Pain Home > Subsys Dosage

The dosing guidelines for Subsys vary from person to person, so your healthcare provider will determine your dosage based on the type and severity of your pain, how you respond to Subsys, and various other factors. The initial dosage is 100 mcg sprayed under the tongue every four hours as needed for breakthrough pain. This dose can be increased slowly if necessary.

An Introduction to Dosing With Subsys

The dosage of Subsys® (fentanyl sublingual spray) your healthcare provider recommends will vary, depending on a number of factors, including:
  • The type and severity of your pain
  • How you respond to the medication
  • Other medications you are taking
  • Other medical conditions you may have.
As is always the case, do not adjust your dosage unless your healthcare provider specifically tells you to do so.

Initial Subsys Dosage

The initial dose of Subsys for treating breakthrough pain is 100 mcg, no matter how bad your pain or how high your dosage of other opioids. If this amount adequately relieves your pain, you should continue using the 100-mcg dosage for each breakthrough pain episode. If this amount does not adequately relieve your pain within 30 minutes, you may take one additional 100-mcg spray. You must then wait at least four hours before taking another dose.
Doses of Subsys are not equivalent to doses of other fentanyl-containing medications. The initial dosage of Subsys should be 100 mcg, even in people who are already taking another fentanyl medication. Starting Subsys at a higher dosage could cause an overdose.

Subsys Dose Titration

If the initial 100-mcg dosage did not adequately relieve your breakthrough pain, your dosage will be slowly increased, until a dosage is found that provides adequate pain relief with minimal side effects. This is called dose titration.
Normally, Subsys is increased to 200 mcg, and then 400 mcg if necessary. If a 400-mcg dosage does not adequately relieve your pain, the next dosage increase is usually to 600 mcg. If this amount is ineffective, the dose is then usually increased to 800 mcg.
If you are still in pain 30 minutes after using Subsys, you may take another dose of the same strength. Do not use more than two doses to treat a breakthrough pain episode.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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