If you are converting a patient to or from fentanyl i. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. A safe and effective method for converting cancer patients. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Her total daily dose of oxycodone is 40 mghow much oral morphine is this. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present.
Percocet contains oxycodone 5mg acetaminophen 325mg. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25. This is especially important for fentanyl and methadone conversions. Fentanyl patch converter globalrph conversion from other. Hi everyone, i am new to this board, but not to taking pain meds. Patients who experience serious adverse effects should have patches removed immediately and should be monitored for at least 24 hours after the patch is removed 412. Remember to enter all opioids the patient is taking. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. 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 approximate starting dose of opana er to be given every 12 hours. Fencino 12 microgramshour transdermal patch summary of. Fentanyl patches are another option, but are expensive and difficult to titrate. 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. So far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. Per the product labeling, oral oxymorphone 10 mg er is approximately equivalent to hydrocodone 20 mg or appendix c. Even with taking 36 norcos a day, you are not opioid tolerant enough for oxymorphone or fentanyl. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Fentanyl can be easily extracted from the patch and used as an injection, smoked or snorted some patches are easier to crack than others, but the truth remains that you can concentrate the dose from a patch and get it to you blood stream faster. The following source was used for morphine equivalent conversion factors per mg of opioid.
Conversion from morphine or equivalent to fentanyl transdermal. The wa state amdg calculator uses higher conversion ratios that increase at higher doses 020 mg 4. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. The second change was he took me off norco 10325 12 tabs every 6 hours max of 8 a day and put me on percocet 10325 1 tab every 4 hours max of 6 a day. Conversion tables show that the oral to parenteral ratio for morphine is 3. 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.
Dose conversion tool butrans buprenorphine transdermal. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. 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. Durogesic dtrans 25 mcghr transdermal patch summary of. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Oral oxymorphone is a new formulation of an existing parenteral opioid that has. Duragesic label page 1 full prescribing information for. Fentanyl remove fentanyl from your drug comparison. Do not use this table to convert from fentanyl transdermal system to other opioid. I am currently on 50mcg fentanyl patches and have been since sept. Transdermal and parenteral fentanyl dosage calculations and.
The patch will take a little while to get in to your system. This calculator should not be used to determine doses when converting a patient from one opioid to another. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. This calculator uses the following conversion factors. They were on a variety of full agonist opioids, including predominantly oxycodone n 12, hydromorphone n 4, oxymorphone n 2, fentanyl n 6, methadone n 5, and morphine n 6. Each butrans patch is intended to be worn for 7 days butrans doses of 7. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Conversion algorithm for instructions on converting from one opioid to. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. Opioid dosage conversion oregon workers compensation. Oct 08, 2014 the equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. Butrans contains buprenorphine, a schedule iii controlled substance.
Oct 10, 2019 40 mg total daily dose of former opioid x 0. Round down, if necessary, to the appropriate opana er tablets strengths available. The patch is fentanyl the strongest family of opiates we have. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Equianalgesic chart changes in italics ui health care. Fentanyl can be abused and is subject to criminal diversion. All this leads to potential od and death, let alone the reality of spiking your tolerance. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. If that is case, might select a fentanyl patch as the best approach. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. Opioid conversion calculator for morphine equivalents.
Opioid oral morphine milligram equivalent mme conversion. Each fentanyl transdermal system patch has a clear plastic release liner that can be. Converting to transdermal fentanyl palliative care. Wait 18 hours after patch removed, then initiate conservative dose of approximately 10 mg once every 12 hours oxycodone controlledrelease for each 25 mcghour. Opioids extracting fentanyl from polymermatrix patches. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Choose either one but not both unless you require a rescue drug.
Oxymorphone to fentanyl equivalent doctor answers on. The equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. Opioid conversion guidelines gippsland region palliative care. Recommend an appropriate dose of transdermal fentanyl when. Compare fentanyl vs oxymorphone comprehensive analysis. 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. If you respond well to the short acting form of it and can afford a brand name med, it may be a good oral med option for you. Equianalgesic dosing of opioids for pain management. The total daily morphine milligram equivalents mme will be displayed. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Opioid oral morphine milligram equivalent mme conversion factors1,2. Select microgram per hour dose of transdermal fentanyl based on table 2.
As a result of continued absorption of fentanyl from the skin depot after removal of the patch, the halflife of fentanyl after transdermal administration is about 2. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Calculate the total shortacting ir opioid dose used in 24 hours convert this total to a. Thus, we have to pay careful attention to switch from oral oxycodone to fentanyl patch for fear of insufficient pain control or overdose.
After application of the fentanyl patch peak plasma levels are achieved 24 hours. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Do not use this tool to convert from one opioid to a different opioid. Oct 15, 2019 patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. Most of the above oral opioids are available as generics. Fentanyl patch converter globalrph conversion from.
Duragesic fentanyl transdermal dosing, indications. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Administer onehalf of the patients total daily po oxycodone dose as once every 12 hours conversion from fentanyl transdermal. Transdermal and parenteral fentanyl dosage calculations. Calculate the total 24hour morphine dose or morphineequivalent.
I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. After discontinuing a fentanyl patch, fentanyl levels fall gradually. After 50% dose reduction for incomplete crosstolerance, reduce dose again by 50% for. To dose for iv use simply take a 1ml syringe and draw out however many micrograms you wish, its best to start with whatever the patch would release in an hour to get a feel for it ived, so 10 units for 50 mcg or 20 for 100 mcg of fentanyl from a 50 mcghr patch. Advanced opioid conversion calculator morphine equivalents. Morphine milligram equivalent mme calculator nyc health. Compare fentanyl vs oxymorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Decrease new dose 3050% to allow for incomplete crosstolerance.
Do not remove the fentanyl transdermal system patch from the blister until you are ready to use it see figure f. Many patients were on combinations of different immediate release and sustained release combinations of opioid medication. Opioid conversion table wiley jun 2015 hydrocodone fentanyl patch mcghr to oral convert oral morphine total daily dose to oral methadone as per the conversion ratios above. Opioid conversion calculator morphine equivalents advanced. Following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours.
Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. Duragesic label page 1 full prescribing information for use. Apr 24, 2012 so far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Each fentanyl transdermal system patch is sealed in its own protective blister. 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. Opioid switch from low dose of oral oxycodone to transdermal.
Peel off both parts of the release liner from the patch. Conversion from highdose fullopioid agonists to sublingual. Oxycontin, xtampza er oxycodone dosing, indications. Round up or down based on patient factors and available patch sizes.
Total daily dose of oxymorphone a 10 mg x 4 times d 40 mgd 2. Converting from oral morphine to fentanyl transdermal patch. You need to be on 60 mg of morphine a day consistently for at least 12 weeks before switching to oxymorphone or fentanyl. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. It is not recommended for people who have never been prescribed opioidtype pain relief before, and deaths have been reported from improper dosing.
I have been battling severe constipation regardless of numerous methods to remedy it. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. Fentanyl transdermal system contains fentanyl, an opioid agonist, and is indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Morphine milligram equivalent mme calculator instructions.
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. Doctors give trusted answers on uses, effects, sideeffects, and cautions. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414. Oxymorphone remove oxymorphone from your drug comparison. It should not be used to determine doses when converting a patient from one opioid to another.
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