There is no direct conversion for fentanyl lozenge to other opioids including morphine the recommended initial dose of lozenge is 200 micrograms if pain is not relieved then the dose can be increased until effective. Page 7 of 12 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. Morphine milligram equivalent mme calculator instructions. Opioid narcotic converter clinicians ultimate guide to drug. Prescribing information does not exclude the 12 mcg h 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. A 25 microgramhour fentanyl patch is equivalent to about 60mg to. Side effects of duragesic fentanyl transdermal, warnings, uses.
I came across a 50 mcgh fentanyl transdermal system today. 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. Opiate conversion norco to fentanyl patch brunokeys2s blog. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Transdermal and parenteral fentanyl dosage calculations. 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. Page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Patient presents using fentanyl patch 100 microgramhour. Doctors give trusted answers on uses, effects, sideeffects, and cautions. The fentanyl patch duragesic is a medicated skin patch used to treat moderatetosevere chronic pain. Any short to intermediate acting narcotic prescribed by your physician specifically for breakthrough pain and taken exactly as directed should be safe.
It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. Opioid converter morphine equivalent calculator omni. Converting to transdermal fentanyl palliative care network. Route onset peak duration fentanyltransdermal fenta. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Remember to enter all opioids the patient is taking. At high doses, conversion from one opiate to another must always be. In the case of converting morphine to methadone, methadone has a relative potency of 4. Question about fentanyl 12mcg hr i have one sandoz fentanyl transdermal system 12 mcghr patch, i have experience with opiates in the past, but i have not had an opiate in 4 months. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcg h see contraindications. Advanced opioid conversion calculator morphine equivalents. Scottish palliative care guidelines fentanyl patches. It should only be used in people who are already using an opioid medication.
Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Opioid conversion calculator for morphine equivalents. Conversions are from micrograms hour patch strength to mg oral morphine. To make any conversion from one opiate to another always convert the dose back to an equivalent oral dose of morphine first these conversions are a guide only. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Yemex 12 microgramhour transdermal patch summary of product. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Ongoing, preventable fatal events with fentanyl transdermal. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
Opioid conversion ratios guide to palliative care practice. Aug 12, 2019 durogesic dtrans doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. 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. It should not be used to determine doses when converting a patient from one opioid to another. Transdermal and parenteral fentanyl dosage calculations and. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Its made by mallinckrodt and appears to be a matrix style patch no gel inside. I probably wouldve overdosed had i tried chewing the entire fentanyl patch, which was 75 mcghr. Durogesic dtrans 12 mcghr transdermal patch summary of.
Opioid equivalence chart gloucestershire hospitals. The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy. 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. If 100mcghrisrequired,usemultipletransdermalsystems. Jun 28, 2007 according to the reporter, a nurse applied a prescribed fentanyl patch, 75 mcghour, to the patients skin before discharge, and gave the patient three patches to take home as well as a prescription for oxycodone prn every 46 hours. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Select microgram per hour dose of transdermal fentanyl based on table 2.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Fentanyl patches scottish palliative care guidelines. Opioid conversion table hop16091451 croni ain anaeen. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor. Initial dose based on previous 24hour opioid requirement consult product literature, for evaluating analgesic efficacy and dose increments, see under chronic intractable pain not currently treated with a strong opioid analgesic, for conversion from long term oral morphine to transdermal fentanyl, see pain management with opioids under. Currently on 12 mcg duragesicfentanyl patch addiction. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Dose equivalence and switching between opioids specialist. Opioid oral morphine milligram equivalent mme conversion. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sciv mg po mg comments morphine 10 30a codeine 120 sc only 200 metabolized to morphine fentanyl patch see table below useful when po pr routes not an option fentanyl 0.
Equianalgesic chart changes in italics ui health care. 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. Converting from oral morphine to fentanyl transdermal patch. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. After discontinuing a fentanyl patch, fentanyl levels fall gradually. Fentanyl patch converter globalrph conversion from other. I have been keeping my constant uppermid back pain and other aches under control with around 30 mg of hydrocodone a day, but sometimes my back and muscles still ache a lot. Patients may continue to require supplemental opioids for breakthroughpain.
Duragesic label page 1 full prescribing information for use. Conversion from morphine or equivalent to fentanyl transdermal. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcg hr fentanyl patch. One opiateopioid can be switched for another, but only if the doses are equianalgesic, and in your sons case, it. Recommend an appropriate dose of transdermal fentanyl when. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily. I am currently a casual opiate user, taking around 4 norco 10s to reach desired effects. Converting to transdermal fentanyl palliative care. Formula for calculating sufentanil breakthrough doses btd for a given fentanyl patch for a given fentanyl patch of x mcghr. Fentanyl 25 patch 25microgramshour 30mg to 4mg24hours. Calculate the total 24hour morphine dose or morphineequivalent. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic 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. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
Ionsys fentanyl dose, indications, adverse effects. I am no expert, but from being on the fentanyl patch for over 10 years, at doses from 75 mcg to 125 mcg i can tell you that 12 mcg is a very low dose. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Duragesic fentanyl transdermal dosing, indications, interactions. Oral morphine milligram equivalent conversion table updated 8. Equivalence between oral morphine and transdermal fentanyl. 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. According to the reporter, a nurse applied a prescribed fentanyl patch, 75 mcghour, to the patients skin before discharge, and gave the patient three patches to take home as well as a prescription for oxycodone prn every 46 hours. My experience chewing a fentanyl patch and almost overdosing. Caution is advised when converting to methadone due. Select microgram per hour dose of transdermal fentanyl based on. Surprisingly, crosstolerance between opioids is often incomplete. 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. Although there are several available strengths, your healthcare provider may prescribe 12.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcg hr 12. Fentanyl patch strength microgramhr, oral morphine mg day. In general, the 12 mcg h dose, which allows for smaller dose. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Appropriate transdermal system dosage adjustments should be based on the daily dose of supplementary opioids, using the ratio of 45 mgday of oral morphine to a 12. The total daily morphine milligram equivalents mme will be displayed. Regular oral analgesia needs to be continued for 1224 hours after commencing either patch. Demystifying opioid conversion calculations 87 n in patients who are not opioid tolerant note. Morphine milligram equivalent mme calculator nyc health. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Durogesic dtrans doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. In 2000, brietbart, et al published an alternative method, based on the results of a multicenter trial by donner, et al, that relied on a fixed dose conversion ratio to calculate the fentanyl transdermal dose. Opioid conversion and brand availability in canada michael g. Fencino 12 microgramshour transdermal patch summary of.
In other words, the conversion factor not accounting for days of use would be 6025 or 2. Dose equivalents and changing opioids faculty of pain medicine. Its too bad the 25 mcg dose makes you sick the fentanyl patch is a very effective pain reliever. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. 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. Sadly, the patient died within 12 hours of discharge. Use supplementaldosesof shortacting opioid analgesics to manage pain until relief is obtained with the transdermal system. Table 2 is for adult patients who have a need for opioid rotation or who are less clinically stable conversion ratio of oral morphine to transdermal fentanyl. Monitor the patient carefully for respiratory depression. Fentanyl patch converter globalrph conversion from. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine. In general, the 12 mcgh dose, which allows for smaller dose. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
1347 932 544 1077 1386 452 1258 1088 72 813 1141 195 76 76 874 862 829 1475 1455 277 1018 807 642 1674 861 595 246 482 1327 1196 1168 1104 654 71 727 418 214