Rather, following removal of the patch, titrate the dose of the new opioid until adequate. Use the dosing and conversion chart for opioid analgesics to. Duragesic label page 1 full prescribing information for. For chronic dosing, 10 mg iv morphine 30 mg oral morphine. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. These mubinding sites are discretely distributed in the human brain, spinal cord, and other tissues. An alternative algorithm for dosing transdermal fentanyl for. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Conversion of intrathecal opioids to fentanyl in chronic pain. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. Iv s fentantyl is included in this table to assist with opioid rotation from fentanyl where patients are admitted to olh s on iv s fentanyl.
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. In clinical settings, fentanyl exerts its principal pharmacologic effects on the central nervous system. Use of iv fentanyl is restricted to oncology, burn service, palliative care. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Advice should be sought from the palliative care team. What are cautions for the use of transdermal fentanyl. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sc iv. A safe and effective method for converting cancer patients from.
Advanced opioid conversion calculator morphine equivalents. In the case of converting morphine to methadone, methadone has a relative potency of 4. Fentanyl interacts predominately with the opioid mureceptor. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h. Scottish palliative care guidelines fentanyl patches. Describe how to transition between intravenous iv fentanyl. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. When using this chart, calculate the total daily dose of morphine. John smith, a terminally ill lung cancer patient has pain that is well.
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. 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. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Oral morphine milligram equivalent conversion table updated 8. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch. Select microgram per hour dose of transdermal fentanyl based. Canadian guideline for safe and effective use of opioids. There are differences in the literature regarding opioid conversion ratios. Mean values for unbound fractions of fentanyl in plasma are estimated to be between and 21%. It conversion ratio, eventual it fentanyl dose, and iv. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a.
Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. What should be considered in prn dosing of opioid equivalents for. Oct 15, 2019 within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. Stop long acting oral morphine after applying patch. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Converting to transdermal fentanyl palliative care. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Recommended initial fentanyl transdermal dose based upon daily oral morphine dose a,b,c. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes.
A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Patients then can be switched from intravenous iv to transdermal fentanyl once stable. Opioid equivalence chart gloucestershire hospitals nhs. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Transdermal and parenteral fentanyl dosage calculations and. Changing an oral or iv opioid to transdermal fentanyl 1. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate.
Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Subcutaneous morphine mgday subcutaneous oxycodone mgday. Dose conversion in opioid rotation from continuous intravenous. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. Convert each number in your list to iv morphine equivalents, by using column 2. It conversion ratio reached to give superior vas from previous it opioid. 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.
There are many opioids and many formulations available e. Note this dose should not be decreased further as it is already conservative. Hps opioid conversion guideline excludes fentanyl, methadone and iv infusions step 6. The amount of residual drug in the patients system must be accounted for. Opioid oral morphine milligram equivalent mme conversion. Converting to transdermal fentanyl palliative care network of. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily parenteral dose. 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. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. Transdermal fentanyl patches should not be initiated in patients with unstable pain.
Converting to transdermal fentanyl palliative care network. Fentanyl patch converter globalrph conversion from. Oct 29, 2018 kawano et al examined dose conversion ratios in patients undergoing opioid rotation from morphine injection continuous iv administration miv to transdermal fentanyl patches in a prospective observational study of 45 patients with chronic pain of cancer origin. What are the steps for converting from morphine or. Converting from oral morphine to fentanyl transdermal patch. Patient is receiving a total of 5 mg of parenteral hydromorphone in a 24hour period via a pca pump. 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. 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 optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid.
Online calculator to convert equianalgesic doses of opioid narcotic analgesics. The table is based on oral dosing for chronic noncancer pain. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Opioid conversions calc single agent equianalgesic. Levys rule to convert from oral morphine to transdermal fentanyl. Opioid conversions calc single agent equianalgesic globalrph. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Convert the oral morphine dose to duragesic there are two methods. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Fentanyl patches are another option, but are expensive and difficult to titrate.
Approximately 9% of the dose is recovered in the feces, primarily as metabolites. Transdermal and parenteral fentanyl dosage calculations. Adjust prn doses if need ed 1020% of total daily dose case study 1 mk is a 80 year old male with lung cancer he is currently taking morphine ir tab 30 mg q4hours prn in the last 24 hours he has taken 6 doses. Practical management of opioid rotation and equianalgesia. Clinical pharmacist, university of new mexico hospitals. This is the number of milligrams that actually gets into the bloodstream. Adding a syringe driver sd to a fentanyl or buprenorphine patch if 2 or more rescue prn doses are needed in 24 hours, start a syringe driver with appropriate opioid and continue patch es. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Fentanyl can be abused and is subject to criminal diversion. So round up the calculated 5 micrograms dosage of fentanyl to 125 micrograms or a 150 microgram patch depending on whether patients pain is under good control or not.
For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. The opioid dose in the sd should equal the total prn doses given in the previous 24 hours up to a maximum of 50% of the existing regular opioid dose. Opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Kawano et al examined dose conversion ratios in patients undergoing opioid rotation from morphine injection continuous iv administration miv to transdermal fentanyl patches in a prospective observational study of 45 patients with chronic pain of cancer origin. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Frail or elderly patients may need lower doses and slower titration. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Equianalgesic chart changes in italics ui health care. 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. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Opioid converter morphine equivalent calculator omni. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. They all interact with specific opioid receptors such as.
Within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Conversion of intrathecal opioids to fentanyl in chronic. No studies directly investigating dose equivalence between morphine injection continuous iv administration and the transdermal fentanyl patch have been. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Although there has been no systematic assessment of such conversion, start with a conservative conversion.
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