Opioid conversion calculator morphine equivalents advanced. Starting dose will range from 75 mcg once daily or every 12 hours to 300 mcg every 12 hours depending on the patients prior opioid experience and risk for abuse potential. Transdermal patch should be used only in opioid tolerant patients. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. This calculator should not be used to determine doses when converting a patient from one opioid to another. This table should not be used to convert from duragesic to other. Table 3 is for adult patients who are on a stable, and welltolerated, opioid regimen conversion ratio of oral morphine to transdermal fentanyl approximately equal to 100. The table is based on oral dosing for chronic noncancer pain.
Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. Patch strengths can be combined to provide an appropriate dose. 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. Duragesic fentanyl transdermal dosing, indications. 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. What happens when someone ingests a duragesic patch. Painkilling patches are used to treat some types of longterm pain. This dose is not possible to provide in slowrelease morphine. Fentanyl patch conversions package insert recommendations. If the form does not start downloading in 10 seconds, please click here.
The conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Fentanyl duragesic patch, buprenorphine butrans patch affix used patch to this sheet once removed from skin 2 affix used patch to sheet once removed from skin 3 affix used patch to this sheet once removed from skin 1 affix used patch to sheet once removed from skin 5 affix used patch to sheet once removed. Duragesic patches are intended for transdermal use on intact skin only. For use in opioidtolerant patients only duragesic contains a. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Make sure the patient takes another regular opioid for the first 12 hours after the patch is first applied to allow the fentanyl to reach therapeutic levels refer to switching opioid to fentanyl patch table below. 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. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Duragesic, a brand name derivative of fentanyl, delivers powerful painrelieving effects through its transdermal patch design.
Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Opioid painkilling patches sideeffects, how long do. Do not use this tool to convert from one opioid to a different opioid. 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. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. Because no systemic evaluation of transdermal fentanyl as the initial strong opioid in the treatment of chronic pain is known, the lowest delivery rate for transdermal fentanyl 25. Calculating total daily dose of opioids for safer dosage. Duragesic label page 1 full prescribing information for use in opioid tolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Those who ingest a fentanyl patch on purpose in order to experience a strong high are also putting themselves in danger of experiencing a severe overdose. Significant amounts of fentanyl continue to be absorbed from the skin for. The initial dose of sandoz fentanyl patch should be obtained or calculated from the conversion tables see dosage and administration, and must not be higher than that dose which is equivalent to the total dose of opioids the patient is receiving at the time of the switch to the patch. The table cannot be used to convert from duragesic to another opioid. In renal impairment gfr opioids of choice are oxycodone posc, fentanyl and buprenorphine patches. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Transdermal dosage use only when converting another opioid to fentanyl patch. Transdermal and parenteral fentanyl dosage calculations.
Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. The following source was used for morphine equivalent conversion factors per mg of opioid. Duragesic fentanyl transdermal system cii pain patch. In the iv form fentanyl is often used in icus for pain control due to its rapid onset of action and due to the minimal histamine release associated with fentanyl in comparison to morphine. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extendedrelease opioid formulations, reserve oxycontin for use in patients for whom alternative treatment options e.
Opioids opiates are a group of analgesic drugs, used primarily for pain management. Gwent guidance on the use of strong opioids in non malignant pain is available at. Canadian guideline for safe and effective use of opioids for. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Fentanyl patches durogesic for chronic pain nps medicinewise. A strong prescription pain medicine that contains an opioid narcotic that is used to manage pain severe enough to require daily aroundtheclock, longterm treatment with an opioid, in people who are already regularly using opioid pain medicine, when other pain treatments such as non opioid pain medicines or immediaterelease opioid medicines do not treat your. 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.
Side effects of duragesic fentanyl transdermal, warnings, uses. Fentanyl patch converter globalrph conversion from other. Oct 15, 2019 in a duragesic clinical trial, patients were converted from their prior opioid to duragesic using table 1 as a guide for the initial duragesic dose. This is especially important for fentanyl and methadone conversions. The patches are used to treat moderate to severe chronic pain in opioid tolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment. The commercially available transdermal system duragesic was used. Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. Durogesic dtrans 100 mcghr transdermal patch summary of. In the case of converting morphine to methadone, methadone has a relative potency of 4. According to the manufacturer, 50% of the patients in clinical trials required a dose increase. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. 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. Nov 05, 2019 duragesic is a skin patch containing fentanyl, an opioid pain medication. Stop long acting oral morphine after applying patch.
Duragesic patch fentanyl patch rationale for inclusion in pa. What are the steps for converting from morphine or. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. Remove transdermal and titrate dose of new analgesic based upon patients report of pain until adequate analgesia has been attained. 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. Department of health and human services, higher dosage, higher risk, why is it important to calculate the total daily dosage of opioids, how much is 50 or 90 mmeday for commonly prescribed opioids, how should the total daily dose of. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Each duragesic patch may be worn continuously for 72 hours.
Fentanyl can be abused and is subject to criminal diversion. Duragesic is a skin patch containing fentanyl, an opioid pain medication. Scottish palliative care guidelines fentanyl patches. It is crucial to appreciate that conversion ratios are never more than an approximate guide 2. Opioid converter morphine equivalent calculator omni. For frail elderly patients, use more conservative conversion or a lower strength patch e. A strong prescription pain medicine that contains an opioid narcotic that is used to manage pain severe enough to require daily aroundtheclock, longterm treatment with an opioid, in people who are already regularly using opioid pain medicine, when other pain treatments such as nonopioid pain medicines or immediaterelease opioid medicines do not treat your. Fentanyl accumulates to form a depot in the skin below the. Canadian guideline for safe and effective use of opioids. The highest available btds strength of 20 mcgh may be equianalgesic to an oral medd of 3655 mg, whereas the product information states that the 20 mcgh patch may not provide adequate analgesia for patients requiring greater than an oral medd of 80 mg. 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. It has a rapid onset and its effects generally last less than two hours. Patches in the last days of life leave the buprenorphine or fentanyl patch in situ and change regularly as prescribed. Opioid conversion table american academy of family.
Duragesic patch and absorption of a potentially fatal dose of fentanyl. There are two types of opioids which are available as patches. Opioid oral morphine milligram equivalent mme conversion. Fentanyl patch converter globalrph conversion from. Converting to transdermal fentanyl palliative care network.
Tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal overdosage. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Thank you for downloading opioid manager switching opioid form. Many opioid abusers do not know the danger of ingesting a duragesic patch, though, and the serious side effects it can cause. 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. Conversion table multiplication factors for converting the daily dose of prior opioids to the equianalgesic 24hour oral morphine dose. Transdermal and parenteral fentanyl dosage calculations and. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Opioid conversion ratios guide to palliative care practice. The conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion.
There are differences in the literature regarding opioid conversion ratios. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. 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.
Equianalgesic chart changes in italics ui health care. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Medically, fentanyl is used by injection, as a patch on the skin. Buprenorphine transdermal delivery system butrans, ciii. The duragesic transdermal system patch is used for the management of persistent, moderate to severe chronic pain in opioid tolerant patients when a continuous, aroundtheclock opioid analgesic is needed for an extended period of time. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Durogesic dtrans 12 mcghr transdermal patch summary of. Are there any other comments, diagnoses, symptoms, medications tried or failed, andor any other information the physician feels is important to this. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Use the dose conversion tool calculate the initial butrans dose for your opioid experienced patients.
Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Converting from oral morphine to fentanyl transdermal patch. Duragesic label page 1 full prescribing information for. Manage breakthrough pain with morphineshortacting opioid prn. Duragesic contains fentanyl, an opioid agonist, and is indicated for the management of pain in opioid tolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. Patches are licensed for dose initiation and titration. Facts about the fentanyl transdermal patch fentanyl is a lipophilic opioid that is hundred times as strong as morphine. Converting to transdermal fentanyl palliative care. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid conversion table hop16091451 croni ain anaeen tooli. Each duragesic transdermal system is worn continuously for up to 72 hours see dosage and administration 2. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Once the conversion has occurred, the dose of new opioid should be titrated carefully. Demystifying opioid conversion calculations 83 chapter 5 transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to.
How should conversion from oral morphine to fentanyl. The opioid equianalgesic conversions calculator allows a clinician to generate an equivalent dose equal amount of analgesia when switching between different opioid analgesics. Frail or elderly patients may need lower doses and slower titration. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. They are prescribed by a doctor when other types of pain relief have not been able to manage your pain. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Conversion of opioid analgesics to fentanyl transdermal. Apr 26, 2020 decrease new dose 3050% to allow for incomplete crosstolerance.
Patients will require frequent reassessment of efficacy and adverse effects and dose titration after patch initiation or dose change, as well as a short acting opioid for breakthrough pain 3. This tool does not contain all of the important safety information needed to prescribe butrans. Aug 12, 2019 durogesic dtrans doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. Rather than ingesting it orally in tablet or film form, duragesic is a patch thats applied to the skin surface. Fentanyl patches are another option, but are expensive and difficult to titrate. Opioid conversion calculator for morphine equivalents. Duragesic patches are a strong prescription pain medicine.
They all interact with specific opioid receptors such as. How should conversion from oral morphine to fentanyl patches be carried out. There may be several possible reasons to switch analgesics including. Oral morphine milligram equivalent conversion table updated 8. Prior authorization request form page 3 of 3 do not copy for future use. These patches usually contain opioid ohpeeoyd drugs. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Opioid oral morphine milligram equivalent mme conversion factors1,2. Opioid conversion and brand availability in canada michael g. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Duragesic label page 1 full prescribing information for use. Do not use a duragesic patch if the seal is broken or the patch is. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic indicated for the management of pain in opioid tolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. Calculating total daily dose of opioids for safer dosage, centers for disease control and prevention, cdc, u. It should not be used to determine doses when converting a patient from one opioid to another.
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