Duragesic label page 1 full prescribing information for use. Round up to and begin treatment with transdermal fentanyl using a patch size of 50 gh. Transdermal and parenteral fentanyl dosage calculations and. Converting from oral morphine to fentanyl transdermal patch. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Advanced opioid conversion calculator morphine equivalents. Parenteral hydromorphone is 20 times as potent as oral morphine. Conversion of intrathecal opioids to fentanyl in chronic pain. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Calculate the total 24hour morphine dose or morphineequivalent. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl patch converter globalrph conversion from other. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine.
Please select conversion type buprenorphine patch mcghr topical codeine mg oral endone oxycodone ir mg oral fentanyl mcg subcutaneous fentanyl mg buccal fentanyl patch mcghr topical hydromorphone cr mg oral hydromorphone ir mg oral hydromorphone ir mg subcutaneous morphine mg oral morphine mg subcutaneous norspan patch. 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. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Select microgram per hour dose of transdermal fentanyl based. Do not use this tool to convert from one opioid to a different opioid. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. For frail elderly patients, use more conservative conversion or a lower strength patch e. The following source was used for morphine equivalent conversion factors per mg of opioid. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine.
How long before the fentanyl patch to absorb into the system and starts to. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Converting to transdermal fentanyl palliative care network. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. In the case of converting morphine to methadone, methadone has a relative potency of 4. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Conversion from other oral hydromorphone formulations. Fentanyl topical may also be used for purposes other than those listed in this medication guide.
Opioid manager switching opioids morphine equivalence table. In one alternative method, breitbard recommends using 2 mg of oral morphine as equivalent to 1. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Stop long acting oral morphine after applying patch. Common questions and answers about fentanyl and hydromorphone. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. An alternative algorithm for dosing transdermal fentanyl. Opioid converter morphine equivalent calculator omni. 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. 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. Morphine milligram equivalent mme calculator nyc health. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Recommend an appropriate dose of transdermal fentanyl when.
Duragesic label page 1 full prescribing information for. Canadian guideline for safe and effective use of opioids. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. 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 dihydrocodeine po pethidine po. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. 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. Opioid conversion ratios guide to palliative care practice 2016. After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. For patients under this age consult with a pain or palliative care specialist. Have studied some and know that conversion can be tricky and is less toxic to liver have stage 2 cirrhosis, so hoping it will be the right decision. 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 dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sciv.
It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Conversion from morphine or equivalent to fentanyl transdermal. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain. An alternative algorithm for dosing transdermal fentanyl for. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. 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. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Select microgram per hour dose of transdermal fentanyl based on table 2. Fentanyl patch converter globalrph conversion from. Decrease new dose 3050% to allow for incomplete crosstolerance.
Conversion of intrathecal opioids to fentanyl in chronic. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. And just fyi hydromorphone is also known as dilaudid. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived.
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. Opioid switching using equivalence tables page 1 of 5. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. Start exalgo dose at 50% of calculated daily dose every 24 hours. She would like to try an immediaterelease opioid agent, hydromorphone. What are the steps for converting from morphine or.
Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. They all interact with specific opioid receptors such as. Surprisingly, crosstolerance between opioids is often incomplete. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Approximate breakthrough doses recommended for fentanyl transdermal patcha breakthrough should be 10% of the total daily opioid dose patch strength mcghour oral morphine immediate release mg oral hydromorphone immediate release mg oral oxycodone immediate release mg 12 5 1 2. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. For this reason the date of birth field is mandatory. Opioid conversion tips changing to another oral opioid question. Oral morphine milligram equivalent conversion table updated 8. Feb 17, 2020 conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Converting from oral morphine mg24 hr to equianalgesic doses of various opioids over 24 hr. Converting from various opioids to an equianalgesic dose of oral morphine. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. 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. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Canadian guideline for safe and effective use of opioids for. Oral hydromorphone is about 47 times as potent as oral morphine. Start with equivalent total daily dose of immediate release formulation and administer once daily. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain brand names of. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Opioid oral morphine milligram equivalent mme conversion. Transdermal and parenteral fentanyl dosage calculations.
What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone. 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. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Another commonly used conversion is to equate 100 mg of oral morphine to a 25. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl.
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