Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Oral opioid dosing equivalents and conversions university of. Fentanyl patch converter globalrph conversion from other. Remember to enter all opioids the patient is taking. Select microgram per hour dose of transdermal fentanyl. Monitor the patient carefully for respiratory depression. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose.
Neither nor any other party involved in the preparation or publication of this site shall be liable for any special. A safe and effective method for converting cancer patients. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours.
Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal overdosage. Opioid conversion ratios guide to palliative care practice. What is the conversion from 150 mcg fentanyl patches every. What is the conversion from 150 mcg fentanyl patches every 3. The amount of residual drug in the patients system must be accounted for. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Dilaudid and fentanyl have the same mechanism of action they work the same way in relieving and stopping pain. Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine.
Converting from oral morphine to fentanyl transdermal patch. Fentanyl patch converter globalrph conversion from. What are the steps for converting from morphine or. It should not be used to determine doses when converting a patient from one opioid to another. The authors make no claims of the accuracy of the information contained herein. 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. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours.
The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Fentanyl transdermal patch opioid doses equivalent to 25mcghr fentanyl patch drug oral iv morphine 45mg24hr 15mg24hr hydromorphone 10mg24hr 2mg24hr patch duration. Twostep titration weans patients from iv to patch fentanyl. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Apr 21, 2020 conversion from morphine or equivalent to fentanyl transdermal. 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. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Both drugs work the same way in the body to relieve pain. The cii rate was decreased by 50% 6 hours after application of the fentanyl. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses.
Transdermal patch should be used only in opioid tolerant patients. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Fentanyl patches are another option, but are expensive and difficult to titrate. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Im in a hosp so i feel a little safe if something goes wrong. 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. The equianalgesic tables for fentanyl have been adjusted, so you can use the doses given in the conversion to transdermal fentanyl duragesic fentanylmorphine conversion tables without further adjustment. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
Conversion of intrathecal opioids to fentanyl in chronic. Opioid converter morphine equivalent calculator omni. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days. Do not use this tool to convert from one opioid to a different opioid. Select microgram per hour dose of transdermal fentanyl based. Effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4, subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Opioid equianalgesic calculator opioid switching from. 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. Transdermal and parenteral fentanyl dosage calculations and. And just fyi hydromorphone is also known as dilaudid. 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. Dilaudid hydromorphone and fentanyl are narcotic pain relievers prescribed to patients for the treatment and management of severe chronic pain, for example, pain related to cancer. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8.
Due to crosstolerance, when switching from one opioid to another, the starting dose of the. Narcotic equivalence converter narcotic route dose duration. For frail elderly patients, use more conservative conversion or a lower strength patch e. 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. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Opioid conversion calculator for morphine equivalents. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Transdermal dosage use only when converting another opioid to fentanyl patch. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Must prescribe shortacting opioid for breakthrough pain. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Currently, there are no empirical studies converting fentanyl to morphine. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. 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. Conversion of opioid analgesics to fentanyl transdermal. The calculation of opioid conversion is a crucial step in intensive care and is. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Calculate the total 24hour morphine dose or morphineequivalent. This is a group of medications that target certain receptors in the body in order to relieve pain. Opioid oral morphine milligram equivalent mme conversion.
Opioid conversion tips changing to another oral opioid question. They all interact with specific opioid receptors such as. If you prefer to not use the rounded off conversion, the full. Titrate liberally and rapidly to analgesic effect during first 24 hours. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. Converting to transdermal fentanyl palliative care. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. There are differences in the literature regarding opioid conversion ratios. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Oct 19, 2004 1 fentanyl has a long halflife, but has a short duration of action due to its lipophilic structure and rapid redistribution hence the advantage of using it in conscious sedation, but if you run it as a drip you fill your reservoir and then the long halflife comes into play thus making a fentanyl drip in the icu setting equivalent to a dilaudid drip from a pharmacokinetic point of view. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
Opioid conversion and brand availability in canada. Degroote national pain centre opioid manager switching opioids download. The total daily morphine milligram equivalents mme will be displayed. Since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3. After application of the fentanyl patch peak plasma levels are achieved 24 hours significant plasma levels.
This calculator should not be used to determine doses when converting a patient from one opioid to another. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. The following source was used for morphine equivalent conversion factors per mg of opioid. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. How to calculate equivalent morphine dosage when changing the method of administration. Morphine milligram equivalent mme calculator nyc health. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. What is the conversion from 150 mcg fentanyl patches. Canadian guideline for safe and effective use of opioids. There are many opioids and many formulations available e.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. Patch duration of effect 48 72 hrs takes 1224 hrs before full analgesic effect of patch occurs after application. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Can a patient be given dilaudid by iv while on a fentanyl patch. Dr prescribed dilaudid and fentanyl patch, is this safe, don. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo.
Transdermal and parenteral fentanyl dosage calculations. Equianalgesic chart changes in italics ui health care. Canadian guideline for safe and effective use of opioids for. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. 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. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Transdermal fentanyl is approximately 80 times as potent as morphine. Morphine milligram equivalent mme calculator instructions. Kornick said the research team is now looking into the best procedure for accomplishing that task. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. These bidirectional differences are not captured in a traditional equianalgesic table.
Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain. This is based on studies converting from morphine to fentanyl. Opioid conversions calc single agent equianalgesic. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. The first tdf product on the market was the branded. What are the steps for converting from morphine or equivalent to. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. 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. Conversion from morphine or equivalent to fentanyl transdermal. 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. Narcotic pain relievers also can be addictive and abused. Oral morphine milligram equivalent conversion table updated 8.
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