Opioid conversion to fentanyl patch

Frail or elderly patients may need lower doses and slower titration. 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. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. 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. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Opioid conversion ratios guide to practice 2010, eastern metropolitan region palliative care consortium.

Fentanyl interacts predominately with the opioid mureceptor. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. If you are converting a patient to or from fentanyl i. Opioid conversion ratios guide to palliative care practice 2016. 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. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. 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. Clinical pharmacist, university of new mexico hospitals.

Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. There is no clear documentation about pain history or the reason for prescribing high levels of opioids. Analgesic therapeutic guidelines, version 6, melbourne 2012 2. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.

Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Transdermal dosage use only when converting another opioid to fentanyl patch. Opioid conversion ratios guide to palliative care practice. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion.

Pain and symptom intensity, expressed as distress score, were recorded before switching doses of the two opioids and after subsequent doses. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. A fixed conversion ratio of fentanyl to methadone of 1. Transdermal and parenteral fentanyl dosage calculations and. It conversion ratio, eventual it fentanyl dose, and iv. Oral morphine milligram equivalent conversion table updated 8. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. Equianalgesic chart changes in italics ui health care. In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. The fentanyl patch comes in multiples of 25 micrograms.

In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Opioid converter morphine equivalent calculator omni. S when converting from 30 to 80 mg of morphine equivalents daily dose, first taper to 30 mg oral morphine equivalents, then start with the 10 mcghr patch. Advanced opioid conversion calculator morphine equivalents. 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.

The conversion ratios are approximate and are intended as a guide only. Conversion of intrathecal opioids to fentanyl in chronic. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Opioid switching using equivalence tables home saskatchewan. Opioid conversion guidelines gippsland region palliative care. Canadian guideline for safe and effective use of opioids. Converting to transdermal fentanyl palliative care network. Patient presents using fentanyl patch 100 microgramhour. Opioid equivalence chart gloucestershire hospitals nhs. 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. Fentanyl patch dosing determination based on current opioid therapy. Rapid switching between transdermal fentanyl and methadone. Fentanyl can be abused and is subject to criminal diversion.

Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. Transdermal patch should be used only in opioid tolerant patients. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Equianalgesic dosing of opioids for pain management. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Canadian guideline for safe and effective use of opioids for. Select microgram per hour dose of transdermal fentanyl based. Thank you for downloading opioid manager switching opioid form.

Patients considered opioid tolerant are those receiving, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone hcl 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. Transdermal and parenteral fentanyl dosage calculations. Although there has been no systematic assessment of such conversion, start with a conservative conversion. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to.

Converting to transdermal fentanyl palliative care. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Degroote national pain centre opioid manager switching opioids download. Calculates total daily morphine milligram equivalents. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. If uncertain, ask for advice from a more experienced practitioner. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. Cdc guidelines recommend prescribing the lowest effective opioid dose and to use caution when prescribing opioids at any dosage, particularly when increasing dosage to. 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.

The amount of residual drug in the patients system must be accounted for. So round up the calculated 5 micrograms dosage of fentanyl to 125 micrograms or a 150 microgram patch depending on whether patients pain is under good control or not. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Opioid conversion calculator morphine equivalents advanced.

What are the steps for converting from morphine or. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Demystifying opioid conversion calculations 83 chapter 5 transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. These mubinding sites are discretely distributed in the human brain, spinal cord, and other tissues. It conversion ratio reached to give superior vas from previous it opioid. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. When using this chart, calculate the total daily dose of morphine. Stop long acting oral morphine after applying patch.

Recommendations based on data contained in the package insert. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Conversion of opioid analgesics to fentanyl transdermal. Morphine milligram equivalents mme calculator mdcalc. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl patches are another option, but are expensive and difficult to titrate. Opioid oral morphine milligram equivalent mme conversion. 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.

Subcutaneous morphine mgday subcutaneous oxycodone mgday. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Converting from oral morphine to fentanyl transdermal patch. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Fentanyl patch converter globalrph conversion from. There are many opioids and many formulations available e. Duragesic label page 1 full prescribing information for. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.

Fentanyl patch converter globalrph conversion from other. American college of emergency physicians acep guidelines recommend avoiding routinely prescribing outpatient opioids. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Advice should be sought from the palliative care team.

Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Dose equivalence and switching between opioids key messages switching from one opioid to another should only be recommended or supervised by a healthcare practitioner with adequate competence and sufficient experience. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. If the form does not start downloading in 10 seconds, please click here. Scottish palliative care guidelines fentanyl patches. They all interact with specific opioid receptors such as.