Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. 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. Upon system removal, 17 hours or more are required for a 50% decrease in serum fentanyl concentrations. Once the conversion has occurred, the dose of new opioid should be titrated carefully. Converting from oral morphine to fentanyl transdermal patch. When initiating transdermal fentanyl in a patient currently treated with oral morphine, the initial dose should be based upon their previous 24hour opioid requirement.
Fentanyl patches are another option, but are expensive and difficult to titrate. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Clinical pharmacist, university of new mexico hospitals. Dec 22, 2019 store fentanyl transdermal patch in a safe place where children cannot see or reach it, and where other people cannot get to it. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci. Transdermal opioid patches are not suitable for acute pain. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Opioid equianalgesic calculator opioid switching from. Opioid conversion table american academy of family. Opioid oral morphine milligram equivalent mme conversion factors1,2. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
Opioid conversion ratios guide to palliative care practice. Changing an oral or iv opioid to transdermal fentanyl 1. Conversion of opioid analgesics to fentanyl transdermal. Feb 17, 2020 monitor patients for signs and symptoms of opioid withdrawal or for signs of oversedationtoxicity after converting patients to exalgo. From 20 to 2017, the number of opioid involved overdose deaths opioid deaths in the united states increased 90%, from 25,052 to 47,600. Conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
There are differences in the literature regarding opioid conversion ratios. Transdermal and parenteral fentanyl dosage calculations and. Sandoz fentanyl patch poses risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. The first tdf product on the market was the branded. Advice should be sought from the palliative care team. Multiply the amount of each drug by its bioavailability column 4, to get a smaller number. 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. Frail or elderly patients may need lower doses and slower titration. Transdermal and parenteral fentanyl dosage calculations. Canadian guideline for safe and effective use of opioids. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. They all interact with specific opioid receptors such as.
Opioid withdrawal symptoms such as nausea, vomiting, diarrhea, anxiety, and shivering are possible in some patients after conversion or dose adjustment. Dose equivalents and changing opioids faculty of pain. Opioid conversion ratios guide to palliative care practice 2016. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily parenteral dose. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. For frail elderly patients, use more conservative conversion or a lower strength patch e.
Accidental transfer of a fentanyl patch to the skin of a non patch wearer particularly a child, while sharing a bed or being in close physical contact with a patch wearer, may result in an opioid overdose for the non patch wearer. Canadian guideline for safe and effective use of opioids for. Fill in the mg per day for whichever opioids your patient is taking. Calculate the total 24hour morphine dose or morphineequivalent. There is a slow onset and slow offset of analgesia and there is a slow onset and slow offset of sideeffects. Fentanyl was initially available in 25, 50, 75 and 100. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Duragesic label page 1 full prescribing information for. This is the number of milligrams that actually gets into the bloodstream. In renal impairment gfr opioids of choice are oxycodone posc, fentanyl and buprenorphine patches. Calculator will only allow conversion from a buprenorphine patch and not to a patch as there is limited evidence about, and experience of its use compared to other opioids. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Opioid conversion table hop16091451 croni ain anaeen tooli.
Each patients risk should be assessed prior to prescribing sandoz fentanyl patch, and all patients should be monitored regularly for the development of these behaviours or conditions see warnings and precautions. Changes in opioid involved overdose deaths by opioid type. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Opioid oral morphine milligram equivalent mme conversion. Levys rule to convert from oral morphine to transdermal fentanyl. Transdermal dosage use only when converting another opioid to fentanyl patch. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. B initiation of fentanyl in patients who are opioid naive is contraindicated at any dose. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch.
Considering patient has not been compliant recently, in addition to recent weight loss indicating cachexia, reducing the dose to a 100mcg patch applied topically. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. The table is based on oral dosing for chronic noncancer pain. Transdermal opioid patches have been associated with medication errors. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Safety of fentanyl initiation according to past opioid. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Due to crosstolerance, when switching from one opioid to another, the starting dose of the. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioid tolerant people. Transdermal patch should be used only in opioid tolerant patients.
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. Each butrans patch is intended to be worn for 7 days. Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Select microgram per hour dose of transdermal fentanyl based. Gwent guidance on the use of strong opioids in non malignant pain is available at. 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. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Converting to transdermal fentanyl palliative care network. A locked box or area may help keep fentanyl transdermal patch safe.
What are the steps for converting from morphine or equivalent to. What are the steps for converting from morphine or. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. According to the manufacturer, 50% of the patients in clinical trials required a dose increase. The conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion. It should not be used to determine doses when converting a patient from one opioid to another. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Aug 12, 2019 accidental exposure by patch transfer. Fentanyl is a highpotency opioid with a strength 100 times that of morphine. 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. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. How should conversion from oral morphine to fentanyl.
An alternative algorithm for dosing transdermal fentanyl. Duragesic label page 1 full prescribing information for use. Incorrect use of opioid patches can result in significant patient harm, including death. Opioid dose conversion chart, syringe driver doses, rescue prn doses and opioid patches use the conversion chart to work out the equivalent doses of different opioid drugs by different routes. Equianalgesic chart changes in italics ui health care. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. From 20 to 2017, the number of opioid involved overdose deaths in the united states increased 90%. 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. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Fentanyl patch converter globalrph conversion from other. Fentanyl patch converter globalrph conversion from. Follow the information that comes with fentanyl transdermal patch for throwing out doses that are not needed. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain.
The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. When using this chart, calculate the total daily dose of morphine. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. Stop long acting oral morphine after applying patch. 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. Opioid analgesic risk evaluation and mitigation strategy rems. Subcutaneous morphine mgday subcutaneous oxycodone mgday. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Opioid conversion calculator for morphine equivalents.
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. 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. Oral morphine milligram equivalent conversion table updated 8. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. The formula to work out the dose is under each drug name. 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. Two parallel dosage conversion ratios are currently recommended by most manufacturers of fentanyl patches. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. Conversion guide for opioid to transdermal fentanyl from to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch 12 hour controlled release cr long acting oral opioid apply the patch at the same time as administering the final 12 hour cr dose. When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration.
Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Durogesic dtrans 12 mcghr transdermal patch summary of. Monitor the patient carefully for respiratory depression. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. There are many opioids and many formulations available e. This is especially important for fentanyl and methadone conversions. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Manage breakthrough pain with morphineshortacting opioid prn.
This dose is not possible to provide in slowrelease morphine. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. 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. Scottish palliative care guidelines fentanyl patches. Apr 21, 2020 conversion from morphine or equivalent to fentanyl transdermal. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours.
Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Converting to transdermal fentanyl palliative care. Opioid converter morphine equivalent calculator omni. Methadone conversion factors increase with increasing dose.
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