In the case of converting morphine to methadone, methadone has a relative potency of 4. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Aug 20, 2014 in an open, parallelgroup, singledose study involving 23 patients, 4mg of immediaterelease hydromorphone dilaudid ir was administered. Converting to transdermal fentanyl palliative care network. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Dec 15, 2001 demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Guidelines for adult patients intravenous pca orders. Transdermal and parenteral fentanyl dosage calculations and. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. What are the steps for converting from morphine or. Conversion from other oral hydromorphone formulations. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Take 2 to 4 mg tablets by mouth every 4 to 6 hours as needed.
Duragesic fentanyl transdermal dosing, indications. Opioid conversion calculator for morphine equivalents. Do not use table 2 to convert from duragesic to other therapies because this conversion to duragesic is. Canadian guideline for safe and effective use of opioids for. This is based on studies converting from morphine to fentanyl. Transdermal and parenteral fentanyl dosage calculations. Stop long acting oral morphine after applying patch. Conversion of intrathecal opioids to fentanyl in chronic pain. Common questions and answers about morphine to dilaudid conversion. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. The mean fentanyl dose at the end of titration was 0. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Opioid conversions calc single agent equianalgesic globalrph.
Transdermal fentanyl is approximately 80 times as potent as morphine. In the case of converting morphine to methadone, methadone has a relative. Fentanyl accumulates to form a depot in the skin below the. Fentora fentanyl dose, indications, adverse effects. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. Dilaudid is the brand name of the drug hydromorphone, which is used to relieve pain. Opioid oral morphine milligram equivalent mme conversion. Dilaudid, exalgo hydromorphone dosing, indications. Advanced opioid conversion calculator morphine equivalents. The results of the study evidenced an increase in the auc corresponding with worsening of renal function. Check with your doctor if you have questions about this. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using.
Conversion of intrathecal opioids to fentanyl in chronic. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Converting to transdermal fentanyl palliative care. The fentanyl skin patch is only used for opioidtolerant patients. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application.
Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. What is the conversion from 150 mcg fentanyl patches every. During the last decade, fentanyl patch transdermal therapeutic system tts has been introduced to the arsenal of opioids for cancer pain control. If you are converting a patient to or from fentanyl i. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. Use of opioids including dilaudid and fentanyl can easily lead to dependency. For frail elderly patients, use more conservative conversion or a lower strength patch e. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose.
Converting from oral morphine to fentanyl transdermal patch. Duragesic fentanyl is stronger than morphine, works quickly, and doesnt cause as many stomach problems. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Degroote national pain centre opioid manager switching opioids download. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to.
In these last 20 years ive used these longacting opioids. Calculate the total 24hour morphine dose or morphineequivalent. What is the conversion from 150 mcg fentanyl patches every 3. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. Transdermal patch should be used only in opioid tolerant patients.
Fentanyl patch converter globalrph conversion from other. Appropriate transdermal system dosage adjustments should be based on the daily dose of supplementary opioids, using the ratio of 45 mgday of oral morphine to a 12. It is one of dozens of opioids contributing to dependencies, substance use disorders, overdoses and deaths happening across the country. So by applying the patch with the last dose of the oral morphine the chances of increasing pain during the drug transition can be avoided. In 2016, over 20,000 overdose fatalities were linked to fentanyl. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Its available in many dosage forms, including a patch, injection, film, nasal spray, and lollipop. Morphine milligram equivalent mme calculator nyc health. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment. Fentanyl, na, 15 microgramshr, transdermal fentanyl isapproximately 80 times as. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours.
Methadone has been associated with disproportionate numbers of overdose deaths relative to the frequency with which it is prescribed for chronic pain, due in part to its long and variable halflife. Currently, there are no empirical studies converting fentanyl to morphine. In an open, parallelgroup, singledose study involving 23 patients, 4mg of immediaterelease hydromorphone dilaudid ir was administered. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. The mean it morphine equivalent dose at initial conversion was 15.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Because transdermal fentanyl has a delayed onset and onset of. Select microgram per hour dose of transdermal fentanyl based on table 2. Eighteen hours following the removal of the transdermal fentanyl patch, xtampza er treatment can be initiated.
Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Opioid conversions calc single agent equianalgesic. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl is among the deadliest drugs currently available. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. For mild pain, the starting regimen should be a nonsteroidal antiinflammatory drug nsaid or acetaminophen.
Equivalence between oral morphine and transdermal fentanyl. The following source was used for morphine equivalent conversion factors per mg of opioid. Both drugs work the same way in the body to relieve pain. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Fentanyl actiq side effects, dosage, interactions drugs. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoralr at 100 mcg. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl patch converter globalrph conversion from. This medicine is in a class of drugs called opiate analgesics. Equivalent doses are based on the 24 hour dose of fentanyl or. Dilaudid dosage administration immediaterelease tablets. Oral morphine milligram equivalent conversion table updated 8.
For moderate pain, an opioid agonist eg, hydrocodone. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. For patients that require more than 100 mcghour, several transdermal systems may be used. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Monitor patients closely for respiratory depression, especially within the first 2472 hours of initiating therapy and following dosage increases with dilaudid injection or dilaudid hp injection and adjust the dosage accordingly. A safe and effective method for converting cancer patients. Fentanyl 50 mcg ml 1500 mcg in 30 ml 10 25 mcg 8 15 minutes 400 800 mcg hydromorphone 0. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Initial fentanyl transdermal dosage use only when converting another opioid to.
Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Start exalgo dose at 50% of calculated daily dose every 24 hours. The mme conversion factor for fentanyl patches is based on the assumption that one milligram of parenteral fentanyl is equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour day. Effects of patch last for 18 24 hours after the patch is removed. Fentanyl is the generic form of the brandname drug duragesic, a prescription opioid narcotic drug used to treat chronic, aroundtheclock pain. Recommend an appropriate dose of transdermal fentanyl when. My guess is that you are on to low of a fentanyl dosage, compared to your oxycontin oxyneo is the same i think and percocet dosage.
Equianalgesic chart changes in italics ui health care. Start with equivalent total daily dose of immediate release formulation and administer once daily. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Do not use this tool to convert from one opioid to a different opioid. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain brand names of fentanyl include. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. Methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Morphine dose equivalence not reliably established. Jan 29, 2018 methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Select microgram per hour dose of transdermal fentanyl based. Opioid switching using equivalence tables home saskatchewan. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a generous dose of common sense.
Highdose fentanyl patch for cancer pain american board. Duragesic label page 1 full prescribing information for. Fentanyl moves in the direction of the lower concentration at a rate. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 9 mg equivalent to 10 mg oxycodone hcl every 12 hours of xtampza er, should be initially substituted for each 25 mcghr. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. Canadian guideline for safe and effective use of opioids.
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