Dosage use only when converting another opioid to fentanyl patch. Changing an oral or iv opioid to transdermal fentanyl 1. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Phoenixa twostep approach to converting patients from intravenous fentanyl to transdermal patches can prevent occurrence of breakthrough pain episodes. 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. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. A safe and effective method for converting cancer patients from. Eight patients initially reported their pain at rest as. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Both drugs work the same way in the body to relieve pain.
A safe and effective method for converting patients from transdermal. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Conversion from morphine or equivalent to fentanyl transdermal.
Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Opioid oral morphine milligram equivalent mme conversion. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Canadian guideline for safe and effective use of opioids. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl patch conversion 25mcghour topically exchanged every 72 hours equivalent to. Converting from oral morphine to fentanyl transdermal patch.
Conversion of intrathecal opioids to fentanyl in chronic. 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. A safe and effective method for converting cancer patients ncbi nih. While this makes the conversion relatively easy, patches tend to be left on longer than needed. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status. The cii rate was decreased by 50% 6 hours after application of the fentanyl. There are many opioids and many formulations available e. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. There are differences in the literature regarding opioid conversion ratios. Fentanyl patches are another option, but are expensive and difficult to titrate. Effects of patch last for 18 24 hours after the patch is removed. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. Transdermal and parenteral fentanyl dosage calculations.
If at any time the patient develops symptoms of withdrawal, return to the previous rate and consider giving an iv bolus of fentanyl. Opioid equianalgesic calculator opioid switching from. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Equianalgesic chart changes in italics ui health care. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Frail or elderly patients may need lower doses and slower titration. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. 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. Efficacy and safety of a sixhour continuous overlap. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Monitor the patient carefully for respiratory depression. In each patient, all transdermal patches were removed, and a continuous infusion ci delivering iv fentanyl.
Twostep titration weans patients from iv to patch fentanyl. The fentanyl infusion dose wasdecreased inhalfsix hours after patch application, then completely stopped after 12 hours. Converting to transdermal fentanyl palliative care. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. 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. In acute pain the conversion of morphine to fentanyl is 1. What are the steps for converting from morphine or. Note this dose should not be decreased further as it is already conservative. These bidirectional differences are not captured in a traditional equianalgesic table.
Discarded patches have the potential to be misused. Opioid equianalgesic dose chart equianalgesic dose drug iv imsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sc iv 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. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. In renal impairment gfr fentanyl and buprenorphine patches. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Select microgram per hour dose of transdermal fentanyl. Opioid conversion and brand availability in canada. One option that i dont like to use is switching patients over to a fentanyl patch. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediaterelease opioids and should prescribe no greater quantity than needed for the expected duration. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics.
Converting to transdermal fentanyl palliative care network of. Nomura et al used the same method, but shortened the conversion period to six hours, and the dose was cut in half three hours after patch placement. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Use appropriate opioid for situation or care setting. If pain is stable the patient may be considered for conversion to a fentanyl patch. Duragesic label page 1 full prescribing information 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. 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 opioids under. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Patients at the authors institution routinely are switched from transdermal to intravenous iv fentanyl using a 1.
Longterm opioid use often begins with treatment of acute pain. The patches are designed to be worn for three days before being replaced. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. The fentanyl patch comes in multiples of 25 micrograms. Transdermal patch should be used only in opioid tolerant patients. Calculate the total 24hour morphine dose or morphineequivalent. Scottish palliative care guidelines fentanyl patches. For delivery rates in excess of 100 mcghour, multiple systems may be used. This should not be confused with the total amount of fentanyl in the patch. A safe and effective method for converting cancer patients. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Transdermal fentanyl patches should not be initiated in patients with unstable pain. 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.
If 2 extra doses of 15 mg sc morphine are required over the previous 24 hours, the initial syringe driver prescription will. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Transdermal fentanyl and buprenorphine patches are prescribed in. Advice should be sought from the palliative care team. Injecting fentanyl minimising the risks the patch strength on the label indicates the dosage that the fentanyl patch releases each hour when worn. Both dilaudid and fentanyl can be habit forming even at prescribed doses. For frail elderly patients, use more conservative conversion or a lower strength patch e.1453 1392 455 1379 739 315 1233 609 443 1066 199 909 535 1431 66 257 1400 729 301 758 592 1552 42 996 317 820 1273 190 1543 1413 1196 1212 649 688 995 995 229 138 1214 1459 1023 1077 1362 983 355 1465 1226