Most people are familiar with throat lozenges. Typically, they are a small, medicated, round or oval shaped and dissolve slowly in your mouth. They are used to treat sore throats, coughs, and other throat irritations. Common lozenges include brand name products such as Chloraseptic, Delsym and Vicks (figure 1) and can be purchased over-the-counter (OTC).
However, not all lozenges are used to treat a sore throat. For example, Actiq (fentanyl citrate oral transmucosal lozenge) (figure 2) is a powerful opioid that is prescribed by a doctor to treat severe pain that can occur anywhere in the body. It is usually prescribed for severe pain related to cancer and other chronic non-cancer pain. Because Actiq is so potent, it should ONLY be used by people who have previously taken high doses of prescription pain medicine (opioids) for 7 or more days. Otherwise, the medicine can cause life threatening breathing problems. Actiq is referred to as a lozenge because the active medicine (fentanyl) is delivered in a solid substance attached to a stick. Actiq slowly dissolves in the mouth like a lozenge (or lollipop).
ISMP is aware of several events in which a doctor attempted to prescribe Actiq to treat a sore throat by mistaking the powerful opioid for a typical throat lozenge. In two cases, the pharmacist caught the error and contacted the doctor to change the order. In the third case, the doctor caught his own error. In each case, the patients were not taking other opioids or have a history of opioid use.
If you have a sore throat, Actiq is NOT for you. Any type of lozenge (whether OTC or prescribed by a doctor) should be kept up and away and out of sight and reach of a child. Never call a medicated lozenge (or any medicine) a piece of candy.
