Conversion of intrathecal opioids to fentanyl in chronic. Dilaudid dosage administration immediaterelease tablets. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Select microgram per hour dose of transdermal fentanyl based.
If the patch is stopped it may take 12h or longer before the effect of the fentanyl. Potency if switching from hydromorphone to morphine is less than from morphine to hydromorphone. 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. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Opioids dosage conversion on the app store itunes 8 oct 2014 opioids by norris. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Furthermore, more respondents applied a more aggressive conversion strategy for hydromorphone and fentanyl. Scottish palliative care guidelines fentanyl patches. Opioid tolerant patients are those patients taking for 1 week or longer, at least. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient.
Do not use this tool to convert from one opioid to a different opioid. Start with equivalent total daily dose of immediate release formulation and administer once daily. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. The following source was used for morphine equivalent conversion factors per mg of opioid. We used the equianalgesic chart from wikipedia to build the opioid conversion calculator. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Fentanyl patch converter globalrph conversion from other. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Its available as both a generic drug and as the brand. Morphine milligram equivalent mme calculator instructions.
In an open, parallelgroup, single dose study involving 23 patients, 4mg of immediaterelease hydromorphone dilaudid ir was administered. Senior dosage ages 65 years and older the kidneys of older adults may not work. Fentora fentanyl dose, indications, adverse effects. 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. After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Schedule ii opioid substances which include fentanyl, hydromorphone. 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. Fentanyl transdermal patch has not been established as safe or effective for use in children younger than 2 years. Stop long acting oral morphine after applying patch. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Buprenorphine buprenex butorphanol stadol codeine fentanyl duragesic hydrocodone hydromorphone dilaudid levorphanol meperidine demerol. In the case of converting morphine to methadone, methadone has a relative potency of 4. 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.
Dosage titration of the new opioid should be completed slowly and with frequent monitoring. Fentanyl patch converter globalrph conversion from. Hydromorphone mgday 15 dilaudid fi, dilaudid hp fi codeine mgday 0. Advanced opioid conversion calculator morphine equivalents. It usually includes information on the dosage, relative potency, and halflives, compared to morphine. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pms hydromorphone morphine sulfate. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Converting to transdermal fentanyl palliative care. One twentieth the morphine dose morphine to fentanyl patch conversion each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Dilaudid, exalgo hydromorphone dosing, indications. Opioid converter morphine equivalent calculator omni. Hydromorphone oral tablet is a prescription opioid medication thats used to treat severe pain that isnt controlled by other opioid drugs. Another commonly used conversion is to equate 100 mg of oral morphine to a 25. If you are converting a patient to or from fentanyl i.
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. This is especially important for fentanyl and methadone conversions. Opioid conversions calc single agent equianalgesic. Addressing adverse effects from opioids if the ae is not managed symptomatically and persists for more than one week, switch to another opioid. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. The next step is to convert 25 mg of oral hydromorphone to the daily. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. 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. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to fentanyl transdermal system.
Approximately 37% of hydromorphone undergoes glucuronidation to produce hydromorphone 3glucuronide h3g. If the form does not start downloading in 10 seconds, please click here. You should take your vicodin with it for the first 23 days. There are many opioids and many formulations available e. Conversion from other oral hydromorphone formulations.
Canadian guideline for safe and effective use of opioids. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Converting to transdermal fentanyl palliative care network. Here is a table of substance dosage and potency, related to 10 mg of intravenously administered morphine. Parenteral hydromorphone is 20 times as potent as oral morphine. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Conversion from morphine or equivalent to fentanyl transdermal. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs.
Take 2 to 4 mg tablets by mouth every 4 to 6 hours as needed. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoralr at 100 mcg. Duragesic label page 1 full prescribing information for. The amount of residual drug in the patients system must be accounted for. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Transdermal and parenteral fentanyl dosage calculations. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Ammendment to include tapentadol june 2012 fentanyl patch. The patients current dose of 5 mg per day of parenteral hydromorphone is equal to 25 mg per day of oral hydromorphone. Recommend an appropriate dose of transdermal fentanyl when.
Table 2 should not be used to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl transdermal system is conservative. Fentanyl transdermal system fentanyl transdermal system for. Thank you for downloading opioid manager switching opioid form. Pain and symptom management pain management 2017 3 3. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.
Calculate the total 24hour morphine dose or morphineequivalent. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Adverse effect intervention constipation stepwise escalation of regular oral stimulant or osmotic laxative on opioid initiation. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Opioid conversion ratios guide to palliative care practice 2016. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Oral hydromorphone is about 47 times as potent as oral morphine. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Select microgram per hour dose of transdermal fentanyl based on table 2.
A shortacting opioid, such as hydrocodone 5 mg every 4 hours, should be fentanyl patch to oxycodone conversionconverting from oral morphine to fentanyl transdermal patch opioid for moderate pain, an opioid agonist eg, hydrocodone, oxycodone can be used. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. In one alternative method, breitbard recommends using 2 mg of oral morphine as equivalent to 1. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. This calculator should not be used to determine doses when converting a patient from one opioid to another. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Start exalgo dose at 50% of calculated daily dose q24hr. Fentanyl conversion not to be used for acute pain management oral morphine 50100mg 24 hours fentanyl 25 mcg hour patch.
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. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Opioid conversion ratios guide to palliative care practice. For each opioid, select the strength from the drop down menu and enter the number of tablets per day for fentanyl transdermal.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Select microgram per hour dose of transdermal fentanyl. Start exalgo dose at 50% of calculated daily dose every 24 hours. What is the conversion from 150 mcg fentanyl patches every. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. Opioids opiates are a group of analgesic drugs, used. Survey of pain specialists regarding conversion of high. Oral morphine milligram equivalent conversion table updated 8. 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.
Conversion of intrathecal opioids to fentanyl in chronic pain. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The mean it morphine equivalent dose at initial conversion was 15. Degroote national pain centre opioid manager switching opioids download. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Duragesic label page 1 full prescribing information for use. For frail elderly patients, use more conservative conversion or a lower strength patch e. Additional or alternative analgesia is required when fentanyl transdermal dose exceeds 300mcghr. Opioid oral morphine milligram equivalent mme conversion. May 01, 2020 conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Converting from oral morphine to fentanyl transdermal patch. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer.
The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy. Transdermal and parenteral fentanyl dosage calculations and. Duragesic fentanyl transdermal dosing, indications. What are the steps for converting from morphine or. It may be 812h or longer after putting on the first patch before pain relief is experienced.
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