Remember to enter all opioids the patient is taking. After application of the fentanyl patch peak plasma levels are achieved 24 hours. Opioid switch from low dose of oral oxycodone to transdermal. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. Duragesic label page 1 full prescribing information for. A safe and effective method for converting cancer patients. If you respond well to the short acting form of it and can afford a brand name med, it may be a good oral med option for you.
Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Do not remove the fentanyl transdermal system patch from the blister until you are ready to use it see figure f. This calculator uses the following conversion factors. Calculate the total 24hour morphine dose or morphineequivalent. Dec 15, 2001 demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Oral oxymorphone is a new formulation of an existing parenteral opioid that has. Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. It is not recommended for people who have never been prescribed opioidtype pain relief before, and deaths have been reported from improper dosing. Opioid conversion calculator for morphine equivalents. Oxymorphone to fentanyl equivalent doctor answers on. Decrease new dose 3050% to allow for incomplete crosstolerance. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Most of the above oral opioids are available as generics. If you are converting a patient to or from fentanyl i.
Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Opioid conversion table wiley jun 2015 hydrocodone fentanyl patch mcghr to oral convert oral morphine total daily dose to oral methadone as per the conversion ratios above. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature.
Fentanyl transdermal system contains fentanyl, an opioid agonist, and 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. It should not be used to determine doses when converting a patient from one opioid to another. Opioid oral morphine milligram equivalent mme conversion factors1,2. The patch is fentanyl the strongest family of opiates we have. The equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. Duragesic fentanyl transdermal dosing, indications. Choose either one but not both unless you require a rescue drug. Oxycontin, xtampza er oxycodone dosing, indications. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. This calculator should not be used to determine doses when converting a patient from one opioid to another.
Fentanyl remove fentanyl from your drug comparison. Some experts use this conversion in cancer patients. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Even with taking 36 norcos a day, you are not opioid tolerant enough for oxymorphone or fentanyl. Fentanyl patches are another option, but are expensive and difficult to titrate. Calculate the total shortacting ir opioid dose used in 24 hours convert this total to a. The second change was he took me off norco 10325 12 tabs every 6 hours max of 8 a day and put me on percocet 10325 1 tab every 4 hours max of 6 a day.
Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Advanced opioid conversion calculator morphine equivalents. After 50% dose reduction for incomplete crosstolerance, reduce dose again by 50% for. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. Converting to transdermal fentanyl palliative care. Oct 15, 2019 patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone 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. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. Fencino doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. Duragesic label page 1 full prescribing information for use. Following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
If that is case, might select a fentanyl patch as the best approach. Opioids extracting fentanyl from polymermatrix patches. Wait 18 hours after patch removed, then initiate conservative dose of approximately 10 mg once every 12 hours oxycodone controlledrelease for each 25 mcghour. Compare fentanyl vs oxymorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Conversion from morphine or equivalent to fentanyl transdermal. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. Thus, we have to pay careful attention to switch from oral oxycodone to fentanyl patch for fear of insufficient pain control or overdose. Conversion from highdose fullopioid agonists to sublingual.
The total daily morphine milligram equivalents mme will be displayed. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Apr 24, 2012 so far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. All this leads to potential od and death, let alone the reality of spiking your tolerance. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. Percocet contains oxycodone 5mg acetaminophen 325mg. Fentanyl can be easily extracted from the patch and used as an injection, smoked or snorted some patches are easier to crack than others, but the truth remains that you can concentrate the dose from a patch and get it to you blood stream faster. To dose for iv use simply take a 1ml syringe and draw out however many micrograms you wish, its best to start with whatever the patch would release in an hour to get a feel for it ived, so 10 units for 50 mcg or 20 for 100 mcg of fentanyl from a 50 mcghr patch. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25. They were on a variety of full agonist opioids, including predominantly oxycodone n 12, hydromorphone n 4, oxymorphone n 2, fentanyl n 6, methadone n 5, and morphine n 6. Each fentanyl transdermal system patch is sealed in its own protective blister. Fentanyl patch converter globalrph conversion from. Fentanyl patch converter globalrph conversion from other.
Oxymorphone remove oxymorphone from your drug comparison. Conversion tables show that the oral to parenteral ratio for morphine is 3. Recommend an appropriate dose of transdermal fentanyl when. Butrans contains buprenorphine, a schedule iii controlled substance. Patients who experience serious adverse effects should have patches removed immediately and should be monitored for at least 24 hours after the patch is removed 412. The patch will take a little while to get in to your system.
Advice should be sought from the palliative care team. So far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. 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. Opioid conversion guidelines gippsland region palliative care. Administer onehalf of the patients total daily po oxycodone dose as once every 12 hours conversion from fentanyl transdermal. Calculate the approximate starting dose of opana er to be given every 12 hours. Hi everyone, i am new to this board, but not to taking pain meds. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. This is especially important for fentanyl and methadone conversions. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414. Do not use this table to convert from fentanyl transdermal system to other opioid. Conversion algorithm for instructions on converting from one opioid to. Opioid oral morphine milligram equivalent mme conversion. Dose conversion tool butrans buprenorphine transdermal. You need to be on 60 mg of morphine a day consistently for at least 12 weeks before switching to oxymorphone or fentanyl. Oct 08, 2014 the equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. Each fentanyl transdermal system patch has a clear plastic release liner that can be. Many patients were on combinations of different immediate release and sustained release combinations of opioid medication. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn 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.
The high content of fentanyl in the patches duragesic may be a particular target for abuse and diversion. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. 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. As a result of continued absorption of fentanyl from the skin depot after removal of the patch, the halflife of fentanyl after transdermal administration is about 2. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. Round up or down based on patient factors and available patch sizes. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Fencino 12 microgramshour transdermal patch summary of. Morphine milligram equivalent mme calculator nyc health. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. The wa state amdg calculator uses higher conversion ratios that increase at higher doses 020 mg 4. Opioid conversion calculator morphine equivalents advanced. Oct 10, 2019 40 mg total daily dose of former opioid x 0. Fentanyl can be abused and is subject to criminal diversion. 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. Do not use this tool to convert from one opioid to a different opioid. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg morphine sulfate ir 4 tablets x 15mg 60mg 60mg. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone 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. Morphine milligram equivalent mme calculator instructions.
Converting from oral morphine to fentanyl transdermal patch. Per the product labeling, oral oxymorphone 10 mg er is approximately equivalent to hydrocodone 20 mg or appendix c. Compare fentanyl vs oxymorphone comprehensive analysis by. Peel off both parts of the release liner from the patch. Opioid dosage conversion oregon workers compensation. Compare fentanyl vs oxymorphone comprehensive analysis. Select microgram per hour dose of transdermal fentanyl based on table 2. Total daily dose of oxymorphone a 10 mg x 4 times d 40 mgd 2.
After discontinuing a fentanyl patch, fentanyl levels fall gradually. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Durogesic dtrans 25 mcghr transdermal patch summary of. Her total daily dose of oxycodone is 40 mghow much oral morphine is this.
Doctors give trusted answers on uses, effects, sideeffects, and cautions. The following source was used for morphine equivalent conversion factors per mg of opioid. I have been battling severe constipation regardless of numerous methods to remedy it. Equianalgesic chart changes in italics ui health care. I am currently on 50mcg fentanyl patches and have been since sept. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Review of oral oxymorphone in the management of pain ncbi. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Each butrans patch is intended to be worn for 7 days butrans doses of 7. Transdermal and parenteral fentanyl dosage calculations. Equianalgesic dosing of opioids for pain management. Round down, if necessary, to the appropriate opana er tablets strengths available. Transdermal and parenteral fentanyl dosage calculations and.
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