Conversion from other oral hydromorphone formulations. These bidirectional differences are not captured in a traditional equianalgesic table. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Opioid converter morphine equivalent calculator omni. Opioid manager switching opioids morphine equivalence table. Narcotic pain relievers also can be addictive and abused. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain.
Manage breakthrough pain with morphineshortacting opioid prn. Parenteral hydromorphone is 20 times as potent as oral morphine. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Oral hydromorphone is about 47 times as potent as oral morphine. In the case of converting morphine to methadone, methadone has a relative potency of 4. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain.
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. Calculate the total 24hour morphine dose or morphineequivalent. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much opiate during the conversion period. Transdermal dosage use only when converting another opioid to fentanyl patch. Mar 09, 2012 since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Opioid conversions calc single agent equianalgesic.
You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. For patients under this age consult with a pain or palliative care specialist. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Conversion of intrathecal opioids to fentanyl in chronic pain. Monitor the patient carefully for respiratory depression. There are differences in the literature regarding opioid conversion ratios. Equianalgesic chart changes in italics ui health care. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old.
Oral hydromorphone is about 47 times as potent as oral. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. 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. Opioid conversion guidelines gippsland region palliative care. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Start exalgo dose at 50% of calculated daily dose every 24 hours. Start with equivalent total daily dose of immediate release formulation and administer once daily. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of the new agent and may result in an overdosage. Transdermal and parenteral fentanyl dosage calculations and. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
Since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain. Currently, there are no empirical studies converting fentanyl to morphine. Transdermal and parenteral fentanyl dosage calculations. For this reason the date of birth field is mandatory. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral morphine equivalent 36 x 5 180 mg morphine24 hrs. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Duragesic fentanyl transdermal dosing, indications. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. An alternative algorithm for dosing transdermal fentanyl for. Both drugs work the same way in the body to relieve pain. Please select conversion type buprenorphine patch mcghr topical codeine mg oral endone oxycodone ir mg oral fentanyl mcg subcutaneous fentanyl mg buccal fentanyl patch mcghr topical hydromorphone cr mg oral hydromorphone ir mg oral hydromorphone ir mg subcutaneous morphine mg oral morphine mg subcutaneous norspan patch. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch.
Opioid conversion ratios guide to palliative care practice 2016. For frail elderly patients, use more conservative conversion or a lower strength patch e. 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. Converting from oral morphine to fentanyl transdermal patch. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows.
Recommend an appropriate dose of transdermal fentanyl when. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. She would like to try an immediaterelease opioid agent, hydromorphone. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. 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. Both dilaudid and fentanyl can be habit forming even at prescribed doses. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. What are the steps for converting from morphine or. Transdermal patch should be used only in opioid tolerant patients. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Advanced opioid conversion calculator morphine equivalents.
Approximate breakthrough doses recommended for fentanyl transdermal patcha breakthrough should be 10% of the total daily opioid dose patch strength mcghour oral morphine immediate release mg oral hydromorphone immediate release mg oral oxycodone immediate release mg 12 5 1 2. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Round up to and begin treatment with transdermal fentanyl using a patch size of 50 gh. Oral morphine milligram equivalent conversion table updated 8. Fentanyl topical may also be used for purposes other than those listed in this medication guide. Canadian guideline for safe and effective use of opioids for.
The following source was used for morphine equivalent conversion factors per mg of opioid. 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. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Opioid switching using equivalence tables home saskatchewan. 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. Morphine milligram equivalent mme calculator nyc health. Surprisingly, crosstolerance between opioids is often incomplete. Select microgram per hour dose of transdermal fentanyl based on table 2. Converting to transdermal fentanyl palliative care network. Do not use this tool to convert from one opioid to a different opioid. You wish to convert the therapy to transdermal fentanyl. Select microgram per hour dose of transdermal fentanyl based. 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.
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. Cr 18 mg q12h is being switched to fentanyl patches. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Scottish palliative care guidelines fentanyl patches. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. The amount of residual drug in the patients system must be accounted for. Equianalgesic dose conversions are necessary when changing opioid drug therapy in the clinical setting. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice on removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting. Opioid oral morphine milligram equivalent mme conversion. Fentanyl patch converter globalrph conversion from.
Conversion from morphine or equivalent to fentanyl transdermal. Overestimating the dose when converting patients from another opioid analgesic. Opioid conversion tips changing to another oral opioid question. 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. Fentanyl patch converter globalrph conversion from other. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. What every pharmacist should know about transdermal fentanyl. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
Clinical pharmacist, university of new mexico hospitals. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Duragesic label page 1 full prescribing information for use. Stop long acting oral morphine after applying patch. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
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