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The Drug-Induced Respiratory Disease Website and App

Fentanyl

Fentanyl (fetty, fenty) is the main contributor to the large scale opioid epidemic. High profile deaths still occurring (e.g. New York Times September 22, 2026). Recent data indicate that heroin may be laced with fentanyl (PMID 25869219). Fentanyl congeners have been found in casualties following assault in a public place (PMID 23002178). Poisoning with fentanyl derivatives recently confirmed (PMID 28349714). Recently introduced synthetic opioids and drugs (e.g. cyclorphine) deserve close attention. Look for the fentanyl bent. Naloxone is the antidote.

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.n

Pulmonary alveolar proteinosis (PAP) (secondary)

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

IV - Airway involvement

IV.e

Cough (acute, violent, explosive)
IV.g

Cough syncope

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.c

Upper airway obstruction other than angioedema or hematoma
VIII.e

Laryngospasm (a.k.a. laryngismus)
VIII.h

Vocal cord dysfunction, adduction, closure, injury
VIII.q

Tongue involvement (edema, glossitis, hematoma)

IX - Neuromuscular / CNS involvement - Disordered breathing (during sleep)

IX.c

Chest wall muscle rigidity - Stiff/wooden chest
IX.d

Respiratory failure from ventilatory depression (due to neuromuscular blockade/paralysis)
IX.i

Respiratory arrest - Apnea
IX.t

CNS involvement/dysfunction/damage

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

XI - Miscellaneous

XI.g

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)
XI.n

Death following exposure or poisoning

XII - Cardiovascular involvement / toxicity

XII.f

Cardiomyopathy (acute, subacute, chronic)
XII.n

Cardiovascular collapse - Cardiogenic shock - Hypotension