Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. These bidirectional differences are not captured in a traditional equianalgesic table. Do not use fentanyl patches in opioidnaive patients with noncancer pain. Calculating total daily dose of opioids for safer dosage. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Equianalgesic dosing of opioids for pain management. Conversion of opioid analgesics to fentanyl transdermal. Opioid conversion to hysingla er hydrocodone bitartrate cii. Conversion guide for opioid to transdermal fentanyl from to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch 12 hour controlled release cr long acting oral opioid apply the patch at the same time as administering the final 12 hour cr dose. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch.
Round up or down based on patient factors and available patch sizes. Use the dosing and conversion chart for opioid analgesics to convert from an oral to iv dose. In the case of converting morphine to methadone, methadone has a relative potency of 4. When initiating transdermal fentanyl in a patient currently treated with oral morphine, the initial dose should be based upon their previous 24hour opioid requirement. A study to assess the safety, dose conversion, and dose. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Conversion of intrathecal opioids to fentanyl in chronic. Instruct patients not to use butrans if the pouch seal is broken or the patch is cut, damaged, or changed in. They all interact with specific opioid receptors such as. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic. Store fentanyl transdermal patch in a safe place where children cannot see or reach it, and where other people cannot get to it. In renal impairment gfr fentanyl and buprenorphine patches. Transdermal fentanyl patches are unsuitable for opioid naive patients 1.
For each opioid, select the strength from the drop down menu and enter the number of tablets per day for fentanyl transdermal, see instructions below. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Opioid conversion calculator for morphine equivalents. When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration. If a patient has not been on an equivalent of 6090mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch. Scottish palliative care guidelines fentanyl patches. Morphine milligram equivalents mme calculator mdcalc. A safe and effective method for converting cancer patients. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Follow the information that comes with fentanyl transdermal patch for throwing out doses that are not needed. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po.
Transdermal dosage use only when converting another opioid to fentanyl patch. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. A locked box or area may help keep fentanyl transdermal patch safe. Once the conversion has occurred, the dose of new opioid should be titrated carefully. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Opioid equianalgesic calculator opioid switching from. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours.
You may also need another narcotic while your dose of fentanyl is being adjusted, and to relieve any breakthrough pain that occurs later on. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Remember to enter all opioids the patient is taking. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. What are the steps for converting from morphine or equivalent to.
Fentanyl is the generic form of the brandname drug duragesic, a prescription opioid narcotic drug used to treat chronic, aroundtheclock pain. Opioid switching from transdermal fentanyl to oral. Calculating total daily dose of opioids for safer dosage, centers for disease control and prevention, cdc, u. Conversion from morphine or equivalent to fentanyl transdermal. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of the new agent and may result in an overdosage. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion. Patients who are opioid experienced are those receiving, for one week or longer, daily opioid doses up to 80 mgday of oral morphine or an equianalgesic dose of another opioid. Conversions with methadone methadone is inexpensive and effective in certain patient populations. Opioid metabolism and excretion do differ among the opioids.
Converting from oral morphine to fentanyl transdermal patch. Cdc guidelines recommend prescribing the lowest effective opioid dose and to use caution when prescribing opioids at any dosage, particularly when increasing dosage to. Practical pain management is a remedy health media, llc web property. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Canadian guideline for safe and effective use of opioids.
Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Narcotic equivalence converter narcotic route dose duration. August 20 gippsland region palliative care consortium clinical practice group. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. This dose is not possible to provide in slowrelease morphine. It should be noted that these equivalent doses relate to analgesic equivalence and not opioid equivalence due to the dual mechanism of action of tapentadol mu opioid receptor agonist and noradrenaline reuptake.
The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. What are the steps for converting from morphine or. It conversion ratio reached to give superior vas from previous it opioid. Opioid converter morphine equivalent calculator omni. Fentanyl skin patches are very strong narcotic painkillers that may cause death from overdose. This calculator should not be used to determine doses when converting a patient from one opioid to another. If the form does not start downloading in 10 seconds, please click here. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Fentanyl patches are another option, but are expensive and difficult to titrate. Transdermal and parenteral fentanyl dosage calculations. Patches conversion doses drug name drug dose equivalent oral morphine dose fentanyl 25 patch 25microgramshour 30mg to 4mg24hours fentanyl 50 patch 50 microgramshour 5mg to 224mg24hours fentanyl 75 patch 75 microgramshour 225mg to 314mg24hours fentanyl 100 patch 100 microgramshour 315mg to 404mg24hours transtec 52.
Richard scott, professor emeritus in the department of sociology, shares a very personal story of the last stages of life of his beloved brother charles scott. Opioid conversion ratios guide to palliative care practice. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Calculate the total 24hour morphine dose or morphineequivalent. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1.
Calculate the total daily dose of the original opioid add longacting and rescue doses. Conversion from transdermal fentanyl to hysingla er. Use the dose conversion tool calculate the initial butrans dose for your opioid experienced patients. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Transdermal and parenteral fentanyl dosage calculations and. If you are converting a patient to or from fentanyl i. Dec 22, 2019 store fentanyl transdermal patch in a safe place where children cannot see or reach it, and where other people cannot get to it. The objective of this study is to assess the safety of treatment with duragesic a transdermal patch delivering the narcotic painreliever fentanyl in doses of 12. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. Converting to transdermal fentanyl palliative care network. It should not be used to determine doses when converting a patient from one opioid to another.
Dose equivalents and changing opioids faculty of pain. Levys rule to convert from oral morphine to transdermal fentanyl. Opioids opiates are a group of analgesic drugs, used primarily for pain management. In order to increase knowledge about how best to respond to and alleviate the suffering of seriously ill patients, we have created a free training module on physician assisted death dr. Canadian guideline for safe and effective use of opioids for. The total daily morphine milligram equivalents mme will be displayed.
Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2. How should conversion from oral morphine to fentanyl. Monitor the patient carefully for respiratory depression. Adapted from tarascon pocket pharmacopoeia created. When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete crosstolerance. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Narcotic pain relievers also can be addictive and abused. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Therefore the opioid conversion guidelines have been developed to assist. Overestimating the dose when converting patients from another opioid analgesic. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided.
Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Use the dosing and conversion chart for opioid analgesics to convert original. Titrate liberally and rapidly to analgesic effect during first 24 hours. Fentanyl patch converter globalrph conversion from. The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much opiate during the conversion period. Fentanyl actiq side effects, dosage, interactions drugs. Morphine milligram equivalent mme calculator nyc health. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Morphine milligram equivalent mme calculator instructions. Btd for a given fentanyl patch for a given fentanyl patch of x mcghr. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to. Patients need to follow directions exactly, fda says. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. Jan 22, 2019 fentanyl skin patches are very strong narcotic opioid painkillers that may cause death from overdose.
An alternative algorithm for dosing transdermal fentanyl. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Frail or elderly patients may need lower doses and slower titration. Fentanyl patch converter globalrph conversion from other. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Two parallel dosage conversion ratios are currently recommended by most manufacturers of fentanyl patches. The fentanyl skin patch should always be prescribed at the lowest dose needed for pain. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Converting to transdermal fentanyl palliative care. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
Many people remove the narcotic gel from the patch, heat it to melt it, or mix it with water. It conversion ratio, eventual it fentanyl dose, and iv. Opioid conversion calculator morphine equivalents advanced. Opioid oral morphine milligram equivalent mme conversion factors1,2. Both drugs work the same way in the body to relieve pain. Transdermal patch should be used only in opioid tolerant patients. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Tapentadol dose conversion chart doses in this conversion chart are approximate equivalent doses only.
Opioid conversion and brand availability in canada michael g. 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. Some experts use this conversion in cancer patients. Fentanyl is, however, far more potent than heroin, and this method of rapid drug onset can also lead to rapid overdose. Department of health and human services, higher dosage, higher risk, why is it important to calculate the total daily dosage of opioids, how much is 50 or 90 mmeday for commonly prescribed opioids, how should the total daily dose of. Points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. Opioid oral morphine milligram equivalent mme conversion. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. This tool does not contain all of the important safety information needed to prescribe butrans. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. American college of emergency physicians acep guidelines recommend avoiding routinely prescribing outpatient opioids. Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f.
A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Thank you for downloading opioid manager switching opioid form. There are many opioids and many formulations available e. 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. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Clinical pharmacist, university of new mexico hospitals. The table is based on oral dosing for chronic noncancer pain. Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral.
The fentanyl skin patch should always be prescribed at the lowest dose needed for pain relief. Oral morphine is preferred because of the relative ease of dose adjustments. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Jan 29, 2018 if pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. You will probably need to take a fasteracting narcotic by mouth to relieve pain during the first few days of using fentanyl skin patch. Fentanyl patches durogesic for chronic pain nps medicinewise. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Select microgram per hour dose of transdermal fentanyl. Equianalgesic chart changes in italics ui health care. Jul 15, 2005 deaths seen with fentanyl narcotic pain patch. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose.
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