Fentanyl accumulates to form a depot in the skin below the. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. For moderate pain, an opioid agonist eg, hydrocodone. For use in opioidtolerant patients only duragesic contains a.
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. Evaluation and comparison of online equianalgesic opioid dose. Methadone dosing calculator globalrph opioid conversions. Equianalgesic dosing of opioids for pain management. Opioid withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering are possible in some patients after conversion or dose adjustment. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. Opioid brands and strengths microgramshr available frequency of administration buprenorphine butrans 5, 10, 15, 20 7 days transtec 35, 52.
Fentanyl patches are another option, but are expensive and difficult to titrate. Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. Fentanyl is also available as a sustained release transdermal patch which when. They all interact with specific opioid receptors such as. 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. Morphine equivalent dose med opioid conversions globalrph. Therefore the opioid conversion guidelines have been developed to assist when changing opioid drug therapy. Type of opioid mme conversion factor buprenorphine patch. All fentanyl patch orders must be scrutinized by the. Conversion from avinza to fentanyl patch ive been treated for severe fibromyalgia for the last 3 years. 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. The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy.
In clinical settings, fentanyl exerts its principal pharmacologic effects on the central nervous system. Due to the risk of respiratory depression, the transdermal patch is for use in opioid tolerant patients only. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Fentanyl interacts predominately with the opioid mureceptor. 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. Please use the following guideline when calculating a fentanyl patch dose increase. 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.
Fentanyl patch converter globalrph conversion from. Duragesic fentanyl transdermal dosing, indications. Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2. 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. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine.
Upon system removal, 17 hours or more are required for a 50% decrease in serum fentanyl concentrations. Opioid conversions calc single agent equianalgesic globalrph. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Higher dosesmore frequent administration may be required in opiate. 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. Opioid switching from transdermal fentanyl to oral methadone. To convert patients from oral or parenteral opioids to transdermal formulation, a 24hour. Opioid conversions calc single agent equianalgesic. Conversion from avinza to fentanyl patch healthboards. In other words, the conversion factor not accounting for days of use would be 6025 or 2. 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.
The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl patch converter globalrph conversion from other opiates. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl patch dosing determination based on current opioid therapy. Methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Dec 15, 2004 methadone was initiated 824 hours after fentanyl withdrawal, depending on the patients previous opioid doses from 300 microg per hour. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. If you are converting a patient to or from fentanyl i.
Jan 29, 2018 methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Opioid withdrawal symptoms nausea, vomiting, diarrhea, anxiety, shivering are possible so a gradual downward titration is advised. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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.
For mild pain, the starting regimen should be a nonsteroidal antiinflammatory drug nsaid or acetaminophen. Please use the following guideline to calculate a fentanyl patch dose increase. In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioids opiates are a group of analgesic drugs, used primarily for pain management. 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. These mubinding sites are discretely distributed in the human brain, spinal cord, and other tissues. Changing an oral or iv opioid to transdermal fentanyl 1. Fentanyl patch converter globalrph conversion from other evaluation and comparison of online equianalgesic opioid opioid patch conversion scottish palliative care guidelines choosing and changing.
There are many opioids and many formulations available e. Oral morphine milligram equivalent conversion table updated 8. Methadone was initiated 824 hours after fentanyl withdrawal, depending on the patients previous opioid doses from 300 microg per hour. Fentanyl transdermal patch is available in a generic form and as the brandname drug duragesic. The starting methadone dose was calculated according to a 2step conversion between transdermal fentanyl. The amount of residual drug in the patients system must be accounted for. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. 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.
The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Table 3 shows the comparison of proposed morphine to fentanyl conversion parameters. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Although there has been no systematic assessment of such conversion, start with a conservative conversion. The conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. If patient is currently receiving opiates, convert to fentanyl patch equiv. Morphine milligram equivalent mme calculator nyc health. 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. Fentanyl patch conversions package insert recommendations. 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. Stop long acting oral morphine after applying patch. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. Duragesic label page 1 full prescribing information for use.
A safe and effective method for converting cancer patients. Therefore the opioid conversion guidelines have been developed to assist. 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. To convert patients to another opioid, remove duragesic and titrate the. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Uses morphine as the reference point for conversion of other oral opioids to mme. 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. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. 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. 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. Definitions opioid analgesics vary in potency, side effect and pharmacokinetic profile.
Morphine milligram equivalents mme calculator mdcalc. Points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. 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. Methadone dosing calculator globalrph opioid conversions calculator. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. The following source was used for morphine equivalent conversion factors per mg of opioid. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioid converter morphine equivalent calculator omni. Advice should be sought from the palliative care team. Fentanyl patches durogesic for chronic pain nps medicinewise. Morphine equivalent dose med opioid conversions globalrph morphine milligram equivalents mme opioid. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients.
Opioid conversion calculator morphine equivalents advanced. Opioid conversion guidelines home gippsland region. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. 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. The strength of the patch is prescribed in microgramshour.
Opioid conversion calculator for morphine equivalents. Transdermal and parenteral fentanyl dosage calculations and. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Fentanyl can be abused and is subject to criminal diversion. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Should be used only for oral opioid conversion to mme, not for conversion of one opioid to another.
Evaluation and comparison of online equianalgesic opioid. Transdermal and parenteral fentanyl dosage calculations. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. Converting from oral morphine to fentanyl transdermal patch. Fentanyl patch converter globalrph conversion from other. Opioid oral morphine milligram equivalent mme conversion. Opioid switching from transdermal fentanyl to oral.
Overestimating the dose when converting patients from another opioid analgesic. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Clinical pharmacist, university of new mexico hospitals. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Do not use this tool to convert from one opioid to a different opioid. Opioid equivalence chart gloucestershire hospitals nhs. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphi ne. Duragesic label page 1 full prescribing information for.
Equianalgesic dose ratios are approximations and do not account for genetic factors, incomplete crosstolerance. Fentanyl patch protocol ventura county, california. Fentanyl patches should not be used for rapid titration in pain control. Recommendations based on data contained in the package insert. 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. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours.