What is the conversion from 150 mcg fentanyl patches every 3. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. What are the steps for converting from morphine or. Do not use this tool to convert from one opioid to a different opioid. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Canadian guideline for safe and effective use of opioids. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Titrate liberally and rapidly to analgesic effect during first 24 hours. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative.
The 4 hr limit includes both the continuous basal infusion and patient boluses. Effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4, subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Dilaudid and fentanyl have the same mechanism of action they work the same way in relieving and stopping pain. Can a patient be given dilaudid by iv while on a fentanyl patch. Opioid conversion and brand availability in canada michael g. 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. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. 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 dihydrocodeine po. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Recommendations based on data contained in the package insert.
The cii rate was decreased by 50% 6 hours after application of the fentanyl. For this reason the date of birth field is mandatory. Converting from oral morphine to fentanyl transdermal patch. The table is based on oral dosing for chronic noncancer pain. Fentanyl patch converter globalrph conversion from. Opioid switching using equivalence tables saskatchewan. 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. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. 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. Opioid conversion calculator for morphine equivalents. Some experts use this conversion in cancer patients.
Opioid oral morphine milligram equivalent mme conversion. Converting to transdermal fentanyl palliative care. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. 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. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days. Opioid conversion and brand availability in canada.
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. Conversion of opioid analgesics to fentanyl transdermal. A safe and effective method for converting cancer patients. Thank you for downloading opioid manager switching opioid form. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. There are many opioids and many formulations available e. 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. Usual starting infusion rate would be morphine 1 2 mghr, fentanyl 1025 mcghr, hydromorphone 0. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. When available, patientcontrolled analgesia pca pumps should be used, per iv if access available, and per sq if no iv access is available. Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Duragesic fentanyl transdermal dosing, indications. Degroote national pain centre opioid manager switching opioids download.
Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. The patch will take a little while to get in to your system. Surprisingly, crosstolerance between opioids is often incomplete. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. The following source was used for morphine equivalent conversion factors per mg of opioid.
Equianalgesic chart changes in italics ui health care. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. These bidirectional differences are not captured in a traditional equianalgesic table. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression.
The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Fentanyl patch converter globalrph conversion from other. The patch is fentanyl the strongest family of opiates we have. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. You wish to convert the therapy to transdermal fentanyl. Im in a hosp so i feel a little safe if something goes wrong. In other words, the conversion factor not accounting for days of use would be 6025 or 2. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. An alternative algorithm for dosing transdermal fentanyl. Oral opioid dosing equivalents and conversions university of. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Opioid equianalgesic calculator opioid switching from. The total daily morphine milligram equivalents mme will be displayed.
Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain. Guidelines for adult patients intravenous pca orders. Fentanyl patch dosing determination based on current opioid therapy. Morphine milligram equivalent mme calculator nyc health. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Opioid conversion ratios guide to palliative care practice. Iv drugs in order of choice are morphine, dilaudid, fentanyl, and sq drugs in order of choice are morphine, dilaudid. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches.
When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. 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. Opioids opiates are a group of analgesic drugs, used primarily for pain management. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Conversion from morphine or equivalent to fentanyl transdermal. 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. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sciv mg po mg comments morphine 10 30a codeine 120 sc only 200 metabolized to morphine fentanyl patch see table below useful when po pr routes not an option fentanyl 0. Kornick said the research team is now looking into the best procedure for accomplishing that task. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. Morphine milligram equivalent mme calculator instructions. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. 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 and parenteral fentanyl dosage calculations.
Select microgram per hour dose of transdermal fentanyl based. 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. 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. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. It should not be used to determine doses when converting a patient from one opioid to another. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Fentanyl patches are another option, but are expensive and difficult to titrate. Narcotic pain relievers also can be addictive and abused. What is the conversion from 150 mcg fentanyl patches every. 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. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Round up or down based on patient factors and available patch sizes.
Opioid conversion tips changing to another oral opioid question. Both drugs work the same way in the body to relieve pain. A 33% dose reduction from the calculated dose of 100 mg is equal to 67 mg of oral morphine per day. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. For frail elderly patients, use more conservative conversion or a lower strength patch e. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Canadian guideline for safe and effective use of opioids for. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily. Calculate the total 24hour morphine dose or morphineequivalent. The oral dose of morphine should be reduced by 30% to 50% to prevent any risk of overdose after the conversion, since opioids do not have complete crosstolerance.
Oral morphine milligram equivalent conversion table updated 8. Twostep titration weans patients from iv to patch fentanyl. Opioid converter morphine equivalent calculator omni. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Adapted from tarascon pocket pharmacopoeia created. Sickle cell pain crisis guidlines virginia premier. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch.
Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Remember to enter all opioids the patient is taking. Conversion of intrathecal opioids to fentanyl in chronic. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. In the case of converting morphine to methadone, methadone has a relative potency of 4. She would like to try an immediaterelease opioid agent, hydromorphone. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc.
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. If the form does not start downloading in 10 seconds, please click here. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Currently, there are no empirical studies converting fentanyl to morphine. Dilaudid hydromorphone and fentanyl are narcotic pain relievers prescribed to patients for the treatment and management of severe chronic pain, for example, pain related to cancer. Transdermal and parenteral fentanyl dosage calculations and.
Dr prescribed dilaudid and fentanyl patch, is this safe, don. Equianalgesic dosing of opioids for pain management. There are differences in the literature regarding opioid conversion ratios. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
They all interact with specific opioid receptors such as. Narcotic equivalence converter narcotic route dose. Select microgram per hour dose of transdermal fentanyl. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. And just fyi hydromorphone is also known as dilaudid. If you prefer to not use the rounded off conversion, the full. Conversion of intrathecal opioids to fentanyl in chronic pain.
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