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