If a patient has not been on an equivalent of 6090mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch. 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 amount of residual drug in the patients system must be accounted for. Pain management in hospice care todays geriatric medicine. Fentanyl to ms contin conversion pain management medhelp. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Ms contin 60 mg by mouth every 12 hours, with morphine oral solution 20 mg every 2. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Opioid conversion calculator for morphine equivalents. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its.
Conversion of opioid analgesics to fentanyl transdermal. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Side effects of duragesic fentanyl transdermal, warnings, uses. Oct 25, 2019 there are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. Ms contin 100 mg and 200 mg tablets, a single dose greater than 60 mg, or a total daily dose greater than 120 mg, are only for use in patients in whom tolerance to an opioid of comparable potency has been established. Failure or clinically significant adverse effects to two of the following.
Eighteen hours following the removal of the transdermal fentanyl patch, xtampza er treatment can be initiated. For frail elderly patients, use more conservative conversion or a lower strength patch e. Opioid conversion ratios guide to palliative care practice 2016 352016 2016. 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.
The total daily morphine milligram equivalents mme will be displayed. Oxycontin, xtampza er oxycodone dosing, indications. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. The table is based on oral dosing for chronic noncancer pain. Duragesic label page 1 full prescribing information for. It should not be used to determine doses when converting a patient from one opioid to another.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Outpatient detoxification commonly employs a slower tapering protocol. Fentanyl patch converter globalrph conversion from other. Fentanyl patch converter globalrph conversion from other opiates. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. Remember to enter all opioids the patient is taking.
This is my 1st post so ill give a little background. Morphine milligram equivalent mme calculator instructions. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. The patch dosage form of duragesic12 actually delivers 12. Advice should be sought from the palliative care team. 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. After 72 hours, approximately 40% of fentanyl remains in the patch. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative care consortium is acknowledged. Opioid conversion ratios guide to palliative care practice. Convert each number in your list to iv morphine equivalents, by using column 2. Fentanyl patch 25mcghr patch roughly 50mg oral morphineday buprenorphine patch 10mcghr patch 25mg oral morphineday weaker stronger how to use the ome table drug multiply current dose by this factor to equal oral morphine dose tramadol 0. Fentanyl patch converter globalrph conversion from.
Transdermal and parenteral fentanyl dosage calculations. Fentanyl patch dosing determination based on current opioid therapy. Opioid oral morphine milligram equivalent mme conversion. 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. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. In these last 20 years ive used these longacting opioids. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Oral morphine milligram equivalent conversion tablei. Round up or down based on patient factors and available patch sizes. Canadian guideline for safe and effective use of opioids for. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment. Some experts use this conversion in cancer patients.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Butrans contains buprenorphine, a schedule iii controlled substance. Recommendations based on data contained in the package insert. Opioid conversions calc single agent equianalgesic. 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. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. Canadian guideline for safe and effective use of opioids. Note this dose should not be decreased further as it is already conservative. Dosage use only when converting another opioid to fentanyl patch. Oxycontin, ms contin, fentanyl patch should be started once pain is controlled on shortacting preparations. Opioid conversion ratios guide to palliative care practice 2016.
Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice on removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Transdermal and parenteral fentanyl dosage calculations and. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid.
Oral morphine milligram equivalent conversion table updated 8. See fentanyl information below for initiating patch and patch to po dosing. 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. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. My question is, if im going to the right dosage of fentanyl patch which is 25 milligrams every 72 hours from, 60 milligrams of ms contin. Equianalgesic dosing of opioids for pain management. Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day.
A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg morphine per day, 25 mcg. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. It is safer to underestimate a patients 24hour oral morphine dosage and provide rescue medication e. If a patient is taking ms contin 30 mg bd that is, 30 mg oral morphine x 2 dosesday or 60 mg oral morphineday then, 60 mg oral morphineday. Select microgram per hour dose of transdermal fentanyl based. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. Transdermal patch should be used only in opioid tolerant patients. The tablet strength closest to the calculated dose is 30 mg. Conversion algorithm for instructions on converting from one opioid to another. In the case of converting morphine to methadone, methadone has a relative potency of 4. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs.
The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Proper storage of patches and disposal of used fentanyl patches is necessary to prevent accidental exposurerisk of death by others. Bedside teaching opiate conversion stacie levine md. Duragesic label page 1 full prescribing information for use. All noninjectable fentanyl products are for opioidtolerant patients. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. What are the steps for converting from morphine or equivalent to. What are the steps for converting from morphine or.
Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Practical pain management is a remedy health media, llc web property. Ms camilla young, mcn coordinator ms lyn watson, nurse representative, education subgroup.
Equianalgesic chart changes in italics ui health care. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice. Common questions and answers about convert duragesic to oxycontin duragesic been in therapy for very paiful neck. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Morphine to fentanyl patch conversion each 2 mg po morphine approximately equivalent to 1 mcg hr fentanyl patch e. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. Do not initiate fentanyl patches at the end of life when the oral route is no longer available. Guide to practice october 2008 and the members of the emrpcc clinical groups who revised the document emrpcc opioid conversion ratios guide to practice december 2010 and again in july 20. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. 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. Only persons with experience should be using methadone.
Degroote national pain centre opioid manager switching opioids download. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Morphine milligram equivalent mme calculator nyc health. Switching from 100mcg duragesic patch to ms contin or.
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. Dose conversion tool butrans buprenorphine transdermal. May 05, 2020 duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic 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. While it is common practice to replace shortacting opioids with extended release products e. If any opioids are being given parenterally, add them to the list at this point, and. Hi, what would be the approx correct equivalency for switching from using 100mcg duragesic patch to ms contin pills what mg dosage should the pills be at to equal the patch. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Opioid conversions calc single agent equianalgesic globalrph. Switched from fentanyl patch 15mcg to mscontin 15mg. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. 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. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 9 mg equivalent to 10 mg oxycodone hcl every 12 hours of xtampza er, should be initially substituted for each 25 mcghr.
I did that because it says it takes the patch 8 hours to work. Converting from oral morphine to fentanyl transdermal patch. 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. Duragesic patches are intended for transdermal use on intact skin only.
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