The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Administer onehalf of the patients total daily po oxycodone dose as once every 12 hours conversion from fentanyl transdermal. Some experts use this conversion in cancer patients. Round up or down based on patient factors and available patch sizes. The following source was used for morphine equivalent conversion factors per mg of opioid.
Select microgram per hour dose of transdermal fentanyl based on table 2. 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. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. You need to be on 60 mg of morphine a day consistently for at least 12 weeks before switching to oxymorphone or fentanyl. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. Converting from oral morphine to fentanyl transdermal patch. 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. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics.
Do not use this tool to convert from one opioid to a different opioid. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. It should not be used to determine doses when converting a patient from one opioid to another. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Calculate the total 24hour morphine dose or morphineequivalent. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. This calculator uses the following conversion factors.
It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. 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. Fencino doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. Compare fentanyl vs oxymorphone comprehensive analysis by. 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. 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 high content of fentanyl in the patches duragesic may be a particular target for abuse and diversion. Opioid conversion calculator for morphine equivalents. Fentanyl patch converter globalrph conversion from. Duragesic label page 1 full prescribing information for. Do not remove the fentanyl transdermal system patch from the blister until you are ready to use it see figure f. 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. Peel off both parts of the release liner from the patch. Thus, we have to pay careful attention to switch from oral oxycodone to fentanyl patch for fear of insufficient pain control or overdose.
Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Opioid dosage conversion oregon workers compensation. Advanced opioid conversion calculator morphine equivalents. Opioid conversion calculator morphine equivalents advanced. 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. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. Advice should be sought from the palliative care team. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone.
Do not use this table to convert from fentanyl transdermal system to other opioid. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. Per the product labeling, oral oxymorphone 10 mg er is approximately equivalent to hydrocodone 20 mg or appendix c. 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.
Transdermal and parenteral fentanyl dosage calculations and. 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. Opioids extracting fentanyl from polymermatrix patches. 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. Round down, if necessary, to the appropriate opana er tablets strengths available. Choose either one but not both unless you require a rescue drug. The total daily morphine milligram equivalents mme will be displayed. 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. Transdermal and parenteral fentanyl dosage calculations. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. After application of the fentanyl patch peak plasma levels are achieved 24 hours. Opioid oral morphine milligram equivalent mme conversion factors1,2. Equianalgesic chart changes in italics ui health care.
Opioid conversion guidelines gippsland region palliative care. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. 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.
Butrans contains buprenorphine, a schedule iii controlled substance. 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. 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. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Fentanyl patch converter globalrph conversion from other. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. If that is case, might select a fentanyl patch as the best approach.
Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. Conversion algorithm for instructions on converting from one opioid to. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Total daily dose of oxymorphone a 10 mg x 4 times d 40 mgd 2. 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. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Durogesic dtrans 25 mcghr transdermal patch summary of.
Compare fentanyl vs oxymorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours. Oxymorphone to fentanyl equivalent doctor answers on. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414.
Converting to transdermal fentanyl palliative care. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Conversion tables show that the oral to parenteral ratio for morphine is 3. 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. Each butrans patch is intended to be worn for 7 days butrans doses of 7. A safe and effective method for converting cancer patients. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25. Each fentanyl transdermal system patch is sealed in its own protective blister.
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. Equianalgesic dosing of opioids for pain management. 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. Calculate the total shortacting ir opioid dose used in 24 hours convert this total to a. Her total daily dose of oxycodone is 40 mghow much oral morphine is this. Oral oxymorphone is a new formulation of an existing parenteral opioid that has. Fentanyl remove fentanyl from your drug comparison. After 50% dose reduction for incomplete crosstolerance, reduce dose again by 50% for. Duragesic label page 1 full prescribing information for use. Morphine milligram equivalent mme calculator nyc health. Oct 10, 2019 40 mg total daily dose of former opioid x 0. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Opioid oral morphine milligram equivalent mme conversion. Compare fentanyl vs oxymorphone comprehensive analysis.
Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Fentanyl can be abused and is subject to criminal diversion. The patch will take a little while to get in to your system. I have been battling severe constipation regardless of numerous methods to remedy it. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Duragesic fentanyl transdermal dosing, indications. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Opioid switch from low dose of oral oxycodone to transdermal. Decrease new dose 3050% to allow for incomplete crosstolerance.
The patch is fentanyl the strongest family of opiates we have. After discontinuing a fentanyl patch, fentanyl levels fall gradually. Percocet contains oxycodone 5mg acetaminophen 325mg. For each opioid, select the strength from the drop down menu and enter the number of tablets per day for fentanyl transdermal, see instructions below. Fencino 12 microgramshour transdermal patch summary of. Even with taking 36 norcos a day, you are not opioid tolerant enough for oxymorphone or fentanyl. Remember to enter all opioids the patient is taking. 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. Conversion from highdose fullopioid agonists to sublingual. Many patients were on combinations of different immediate release and sustained release combinations of opioid medication. If you are converting a patient to or from fentanyl i. Wait 18 hours after patch removed, then initiate conservative dose of approximately 10 mg once every 12 hours oxycodone controlledrelease for each 25 mcghour. This is especially important for fentanyl and methadone conversions.
Fentanyl patches are another option, but are expensive and difficult to titrate. I am currently on 50mcg fentanyl patches and have been since sept. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Review of oral oxymorphone in the management of pain ncbi. The wa state amdg calculator uses higher conversion ratios that increase at higher doses 020 mg 4. Hi everyone, i am new to this board, but not to taking pain meds. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. 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.
All this leads to potential od and death, let alone the reality of spiking your tolerance. 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. Calculate the approximate starting dose of opana er to be given every 12 hours. Oxycontin, xtampza er oxycodone dosing, indications. This calculator should not be used to determine doses when converting a patient from one opioid to another. Dose conversion tool butrans buprenorphine transdermal. 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.
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