It can help identify patients who may be misusing prescription opioids or. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Converting to transdermal fentanyl palliative care. Changing an oral or iv opioid to transdermal fentanyl 1. Levys rule to convert from oral morphine to transdermal fentanyl. Calculate the total 24hour morphine dose or morphineequivalent.
Land mines prenteral form of opioids are more potent than the oral formulation, milligram for milligram always remember to convert to the correct dosage and double check before administration n. This is based on performing a morphine to fentanyl conversion. Their product information stresses that conservative conversion values used for converting to fentanyl patches may result in drug overdosage if used to convert from patches to other opioids, highlighting the danger of a simplistic use of conversion tables. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Calculators for emergency and anesthetic drugs, constant rate infusions cri, iv fluid rates, chocolate toxicity, calorie requirements for dogs and cats and unit conversion including weight, temperature, body surface area, mg to ug, ccs to ouncess, cms to inches. Infuse slowly over at least 35 minutes longer period of time for bigger doses to prevent chest wall rigidity. 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. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. This is especially important for fentanyl and methadone conversions. Listed below are methods for common conversions using standard published conversion ratios.
When administered directly into the intrathecal space, hydrophilic opioids are more likely to bind specific receptors in the dorsal horn, where. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. Remember to enter all opioids the patient is taking. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio.
Titrate liberally and rapidly to analgesic effect during first 24 hours. Only persons with experience should be using methadone. Estimates on equivalence vary but a conversion factor of 1mcg fentanyl hr 2 mg morphineday is suggested as a conservative starting pint. If a deteriorating patient already has a fentanyl patch, leave patch on and titrate extra analgesic needs on top, either orally or via syringe driver. A collection of drug calculators for veterinarians and support staff. Duragesic label page 1 full prescribing information for. Monitor the patient carefully for respiratory depression. Fentanyl injection fda prescribing information, side. Opioid intake reduces pain but improper dosage results in serious side effects. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Use this online opioid dosage calculator to calculate the daily morphine equivalent dose med based on the opioid taken by the patient per day. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old.
Calculating opioid dose conversions palliative care. Morphine milligram equivalent mme calculator instructions. Asking the right questions to find the best answers cheryl k genord, r. Narcotic equivalence converter narcotic route dose. An alternative algorithm for dosing transdermal fentanyl for. 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. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. For example, when administered as a prolonged infusion, hydrophobic epidural opioids such as fentanyl will reach plasma levels similar to iv infusions. Conversion to butrans buprenorphine transdermal system ciii. This may be necessary for severe pain, opioid tolerant patients, or those patients who are unable to activate the pca button. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The web page will automatically calculate the total morphine equivalents per day. The conversion calculation for a continuous fentanyl drip at 100mcghr is needless to say, much much more than 1020mg of oxycodone q6 hrs.
Conversion calculations for opioids and benzodiazepines opioid conversions. Opioid converter morphine equivalent calculator omni. Included on this page are a large number of drug infusion calculators and drug dosing calculators. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. 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. Duragesic patches are intended for transdermal use on intact skin only. Duragesic label page 1 full prescribing information for use. 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. How should conversion from oral morphine to fentanyl patches be carried out.
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. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Actions qualitatively similar to those of morphine. May 09, 2016 ive been using fentanyl infusions as the backbone of my sedative strategy, in keeping with the 20 sccm guidelines. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci.
Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. For severe pain and opioid tolerant patients, do not use 4 hour limit. Current breakthrough opioid entered to be what the patient is actually taking rather than what has been prescribed. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Sublimaze fentanyl dosing, indications, interactions. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100. Fentanyl citrate, a narcotic analgesic, is 50100 times more potent than morphine. Opioid oral morphine milligram equivalent mme conversion. Therefore when converting morphine iv to enteral multiply the iv dose by 3.
Increased intracranial pressure, severe respiratory depression or severe liver or renal dysfunction 3. 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. The examples assume a change in drug or route at a time of stable pain control using equianalgesic. Fentanyl citrate injection, usp, equivalent to 50 mcg 0. Yet this dose or similar doses seem to have a much greater impact on the patient compared to what id expect. The texas prescription monitoring program is an electronic database that tracks controlled substance prescriptions. Mar 28, 2016 the conversion calculation for a continuous fentanyl drip at 100mcghr is needless to say, much much more than 1020mg of oxycodone q6 hrs. Calculate the equivalent 24 hour dose of morphine milligram equivalent do not use table 1. For patients under this age consult with a pain or palliative care specialist. This generally works well for patients who can be extubated quickly. Transdermal fentanyl patches were designed to provide.
Opioid conversion ratios guide to palliative care practice. Continuous subcutaneous infusion in a cme t34 syringe pump over 24 hours. Convert the iv dose to the equianalgesic oral morphine dose using a ratio. We offer a rich library of resources available for direct download and online use. Since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. You mention it above but i was curious if you had any additional thoughts on why this might be. 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. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. Usual starting infusion rate would be morphine 1 2 mghr.
Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Transdermal fentanyl and buprenorphine patches are prescribed in. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Introduction a variety of published conversion tables exist to provide clinicians a rough guide for making calculations when switching between different opioid routes or preparations. Constantrate infusions for pain and anxiety in dogs and. Converting to transdermal fentanyl palliative care network of. If pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. 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. Opioid conversion and brand availability in canada.
However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Opioid dose calculator morphine equivalent dose calculation. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Converting to transdermal fentanyl palliative care network. Use appropriate opioid for situation or care setting. 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.
Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a. If 2 extra doses of 15 mg sc morphine are required over the previous 24 hours, the initial syringe driver prescription will be morphine 30mg24 hour. A safe and effective method for converting cancer patients. For kathy to use 2 patches, you instruct her to remove her current patch, and apply the 2 new patches at the same time, adjacent to one another, at a different application site as explained in the full prescribing information. 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. The cii rate was decreased by 50% 6 hours after application of the fentanyl. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Guidelines for adult patients intravenous pca orders. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. For this reason the date of birth field is mandatory. Abrupt discontinuation after prolonged use may precipitate withdrawal or seizures 4. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Surprisingly, crosstolerance between opioids is often incomplete. There are differences in the literature regarding opioid conversion ratios.
However, for patients who remain on the ventilator for longer periods of time, it often leads to problems involving tolerance and withdrawal. Dosage use only when converting another opioid to fentanyl patch. These bidirectional differences are not captured in a traditional equianalgesic table. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. In addition, prescribe 16th to 110th of the 24 hour infusion dose subcutaneously, 1 to 2 hourly as required for breakthrough pain. They all interact with specific opioid receptors such as. The total daily morphine milligram equivalents mme will be displayed.
The data upon which the conversions are based are summarized in the table below. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Morphine milligram equivalent mme calculator nyc health. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Concomitant use of fentanyl injection with cyp3a4 inducers or discontinuation of a cyp3a4 inhibitor could decrease fentanyl plasma concentrations, decrease opioid efficacy or, possibly, lead to a withdrawal syndrome in a patient who had developed physical dependence to fentanyl. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
Canadian guideline for safe and effective use of opioids. Higher dosages of opioids result in higher risk of death. Recommend an appropriate dose of transdermal fentanyl when. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Narcotic equivalence converter narcotic route dose duration. In acute pain the conversion of morphine to fentanyl is 1. Converting from oral morphine to fentanyl transdermal patch. Fentanyl citrate injection is contraindicated in patients with. Transdermal and parenteral fentanyl dosage calculations and. Transdermal and parenteral fentanyl dosage calculations.
If unacceptable opioidrelated adverse events are observed, consider reducing the dosage. Equianalgesic chart changes in italics ui health care. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. How should conversion from oral morphine to fentanyl. Opioid equianalgesic calculator opioid switching from. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Tjuh opioid infusion guidelines for palliative care other considerations zonce patient is started on an opioid infusion, do not abruptly stop the infusion or give naloxone. Conversion from morphine or equivalent to fentanyl transdermal. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Jan 29, 2018 if pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Alterations in respiratory rate and alveolar ventilation may last longer than analgesic effect.
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