Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Both opioidnaive n 14 and codeineusing n 14 patients started with transdermal. Agreed to dose of 280mg morphine daily in 2 divided doses 140mg morphine sr twice daily 4. Levys rule to convert from oral morphine to transdermal fentanyl. This drug comes as a transdermal patch, lollipop, or in traditional pill form. 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. Do not use this tool to convert from one opioid to a different opioid. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Fentanyl patch converter globalrph conversion from other opiates. Fentanyl patch dosing determination based on current opioid therapy. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment.
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. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. 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. Both opioidnaive n 14 and codeineusing n 14 patients started with transdermal fentanyl in the. Stop long acting oral morphine after applying patch.
To treat cancer pain, physicians often decide to jump directly from step 1 of the world health organization who analgesic ladder to step 3. 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. There is no dose equivalence between fentanyl lozenges and other opioid formulations. The following source was used for morphine equivalent conversion factors per mg of opioid. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. What every pharmacist should know about transdermal fentanyl. Morphine milligram equivalent mme calculator nyc health. Dose equivalents and changing opioids faculty of pain. Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Opioid equivalence chart gloucestershire hospitals nhs. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Converting from oral morphine to fentanyl transdermal patch. Ongoing, preventable fatal events with fentanyl transdermal.
Fentanyl duragesic side effects, withdrawal and faqs. 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. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Opiate equianalgesic dosing chart committee 1nn s of age. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. This is especially important for fentanyl and methadone conversions. Opiate bioavailability and response are highly variable. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. This dose is not possible to provide in slowrelease morphine preparation c. If you are converting a patient to or from fentanyl i.
Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. 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. 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. Butrans contains buprenorphine, a schedule iii controlled substance. In most cases, when switching between different opioids, the calculated doseequivalent must be reduced to ensure safety. 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. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. What every pharmacist should know about transdermal. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid.
Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. 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. Transdermal and parenteral fentanyl dosage calculations. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. 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. 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. If 2 extra doses of 15 mg sc morphine are required over the previous 24 hours, the initial syringe driver prescription will be morphine 30mg24 hour. 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. Gwent guidance on the use of strong opioids in non malignant pain is available at.
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. Advanced opioid conversion calculator morphine equivalents. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Recommendations based on data contained in the package insert. It is available in six dosages, from 2001600 micrograms. Fentanyl alternatives, side effects, withdrawal and faqs home. I just ended my use of fentanyl 25mghr transdermal patches. Clinical pharmacist, university of new mexico hospitals. The patch comes in five sizes, delivering between 12. Scottish palliative care guidelines fentanyl patches. Two parallel dosage conversion ratios are currently recommended by most manufacturers of fentanyl patches.
Though the medication can be taken safely under a doctors care, many individuals do abuse it in order to experience the euphoric effects it can cause when taken in high doses. 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. Fentanyl is an opioid drug often used to treat severe and longterm pain issues. How should conversion from oral morphine to fentanyl. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. John smith, a terminally ill lung cancer patient has pain that is well. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. 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. Transdermal and parenteral fentanyl dosage calculations and.
Fentanyl patch converter globalrph conversion from other. Comparative doses of oral morphine and transdermal fentanyl are given in tables 1 and 2. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor.
Canadian guideline for safe and effective use of opioids. To convert from morphine mg to fentanyl microgra mhour divide by 3. What are the steps for converting from morphine or equivalent to. Transdermal fentanyl in opioidnaive cancer pain patients. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Butrans patches buprenorphine should only be used if patient.
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. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. It should not be used to determine doses when converting a patient from one opioid to another.
They all interact with specific opioid receptors such as. Conversion of opioid analgesics to fentanyl transdermal. Opioid converter morphine equivalent calculator omni. Subcutaneous morphine mgday subcutaneous oxycodone mgday. My experience chewing a fentanyl patch and almost overdosing. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Opioid oral morphine milligram equivalent mme conversion.
Fentanyl is used for long term, severe, chronic pain and is not for use in relieving temporary pain. Recommend an appropriate dose of transdermal fentanyl when. 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. Opioid conversion ratios guide to palliative care practice. 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.
Its also used when other opiates have failed to relieve pain. Opioid opiate equianalgesia conversion calculator hospital palliative care service 68 logical fentanyl patch placement chart palliation of. The starting point for dose reduction from the calculated equianalgesic dose is around 2550%. This calculator should not be used to determine doses when converting a patient from one opioid to another. The lozenges are berry flavored lollipops that dissolve slowly in the mouth and are intended for opiatetolerant users. Converting to transdermal fentanyl palliative care. These should be used in conjunction with the summary of product characteristics for the fentanyl patch being used. 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.
If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Canadian guideline for safe and effective use of opioids for. 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.
The lozenges are berry flavored lollipops that dissolve slowly in the mouth and are intended for opiate tolerant users. A dose reduction of at least 50% is recommended when switching at high doses eg, oral morphine or equivalent doses of 500mg24. Opioidtolerant patients are those who have been taking daily, for a week or longer. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. 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. 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. Opioid conversion calculator for morphine equivalents. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Dose conversion tool butrans buprenorphine transdermal. When converting, because the patches cover a range of equivalent oral morphine doses, it is usually safer to choose an initial dose at the lower end of the. Patients who are opioidexperienced are those receiving, for one week or longer, daily opioid doses up to 80 mgday of oral morphine or an equianalgesic dose of. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be reduced. Fentanyl is an opiate, similar to morphine or methadone. I probably wouldve overdosed had i tried chewing the entire fentanyl patch, which was 75 mcghr.
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. Use appropriate opioid for situation or care setting. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Opioid conversion ratios guide to palliative care practice 2016. Fentanyl fentanyl is a synthetic opiate 50 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Data from two small studies has shown that conversion of oral morphine to transdermal fentanyl with a ratio of 100. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. In other words, the conversion factor not accounting for days of use would be 6025 or 2. 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. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. It may be 812h or longer after putting on the first patch before pain relief is experienced.