB, QRxPharma Ltd., Quintiles, Shionogi, and Theravance

Advisory Board Honorarium: AcelRx Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, Collegium Pharmaceuticals, Inspirion Pharmaceuticals, LLC, Insys Therapeutics, Inc., Mallinckrodt Pharmaceuticals, Medtronic, Nektar Therapeutics

Jeff Gudin, MD

Consultant/Advisor:  Insys Therapeutics, Inc., Mallinckrodt Pharmaceuticals, Nektar Therapeutics, Purdue Pharma L.P.

Speaker’s Bureau:  Endo Pharmaceuticals, Inc., Johnson & Johnson, Mallinckrodt Pharmaceuticals, Purdue Pharma L.P., Teva Pharmaceuticals, Ltd

Planners, Managers, Reviewers: Lyerka Miller, PhD, CCMEP; Melanie Spurgeon; Sandy Breslow; and Jill McNair hereby state that they or their spouse/life partner do not have any financial relationships to products or devices with any commercials interest related to the content of this activity of any amount during the past 12 months.

Peer Review

This enduring activity has been peer-reviewed by the Journal of Pain and Symptom Management.

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Elsevier Office of CME and Miller Medical Communications, LLC.  Elsevier Office of CME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Elsevier Office of CME designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Financial Support

This activity has been supported by an independent educational grant from Depomend, Inc.

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For all CME inquiries or special needs, please contact

Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Elsevier Office of CME, Miller Medical Communications, LLC, and Depomed, Inc., and do not recommend the use of any agent outside of the labeled indications.  The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of Elsevier Office of CME; Miller Medical Communications, LLC; or Depomed, Inc. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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Course details

  • Course opens: December 19, 2013
  • Course expires: December 18, 2016

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