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. Do not use this tool to convert from one opioid to a different opioid. Select microgram per hour dose of transdermal fentanyl based. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Duragesic label page 1 full prescribing information for use. Opioid conversion guidelines gippsland region palliative care.
Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Exalgo hydromorphone hydrochloride extended release. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. 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 morphine equivalent 36 x 5 180 mg morphine24 hrs. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Oral hydromorphone is about 47 times as potent as oral morphine. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Converting from various opioids to an equianalgesic dose of oral morphine. And just fyi hydromorphone is also known as dilaudid. Practical management of opioid rotation and equianalgesia. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine.
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. They all interact with specific opioid receptors such as. Converting to transdermal fentanyl palliative care network. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Canadian guideline for safe and effective use of opioids.
Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. You wish to convert the therapy to transdermal fentanyl. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Transdermal and parenteral fentanyl dosage calculations and. Round up to and begin treatment with transdermal fentanyl using a patch size of 50 gh. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Equianalgesic chart changes in italics ui health care. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. The medline database was searched with terms cancer pain, opioid rotation, opioid switching, opioid ratio, opioid conversion ratio, and opioid equianalgesia for the major opioids morphine, oxycodone, fentanyl, and hydromorphone and the intravenous, subcutaneous, oral, and transdermal administration routes. 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. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Conversion of intrathecal opioids to fentanyl in chronic. For frail elderly patients, use more conservative conversion or a lower strength patch e. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Advanced opioid conversion calculator morphine equivalents. Fentanyl patch converter globalrph conversion from other opiates. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl.
Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. Parenteral hydromorphone is 20 times as potent as oral morphine. Fentanyl patch converter globalrph conversion from other. 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 pain. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Hydromorphone is more potent than morphine, which simply means that a smaller quantity of hydromorphone has the same pain relieving effect as a larger quantity of morphine. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. 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. Morphine milligram equivalent mme calculator nyc health. 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.
The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. 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. Opioid conversion ratios guide to palliative care practice 2016. Scottish palliative care guidelines fentanyl patches. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Opioid conversion ratios guide to palliative care practice. Hydromorphone injection continuous subcutaneous infusion in a syringe pump over 24 hours. Surprisingly, crosstolerance between opioids is often incomplete. These bidirectional differences are not captured in a traditional equianalgesic table. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. 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. Stop long acting oral morphine after applying patch.
Duragesic label page 1 full prescribing information for. The following source was used for morphine equivalent conversion factors per mg of opioid. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. If you are converting a patient to or from fentanyl i. Transdermal and parenteral fentanyl dosage calculations. Start exalgo dose at 50% of calculated daily dose every 24 hours.
Eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Converting from oral morphine to fentanyl transdermal patch. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Opioid oral morphine milligram equivalent mme conversion. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. An alternative algorithm for dosing transdermal fentanyl. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg.
Opioid switching using equivalence tables saskatchewan. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. 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. Degroote national pain centre opioid manager switching opioids download. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1. 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. Fentanyl patch converter globalrph conversion from. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. 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. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Converting to transdermal fentanyl palliative care. Fentanyl topical may also be used for purposes other than those listed in this medication guide. Canadian guideline for safe and effective use of opioids for. Cr 18 mg q12h is being switched to fentanyl patches.
An alternative algorithm for dosing transdermal fentanyl for. Conversion of intrathecal opioids to fentanyl in chronic pain. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. Converting from oral morphine mg24 hr to equianalgesic doses of various opioids over 24 hr. Conversion from other oral hydromorphone formulations. In addition, prescribe 16th to 110th of the 24hour infusion dose subcutaneously, 1 to 2 hourly as required for breakthrough pain max 6 doses in 24 hours. Start with equivalent total daily dose of immediate release formulation and administer once daily. Overestimating the dose when converting patients from another opioid analgesic. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Recommend an appropriate dose of transdermal fentanyl when.
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. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. What are the steps for converting from morphine or. There is no direct conversion for fentanyl lozenge to other opioids including morphine the recommended initial dose of lozenge is 200 micrograms if pain is not relieved then the dose can be increased until effective. Compare fentanyl vs hydromorphone comprehensive analysis. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. 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. Opioid converter morphine equivalent calculator omni. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator.
Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. In the case of converting morphine to methadone, methadone has a relative potency of 4. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches.
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. 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. Oral morphine milligram equivalent conversion table updated 8. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Exalgo hydromorphone hydrochloride extended release tablets. Advice should be sought from the palliative care team. Opioid switching using equivalence tables page 1 of 5. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. 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.
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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor.
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