Fentanyl is dosed in mcghr instead of mgday, and absorption. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl patches durogesic for chronic pain nps medicinewise. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on singledose studies, and there is substantial individual variation in response. Fencino 12 microgramshour transdermal patch summary of. How should conversion from oral morphine to fentanyl. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion.
Tables 1, 2, and 3 should only be used to convert from other opioids to fencino and not from fencino to other therapies to avoid overestimating the new analgesic dose and potentially causing overdose. Fentanyl patch dose than that which the conversion tables recommend, including the use of the 12 mcgh dose by itself or in combination with another dose, provided the patient is not opioidnaive see contraindications. Oral morphine milligram equivalent conversion table updated 8. Scottish palliative care guidelines fentanyl sublingual. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. If you leave a patch on for more than 3 days 72 hours, remove the patch and apply a. Hack is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate.
An alternative algorithm for dosing transdermal fentanyl for. Agreed to dose of 280mg morphine daily in 2 divided doses 140mg morphine sr twice daily 4. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. When using this chart, calculate the total daily dose of morphine. The dose of the initial fentanyl patch is based on the morphine equivalent daily dose currently used by the patient. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Abstral fentanyl dose, indications, adverse effects. Transdermal and parenteral fentanyl dosage calculations and. The conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Converting to transdermal fentanyl palliative care network of.
For frail elderly patients, use more conservative conversion or a lower strength patch e. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Fentanyl may also cause severe, possibly fatal, breathing problems. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. 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. Current actiq dose 1600 mcg, initial abstral dose 400 mcg. Transdermal and parenteral fentanyl dosage calculations. A 25 microgramhour fentanyl patch is equivalent to about 60mg to. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a.
For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. The fentanyl patch comes in multiples of 25 micrograms. What are the steps for converting from morphine or. 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. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications.
Recommend an appropriate dose of transdermal fentanyl when. Select microgram per hour dose of transdermal fentanyl based on table 2. Fentanyl patch protocol ventura county, california. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. 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. Fencino doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application.
Dose conversion in opioid rotation from continuous intravenous. Calculate the total 24hour morphine dose or morphineequivalent. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a. Methadone conversion factors increase with increasing dose. 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 other words, the conversion factor not accounting for days of use would be 6025 or 2. Decrease new dose 3050% to allow for incomplete crosstolerance. Patients must have been on a stable dose of a regular opioid for at least 7 days equivalent to at least 60mg of oral morphine or 30mg of oral oxycodone in 24 hours or a 25 microgramshour fentanyl patch before rapid acting fentanyl is used. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. 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.
Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. Select microgram per hour dose of transdermal fentanyl based. Conversion from morphine or equivalent to fentanyl transdermal. Canadian guideline for safe and effective use of opioids. Fentanyl patch converter globalrph conversion from other. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
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. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. 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. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid.
At admission to our home care unit, he suffered mostly from severe anal pain verbal pain scale of. 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. Scottish palliative care guidelines fentanyl patches. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. Opioid withdrawal symptoms are possible in some patients after conversion or dose adjustment. This dose is not possible to provide in slowrelease morphine preparation c.
Doses in each column are considered equianalgesic and interchangeable at the. Converting to transdermal fentanyl palliative care network. 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. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. A study to assess the safety, dose conversion, and dose. Converting to transdermal fentanyl palliative care. 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.
Converting from oral morphine to fentanyl transdermal patch. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. An alternative algorithm for dosing transdermal fentanyl. Fentanyl patch converter globalrph conversion from. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response. Effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4, subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Dose conversion in opioid rotation from continuous intravenous infusion of morphine hydrochloride injection to fentanyl patch in the management of cancer pain. The dose of laxatives may need to be reduced and subsequently adjusted according to need as fentanyl is less constipating than morphine. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Advice should be sought from the palliative care team.
Opioid oral morphine milligram equivalent mme conversion. In general, the 12 mcgh dose, which allows for smaller dose. To describe a successful experience with a high dose. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back.
Duragesic patches are intended for transdermal use on intact skin only. 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. Highdose fentanyl patch for cancer pain american board. 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. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Matrifen 12 microgramshour transdermal patch summary of. Subcutaneous morphine mgday subcutaneous oxycodone mgday. Tom hack, a terminally ill colon cancer patient has pain that is well controlled on morphine sustained action, 90mg every 8 hours. How should conversion from oral morphine to fentanyl patches. Advanced opioid conversion calculator morphine equivalents.
The objective of this study is to assess the safety of treatment with duragesic a transdermal patch delivering the narcotic painreliever fentanyl in doses of 12. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Stop long acting oral morphine after applying patch. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. The dose conversions listed above are an estimate and cannot account for an individual patients genetics and pharmacokinetics. A 62yearold man suffering from rectal carcinoma was treated by our home care hospice unit during his last 3. Conversion from transdermal fentanyl to hysingla er. Opioid conversion ratios guide to palliative care practice. Current actiq dose 400, 600, 800, or 1200 mcg, initial abstral dose 200 mcg. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Actiq, fentora fentanyl transmucosal dosing, indications.
Duragesic label page 1 full prescribing information for use. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Duragesic fentanyl transdermal dosing, indications. If you are converting a patient to or from fentanyl i. The levy rule states that the hourly fentanyl patch strength in micrograms is half of the total daily dose of sustained release morphine in milligrams. In the case of converting morphine to methadone, methadone has a relative potency of 4. Dose may be calculated using dose conversion guidelines in the product package insert, local protocol, or another reliable reference. Opioid conversion ratios guide to palliative care practice 2016. These dose conversions are estimated and cannot account for all individual. Opioid conversion to hysingla er hydrocodone bitartrate cii. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Select microgram per hour dose of transdermal fentanyl based on. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
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