Comparative doses of oral morphine and transdermal fentanyl are given in tables 1 and 2. Both opioidnaive n 14 and codeineusing n 14 patients started with transdermal fentanyl in the. When converting from one opioid to another, the initial dose depends on the relative potency. Fentanyl duragesic side effects, withdrawal and faqs. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be. 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. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Patients who are considered opiate tolerant are those who have been taking, for a week or longer, at least 60 mg of morphine daily, at least. Its also used when other opiates have failed to relieve pain. Fentanyl nasal spray is used to treat breakthrough pain sudden episodes of pain that occur despite round the clock treatment with pain medication in cancer patients 18 years of age or older who are taking regularly scheduled doses of another narcotic opiate pain medication, and who are tolerant used to the effects of the medication to narcotic pain medications. Jun 28, 2007 transdermal fentanyl should only be used in patients who are already tolerant to opiate therapy, and who require a total daily dose of other opiates at least equivalent to a 25 mcg per hour fentanyl patch. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. Safety of fentanyl initiation according to past opioid.
Converting to transdermal fentanyl palliative care. Opioid opiate equianalgesia conversion calculator 12 mar 2017 online calculator to convert equianalgesic doses of opioid narcotic because transdermal fentanyl has a delayed onset and onset of peak oral opioid dosing equivalents and conversions university ofhydrocodone vicodin, norco, lorcet morphine to methadone conversion each 2 mg po morphine approximately equivalent to 1. 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. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Converting from morphine to fentanyl can result in opioid withdrawal symptoms e. Transdermal and parenteral fentanyl dosage calculations. If 2 extra doses of 15 mg sc morphine are required over the previous 24 hours, the initial syringe driver prescription will. My experience chewing a fentanyl patch and almost overdosing. Canadian guideline for safe and effective use of opioids for.
Fentanyl was initially available in 25, 50, 75 and 100. Selecting yes will convert the first drug listed fentanyl i. Fentanyl alternatives, side effects, withdrawal and faqs home medications withdrawal opiates fentanyl fentanyl is a synthetic opiate 50 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray. These should be used in conjunction with the summary of product characteristics for the fentanyl patch being used. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. 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. To convert from morphine mg to fentanyl microgra mhour divide by 3. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. The following source was used for morphine equivalent conversion factors per mg of opioid. Much like heroin, opioids, and other drugs, fentanyl acts upon specific receptors in your brain and spinal cord to decrease the feeling of pain and to. Opioid converter morphine equivalent calculator omni.
Duragesic fentanyl transdermal dosing, indications. Patients who are considered opiatetolerant are those who have been taking, for a week or longer, at least 60 mg of morphine daily, at least. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. 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. Clinical pharmacist, university of new mexico hospitals.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Enable specialized fentanyl conversion tdf fentanyl i. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Conversion from morphine or equivalent to fentanyl transdermal. Stop long acting oral morphine after applying patch. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Do not use this tool to convert from one opioid to a different opioid. Fentanyl duragesic, etrans fentanyl is a powerful synthetic opioid stronger than morphine. What every pharmacist should know about transdermal fentanyl.
Dose equivalents and changing opioids faculty of pain medicine. The use of transdermal fentanyl in patients with cancer pain who had either used no opioid before, or only codeine, is evaluated in the present trial. Fentanyl patch converter globalrph conversion from other. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Canadian guideline for safe and effective use of opioids. Scottish palliative care guidelines fentanyl patches. Oct 17, 2017 chewing on the quarter strip of fentanyl patch led to pleasant and strong opiate effects hitting me within 510 minutes, and peaking in about 20 minutes or less. Calculate the total 24hour morphine dose or morphineequivalent. Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day. Fentanyl alternatives, side effects, withdrawal and faqs home. 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. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Opiate bioavailability and response are highly variable.
Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. A common question is how to change a patient from oral morphine to a fentanyl patch. Chewing on the quarter strip of fentanyl patch led to pleasant and strong opiate effects hitting me within 510 minutes, and peaking in about 20 minutes or less. Opioid conversion calculator for morphine equivalents. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. What every pharmacist should know about transdermal. 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 protocol ventura county, california. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv. This drug comes as a transdermal patch, lollipop, or in traditional pill form. Oral morphine milligram equivalent conversion table updated 8. Fentanyl is an opiate, similar to morphine or methadone. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. Opioid conversion ratios guide to palliative care practice. Select microgram per hour dose of transdermal fentanyl based on table 2. Use appropriate opioid for situation or care setting. Opioid opiate equianalgesia conversion calculator hospital palliative care service 68 logical fentanyl patch placement chart palliation of pain. Opioid oral morphine milligram equivalent mme conversion. Fentanyl patches are indicated in patients with stable pain who have difficulty swallowing, unacceptable side effects with oral morphine or other opiates e. Select any drug in the final opiate section it will be ignored. Opiate equianalgesic dosing chart committee 1nn s of age. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Fentanyl is used for long term, severe, chronic pain and is not for use in relieving temporary 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. Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. In the case of converting morphine to methadone, methadone has a relative potency of 4. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.
Fentanyl fentanyl is a synthetic opiate 50 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray. Transdermal and parenteral fentanyl dosage calculations and. 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. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid.
The patch comes in five sizes, delivering between 12. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine. If you are converting a patient to or from fentanyl i. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. It is available in six dosages, from 2001600 micrograms. To convert therapy from oral or parenteral opioids to transdermal fentanyl, the. 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. Transdermal fentanyl in opioidnaive cancer pain patients. The breakthrough dose of any opioid except fentanyl should be one sixth of the total daily dose. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note.
An alternative algorithm for dosing transdermal fentanyl for. Recommendations based on data contained in the package insert. They all interact with specific opioid receptors such as. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor. Particular care is required when dealing with high doses of opiates. 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. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl patch converter globalrph conversion from other opiates.
I just ended my use of fentanyl 25mghr transdermal patches. How should conversion from oral morphine to fentanyl. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Transdermal fentanyl should only be used in patients who are already tolerant to opiate therapy, and who require a total daily dose of other opiates at least equivalent to a 25 mcg per hour fentanyl patch. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be reduced.
Opioid conversion ratios guide to palliative care practice 2016. Opioid equivalence chart gloucestershire hospitals. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Opioid equivalence chart gloucestershire hospitals nhs. Fentanyl patch converter globalrph conversion from. Fentanyl patch dosing determination based on current opioid therapy. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only.
Dose equivalence and switching between opioids specialist. How should conversion from oral morphine to fentanyl patches. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Fentanyl is an opioid drug often used to treat severe and longterm pain issues. Converting from oral morphine to fentanyl transdermal patch. John smith, a terminally ill lung cancer patient has pain that is well. Converting to transdermal fentanyl palliative care network. Levys rule to convert from oral morphine to transdermal fentanyl. The fentanyl patch 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 patients considered opioidtolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1.
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. Advanced opioid conversion calculator morphine equivalents. Fentanyl patch strength microgramhr, oral morphine mgday. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Gwent guidance on the use of strong opioids in non malignant pain is available at. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Recommend an appropriate dose of transdermal fentanyl when. I probably wouldve overdosed had i tried chewing the entire fentanyl patch, which was 75 mcghr. Morphine milligram equivalent mme calculator nyc health.
1512 409 771 1309 368 736 422 348 188 659 647 480 618 1444 1502 1540 419 1373 477 1094 314 48 80 170 1193 725 1471 594 821 1041 1251 1336 761 1010 292 966