Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. The following source was used for morphine equivalent conversion factors per mg of opioid. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. If patient is currently receiving opiates, convert to fentanyl patch equiv. 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.
Evaluation and comparison of online equianalgesic opioid dose. Converting from oral morphine to fentanyl transdermal patch. Opioid conversions calc single agent equianalgesic globalrph. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl patch converter globalrph conversion from other evaluation and comparison of online equianalgesic opioid opioid patch conversion scottish palliative care guidelines choosing and changing whats people lookup in this blog. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Type of opioid mme conversion factor buprenorphine patch. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Fentanyl patch converter globalrph conversion from other. Duragesic fentanyl transdermal dosing, indications. The amount of residual drug in the patients system must be accounted for. Fentanyl interacts predominately with the opioid mureceptor. To convert patients to another opioid, remove duragesic and titrate the. Opioid brands and strengths microgramshr available frequency of administration buprenorphine butrans 5, 10, 15, 20 7 days transtec 35, 52. 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. Higher dosesmore frequent administration may be required in opiate. Recommendations based on data contained in the package insert. Dec 15, 2004 methadone was initiated 824 hours after fentanyl withdrawal, depending on the patients previous opioid doses from 300 microg per hour. Fentanyl patch converter globalrph conversion from other opiates. 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.
Opioid conversion guidelines home gippsland region. C the conversion table is unidirectional only and should only be used to convert adult patients from their current oral or parenteral opioid analgesic to the approximate fentanyl transdermal patch for use in chronic pain. Transdermal and parenteral fentanyl dosage calculations and. To convert patients from oral or parenteral opioids to transdermal formulation, a 24hour. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine. The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Opioid converter morphine equivalent calculator omni. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. Evaluation and comparison of online equianalgesic opioid. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. Should be used only for oral opioid conversion to mme, not for conversion of one opioid to another.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Fentanyl can be abused and is subject to criminal diversion. Definitions opioid analgesics vary in potency, side effect and pharmacokinetic profile. 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. Methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Methadone dosing calculator globalrph opioid conversions calculator.
Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. Morphine milligram equivalent mme calculator nyc health. Please use the following guideline to calculate a fentanyl patch dose increase. Please use the following guideline when calculating a fentanyl patch dose increase. Overestimating the dose when converting patients from another opioid analgesic. For use in opioidtolerant patients only duragesic contains a. Morphine equivalent dose med opioid conversions globalrph. Uses morphine as the reference point for conversion of other oral opioids to mme. Fentanyl patch dosing determination based on current opioid therapy. Opioid withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering are possible in some patients after conversion or dose adjustment.
Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. 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. Opioid withdrawal symptoms nausea, vomiting, diarrhea, anxiety, shivering are possible so a gradual downward titration is advised. Therefore the opioid conversion guidelines have been developed to assist when changing opioid drug therapy. S when converting from 30 to 80 mg of morphine equivalents daily dose, first taper to 30 mg oral morphine equivalents, then start with the 10 mcghr patch. Although there has been no systematic assessment of such conversion, start with a conservative conversion.
Advice should be sought from the palliative care team. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Due to the risk of respiratory depression, the transdermal patch is for use in opioid tolerant patients only. A safe and effective method for converting cancer patients. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Opioid oral morphine milligram equivalent mme conversion. For mild pain, the starting regimen should be a nonsteroidal antiinflammatory drug nsaid or acetaminophen. Buprenorphine transdermal dose recommendations when switching from an alternative opioid to butrans, the manufacturer recommends starting with the lowest strength patch and using additional shortacting analgesia during titration, as required. 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. Clinical pharmacist, university of new mexico hospitals. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Oral morphine milligram equivalent conversion table updated 8.
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. Changing an oral or iv opioid to transdermal fentanyl 1. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. There are many opioids and many formulations available e.
Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Table 3 shows the comparison of proposed morphine to fentanyl conversion parameters. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. The conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. 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 conversion ratio of certain opioids can be dependent on the dose of the original opioid. Opioid conversions calc single agent equianalgesic.
Stop long acting oral morphine after applying patch. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Duragesic label page 1 full prescribing information for use. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Opioid switching from transdermal fentanyl to oral. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. At that time, i was led through an exercise by a pt that severely twisted my trunk and tore all the muscles, ligaments and fascia on my sides and my midback. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily parenteral dose. All fentanyl patch orders must be scrutinized by the. For moderate pain, an opioid agonist eg, hydrocodone.
Fentanyl patch converter globalrph conversion from other evaluation and comparison of online equianalgesic opioid opioid patch conversion scottish palliative care guidelines choosing and changing. These mubinding sites are discretely distributed in the human brain, spinal cord, and other tissues. Fentanyl patches durogesic for chronic pain nps medicinewise. In the case of converting morphine to methadone, methadone has a relative potency of 4. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The starting methadone dose was calculated according to a 2step conversion between transdermal fentanyl. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Morphine milligram equivalents mme calculator mdcalc. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg morphine sulfate ir 4 tablets x 15mg 60mg 60mg. Fentanyl patch conversions package insert recommendations. Equianalgesic dosing of opioids for pain management. Jan 29, 2018 methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency.
Do not use this tool to convert from one opioid to a different opioid. In the iv form fentanyl is often used in icus for pain control due to its rapid onset of action and due to the minimal histamine release associated with fentanyl in comparison to morphine. They all interact with specific opioid receptors such as. Upon system removal, 17 hours or more are required for a 50% decrease in serum fentanyl concentrations. Fentanyl patches should not be used for rapid titration in pain control. Duragesic label page 1 full prescribing information for. 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. If you are converting a patient to or from fentanyl i.
Therefore the opioid conversion guidelines have been developed to assist. Opioid switching from transdermal fentanyl to oral methadone. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. In clinical settings, fentanyl exerts its principal pharmacologic effects on the central nervous system. Demographic data and medication of the pancreatitis patient fentanyl patch converter globalrph conversion from other 65 surprising globalrph opioid conversion 65 surprising globalrph opioid conversion opioid conversions calc single agent equianalgesic globalrph. Morphine equivalent dose med opioid conversions globalrph morphine milligram equivalents mme opioid. Fentanyl accumulates to form a depot in the skin below the. Conversion from avinza to fentanyl patch healthboards. Opioid equivalence chart gloucestershire hospitals nhs. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphi ne. Fentanyl is also available as a sustained release transdermal patch which when. Transdermal and parenteral fentanyl dosage calculations. Fentanyl patches are another option, but are expensive and difficult to titrate.
Opioid conversion calculator morphine equivalents advanced. Methadone was initiated 824 hours after fentanyl withdrawal, depending on the patients previous opioid doses from 300 microg per hour. Points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Equianalgesic dose ratios are approximations and do not account for genetic factors, incomplete crosstolerance. Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2.
Conversion from avinza to fentanyl patch ive been treated for severe fibromyalgia for the last 3 years. Fentanyl patch converter globalrph conversion from. Opioid conversion calculator for morphine equivalents. Methadone dosing calculator globalrph opioid conversions. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Fentanyl patch protocol ventura county, california. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Demystifying opioid conversion calculations 83 chapter 5 transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Fentanyl transdermal patch is available in a generic form and as the brandname drug duragesic.