Fentanyl patch conversion from hydromorphone 4

A safe and effective method for converting cancer patients. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Hydromorphone 4 mg po q2h prn breakthrough pain, using on average 6 doses. In one alternative method, breitbard recommends using 2 mg of oral morphine as equivalent to 1. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. There are many opioids and many formulations available e. First, convert any opioid in use to its equivalent amount of morphine in mgday. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Opioid converter morphine equivalent calculator omni. 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. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.

Calculate the total 24hour morphine dose or morphineequivalent. Recommend an appropriate dose of transdermal fentanyl when switching. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Morphine milligram equivalent mme calculator nyc health. An alternative algorithm for dosing transdermal fentanyl. Equianalgesic chart changes in italics ui health care. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Do not use this table to convert from fentanyl transdermal system to other. 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. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Oral opioid dosing equivalents and conversions university of. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.

To convert therapy from oral or parenteral opioids to transdermal fentanyl, the. Conversion of 4 hourly morphine to a 72 hr fentanyl patch. Opioid conversion and brand availability in canada. Equianalgesic dosing of opioids for pain management. The dose adjustment, if necessary, should be based on the amount of rescue. Scottish palliative care guidelines fentanyl patches. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. The total daily morphine milligram equivalents mme will be displayed. Select microgram per hour dose of transdermal fentanyl. Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Duragesic label page 1 full prescribing information for. If the form does not start downloading in 10 seconds, please click here. Continuous subcutaneous infusion fentanyl syringe driver continue the syringe driver at the same rate for 6 hours after applying the patch, then cease effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4.

Conversion from morphine or equivalent to fentanyl transdermal. The dose of fentanyl should not be adjusted for at least 72 hours after application of the initial patch. 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. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Guidelines for adult patients intravenous pca orders. The cii rate was decreased by 50% 6 hours after application of the fentanyl. Opioid oral morphine milligram equivalent mme conversion. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario.

Iv use even at low doses and when given very slowly may cause. This is based on studies converting from morphine to fentanyl. Morphine milligram equivalent mme calculator instructions. What are the steps for converting from morphine or. The 4 hr limit includes both the continuous basal infusion and patient boluses. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily. Currently, there are no empirical studies converting fentanyl to morphine. Opioid switching using equivalence tables saskatchewan.

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. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Opioid equianalgesic calculator opioid switching from. Oral hydromorphone is about 47 times as potent as oral morphine. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Round up or down based on patient factors and available patch sizes. Thank you for downloading opioid manager switching opioid form. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. Converting from oral morphine to fentanyl transdermal patch.

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. Usual starting infusion rate would be morphine 1 2 mghr, fentanyl 1025 mcghr, hydromorphone 0. Transdermal and parenteral fentanyl dosage calculations. Opioid conversion and brand availability in canada michael g. Opioid conversion ratios guide to palliative care practice. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Changing fentanyl patches more often than every 48 hours is not recommended. Parenteral hydromorphone is 20 times as potent as oral morphine. 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. I did the conversion and 80 er mg of opana is about 66 mcg of fentanyl so when they get you up to the 75 mcg i think you will feel fine. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Remember to enter all opioids the patient is taking. Compare fentanyl vs hydromorphone comprehensive analysis.

Both dilaudid and fentanyl can be habit forming even at prescribed doses. Another commonly used conversion is to equate 100 mg of oral morphine to a 25. To convert to oral morphine equivalent, multiply by. After application of the fentanyl patch peak plasma levels are achieved 24 hours significant plasma levels occur in 12 to 16 hours. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Do not initiate fentanyl patches at the end of life when the oral route is no longer available. Canadian guideline for safe and effective use of opioids. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. An alternative algorithm for dosing transdermal fentanyl for.

Kornick said the research team is now looking into the best procedure for accomplishing that task. Most people do quite well on the patch but i have severe depression and chronic fatigue syndrome so those combinef with the patch can make me never leave my room. Both drugs work the same way in the body to relieve pain. Hydrocodone 15 3 4 hours fentanyl transdermal patch opioid doses equivalent to 25mcghr fentanyl patch drug oral iv morphine 45mg24hr 15mg24hr hydromorphone 10mg24hr 2mg24hr patch duration. Table 4 recommended dose conversion to fentanyl from other opioids.