Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Agreed to dose of 280mg morphine daily in 2 divided doses 140mg morphine sr twice daily 4. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. Transdermal and parenteral fentanyl dosage calculations. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Conversion of my oxycodone to fentanyl pain management. Wait 18 hr after patch removed, then initiate conservative dose of 10 mg q12hr oxycodone controlledrelease for each 25 mcghr fentanyl transdermal patch. The authors make no claims of the accuracy of the information contained herein. Do not initiate treatment with duragesic in opioid nontolerant patients see contraindications 4 the recommended starting dose when converting from other opioids to duragesic is intended to minimize the potential for overdosing patients with the first dose. For patients that require more than 100 mcghour, several transdermal systems may be used. A safe and effective method for converting cancer patients. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Morphine milligram equivalent mme calculator instructions.
To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose. Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life.
Opioid conversion calculator morphine equivalents advanced. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. However and again only your physician can do the correct conversion based on your opiate history. Calculate opioid dose adjustments and opioid starting doses. 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. The lowest strength fentanyl patch 25mcghr provides the equivalent. Conversion from morphine or equivalent to fentanyl transdermal. Remember to enter all opioids the patient is taking. Converting to transdermal fentanyl palliative care network. Fentanyl transdermal patch 72 hour 100mcg drug medication dosage information.
Initial dose based on previous 24hour opioid requirement consult product literature, for evaluating analgesic efficacy and dose increments, see under chronic intractable pain not currently treated with a strong opioid analgesic, for conversion from long term oral morphine to transdermal fentanyl, see pain management with. Stop long acting oral morphine after applying patch. If the patient shows signs of opioid toxicity drowsiness, confusion, reduce the dose and reassess the pain. How to calculate equivalent morphine dosage when changing the method of administration. Select microgram per hour dose of transdermal fentanyl based on. I too use the fentanyl 75mcg patch along with the oxycodone. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. Fentanyl patch converter globalrph conversion from. To convert from morphine mg to fentanyl microgra mhour divide by 3. Dose equivalents and changing opioids faculty of pain.
Fentanyl patch converter globalrph conversion from other opiates. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Duragesic patches typically come in the following doses. Total dose from both patches should not exceed 20 mcghour.
Duragesic label page 1 full prescribing information for. Morphine milligram equivalent mme calculator nyc health. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Interactions between fentanyl bulk and avoidgrapefruit.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioid oral morphine milligram equivalent mme conversion. It may be 812h or longer after putting on the first patch before pain relief is experienced. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Administer onehalf of the patients total daily po oxycodone dose as q12hr. Fentanyl patch converter globalrph conversion from other. 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. Fentanyl patch dosing guidelines fentanyl patches should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least fentanyl patch 25 mcg.
Neither nor any other party involved in the preparation or publication of this site shall be liable for any special. 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. Duragesic patches are intended for transdermal use on intact skin only. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Opioid oral morphine milligram equivalent mme conversion factors1,2. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours.
In an inpatient setting, rescue doses can be provided iv every 1530 minutes. The dose is determined by the surface area of the patch, therefore the patches are larger as the dose increases. Learn about the reported side effects, related class drugs, and how these medications will affect your daily lifestyle. These dose conversions are estimated and cannot account for all. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Quickwhat dose of the transdermal fentanyl patch duragesica is. There are many conversion tables available through the internet and doctors also use theconversion method when finding the right dose for you. A conversion chart says 50mg of oxycodone a day converts to approximately 25. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Hello, i have been taking norco 10mg, 45 times a day for about 3 months for chronic pain, legally prescribed of course norco is just hydrocodone like vicodin, but without so much tylenol. Duragesic label page 1 full prescribing information for use. For kathy to use 2 patches, you instruct her to remove her current patch, and apply the 2 new patches at the same time, adjacent to one another, at a different application site as explained in the full prescribing information.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Canadian guideline for safe and effective use of opioids for. Convert the iv dose to the equianalgesic oral morphine dose using a ratio of. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Iv use even at low doses and when given very slowly may cause marked. Opioid converter morphine equivalent calculator omni. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Webmd provides information about interactions between fentanyl bulk and avoidgrapefruitunlessmdinstructsotherwise. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Calculates total daily morphine milligram equivalents. Select microgram per hour dose of transdermal fentanyl based.
Fentanyl is one of the strongest pain meds on the market and it will take a high dose to reach the equivalency. Remove transdermal and titrate dose of new analgesic based upon patients report of pain until adequate analgesia has been attained. Recommendations based on data contained in the package insert. The calculation of opioid conversion is a crucial step in intensive care and is.
Calculate an opioid starting dose for an opioidnaive patient. Slowed breathing, falling unconscious, and losing physical coordination can all lead to serious accidents, brain damage, coma, and death. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Dose conversion in opioid rotation from continuous intravenous infusion of morphine hydrochloride injection to fentanyl patch in the management of cancer pain. Converting to transdermal fentanyl palliative care network of. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. If you leave a patch on for more than 3 days 72 hours, remove the patch and apply a.
An alternative algorithm for dosing transdermal fentanyl for. When the doctor tested my blood, it did not show up. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Stronger dosed duragesic patches may be available for particularly severe cases of chronic pain. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch. It should not be used to determine doses when converting a patient from one opioid to another. The stronger the dose, the larger the patch, as more area of skin needs to be covered to ensure that more of the drug is being absorbed over the same period of time. All doses expressed in mg per day with exception of fentanyl transdermal. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. I dont understand these results because i faithfully use the patch for cronic pain from a radical neck disscection i had in 2001. The table is based on oral dosing for chronic noncancer pain.
Patients who are opioidexperienced are those receiving, for one week or longer, daily opioid doses up to 80 mgday of oral morphine or an equianalgesic dose of. Transdermal and parenteral fentanyl dosage calculations and. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Serious dangers of fentanyl patch abuse the biggest risk of abusing fentanyl, especially via timerelease patches, is overdose. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Oral morphine milligram equivalent conversion table updated 8. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients.
Practical pain management is a remedy health media, llc web property. Significant amounts of fentanyl continue to be absorbed from the skin for. Do not use table 2 to convert from duragesic to other therapies because this conversion to duragesic is. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. This tool does not contain all of the important safety information needed to prescribe butrans. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. Transdermal fentanyl is formulated as both a gelcontaining reservoir and a drug inadhesive. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion.
For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoralr at 100 mcg. Example calculations from total daily dose of 80mg oral morphine daily dose of morphine mg calculation to alternative drug suggested prescribed dose of alternative drug 80 fentanyl patch 80. 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. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. This dose is not possible to provide in slowrelease morphine preparation c. 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. Opioid conversion calculator for morphine equivalents. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. Recommend an appropriate dose of transdermal fentanyl when. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via.
Apr 26, 2020 conversion from morphine or equivalent to fentanyl transdermal. Oxycontin, xtampza er oxycodone dosing, indications. They all interact with specific opioid receptors such as. Fentanyl patches scottish palliative care guidelines. Dose conversion in opioid rotation from continuous intravenous. Calculate total dose oral morphine over 24 hours, 2 x 90 mg 180 mg. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. Morphine milligram equivalents mme calculator mdcalc. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Fentanyl is a synthetic centrally acting opioid agonist that has a rapid onset of action, short duration of effect, and lack of histamine release.
Particular care is required when dealing with high doses of opiates. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Fentanyl duragesic patches come in six different sizes and doses, including. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Duragesic fentanyl transdermal dosing, indications. Tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal overdosage. What are the steps for converting from morphine or. But the pain is still pretty bad, so i was just today prescribed the fentanyl patch which is longer. Converting from oral morphine to fentanyl transdermal patch. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. Equianalgesic chart changes in italics ui health care. Dose equivalents and changing opioids faculty of pain medicine.
Use appropriate opioid for situation or care setting. Once the dose is calculated, the new opioid should not be prescribed at the equivalent dose. It may be 812h or longer after putting on the first patch. Scottish palliative care guidelines fentanyl patches. Calculate the total 24hour morphine dose or morphineequivalent.
Fentanyl patch dosing determination based on current opioid therapy. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The total daily morphine milligram equivalents mme will be displayed. The goal is to convert this to oral morphine for discharge. Converting to transdermal fentanyl palliative care. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. 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.