Fentanyl Withdrawal Timeline

Last Updated: November 1, 2023

Fentanyl is an extremely powerful opioid that is at least 50 times more potent than morphine. Fentanyl is generally used for the treatment of severe acute pain after surgery. It may also be used for the management of chronic pain in individuals who have developed a tolerance to other opioids. Like other prescription opioids, the use of fentanyl over a prolonged period results in the development of physical dependence on the drug. Such dependence occurs even when fentanyl is used as prescribed, and subsequent discontinuation results in withdrawal symptoms.

Withdrawal symptoms are generally not life-threatening but cause significant discomfort. The symptoms of fentanyl withdrawal may emerge 6-12 hours after discontinuation of the drug and persist for 7-10 days. The use of transdermal patches of fentanyl may result in a slower onset of symptoms and a lengthier withdrawal period.

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Fentanyl Withdrawal Symptoms Duration

Fentanyl is an extremely potent opioid with a half-life of approximately 7-10 hours. However, the half-life of fentanyl tends to vary depending upon the formulation of the drug and the route of administration. For example, the transmucosal formulation of fentanyl has a half-life of around seven hours (intravenous injection – 3.7hrs), whereas the half-life of fentanyl is approximately 17 hours when administered via transdermal patches. Such a difference in the half-life of fentanyl according to the formulation and mode of administration of the drug has an impact on the onset and the duration of withdrawal symptoms.

Withdrawal symptoms may emerge within the first 6-12 hours of cessation of fentanyl use. However, in cases involving a prolonged use of transdermal patches, the withdrawal symptoms may arise between 18-48 hours after discontinuation of the usage of fentanyl patches. There is very limited evidence on the duration of fentanyl withdrawal symptoms since most evidence is based on reports in an inpatient setting where the symptoms are generally stabilized by reinstating fentanyl administration or by use of other medications, including the opioid methadone. Given the relatively short half-life of fentanyl when administered as a transmucosal lozenge or through intravenous infusion, the symptoms of fentanyl withdrawal may be expected to last between 4-10 days. However, given the relatively longer half-life of transdermal fentanyl, these symptoms may persist for longer than ten days.

Fentanyl Withdrawal Symptoms Timeline

The fentanyl withdrawal syndrome may occur in two phases, with the primary phase referred to as the acute withdrawal phase, and the subsequent chronic phase referred to as the protracted withdrawal phase. Most of the symptoms of fentanyl withdrawal resolve within the first ten days after discontinuation of drug use. Symptoms experienced during this phase are referred to as acute withdrawal symptoms or simply as withdrawal symptoms.

Certain symptoms of fentanyl withdrawal may persist beyond the initial 10-day period and last for several weeks or months after abstinence. This chronic, secondary phase is referred to as the post-acute withdrawal phase or the protracted withdrawal syndrome.

  • Acute fentanyl withdrawal (Six hours to ten days): The symptoms during this initial, acute phase include agitation, anxiety, insomnia, nausea, shivering, vomiting, diarrhea, sweating, excessive nasal discharge, elevated heart rate and uncontrollable limb movements. These symptoms generally peak within the first three days after abstinence from fentanyl and may persist for between 7-10 days.
  • Protracted withdrawal (Beyond ten days): Some of the symptoms of opioid withdrawal may persist beyond the acute withdrawal phase and may be experienced for several weeks or months. These protracted withdrawal symptoms usually include anxiety, depressed mood, fatigue, irritability and sleep disturbances. These symptoms are collectively referred to as post-acute withdrawal syndrome and are not present in all individuals who develop a dependence on fentanyl. Furthermore, like the acute withdrawal symptoms, the duration and severity of these symptoms tend to vary from person to person.

How Long Does Fentanyl Withdrawal Last?

The length of fentanyl withdrawal may vary from individual to individual and is often influenced by the severity of dependence on the drug. The acute withdrawal phase generally lasts between 4-10 days when fentanyl is injected or a transmucosal formulation of the drug is used. When transdermal patches of fentanyl are used, fentanyl has a much longer half-life of 17 hours.

The symptoms of fentanyl withdrawal when using a transdermal patch tend to emerge between 18-48 hours, similar to long-acting opioids (buprenorphine and methadone). Although there is a lack of scientific data regarding the duration of fentanyl withdrawal symptoms, withdrawal symptoms after discontinuation of the use of fentanyl patches may be prolonged (between 10-20 days).

Factors Affecting Fentanyl Withdrawal Duration

The intensity and duration of fentanyl withdrawal symptoms are influenced by a variety of factors, including the severity of dependence on fentanyl and the individual’s physiological characteristics. Severe dependence on fentanyl, associated with the use of higher doses of the drug for a long duration, is associated with a longer duration of withdrawal symptoms that are often more severe. Co-dependence on illicit substances, prescription medication or alcohol can also result in more severe withdrawal symptoms.

The severity of the withdrawal symptoms and their duration is also influenced by the physiological characteristics of the individual. These physiological characteristics of an individual, in turn, are influenced by genetics, environmental factors, lifestyle choices, overall health and age.

Abrupt discontinuation of fentanyl use (quitting the drug cold-turkey), can lead to the incidence of severe withdrawal symptoms. Instead, the dosage of fentanyl should be gradually tapered to reduce the severity of withdrawal symptoms. The tapering schedule should be discussed with the healthcare provider before reducing the dosage. In certain instances, withdrawal symptoms may emerge even while following the prescribed tapering regimen. A more gradual tapering schedule is often used in such cases, but medications to manage the withdrawal symptoms may also be used.

If you or a loved one are dependent on or are addicted to opioids like fentanyl, Orlando Recovery Center can help. The Orlando Recovery Center provides evidence-based detoxification and rehabilitation services for substance use disorders delivered by experienced and accredited professionals.

Sources

Han, Paul KJ.; Arnold, Robert; Bond, Geoffrey; Janson, Douglas; Abu-Elmagd, Kareem. “Myoclonus secondary to withdrawal from t[…]d literature review.” Journal Of Pain And Symptom Management, January 2002. Accessed October 29, 2019.

Maathuis, M. Hugo J.; Dijkstra, Daniel DP. “Disaster after the plaster. Fentanyl wit[…]ble hospice patient.” The European journal of general practice, December 2011. Accessed October 29, 2019.

Alcohol and Drug Foundation. ”Fentanyl. “ August 2019. Accessed October 29, 2019.

World Health Organization. “Clinical Guidelines for Withdrawal Manag[…] in Closed Settings.” 2009. Accessed October 29, 2019.

Ripamonti, Carla; Campa,Tiziana ; Conno, Franco De . “Withdrawal symptoms during chronic trans[…]with oral methadone.” Journal Of Pain And Symptom Management, March 2004. Accessed October 29, 2019.

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