Opioid conversion ratios guide to palliative care practice. 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. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20%. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Please use the following guideline to calculate a fentanyl patch dose increase. One important safety issue, and a factor under the control of prescribers, is the recommendation that firsttime users of the fentanyl patch have adequate prior exposure to opioids. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. When converting from one opioid to another, the initial dose depends on the relative potency. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine. An old patch can continue to release the drug and cause an overdose.
However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Opioid oral morphine milligram equivalent mme conversion. Calculate the total 24hour morphine dose or morphineequivalent. Some of the opioid receptors in the brain that fentanyl binds to also help control. Remember to enter all opioids the patient is taking. There is no dose equivalence between fentanyl lozenges and other opioid formulations.
When using this chart, calculate the total daily dose of morphine. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. 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. Fentanyl is an opioid pain medicine that is used to treat moderate to severe chronic pain around the clock. Opioid conversions based on equianalgesia potency for all of the common opioids hydrocodone, oxycodone, morphine, etc. 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. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. The patient should avoid exposure to excessive heat e. These mubinding sites are discretely distributed in the human brain, 5 spinal cord, and other tissues. Fentanyl transdermal is not for treating mild or occasional pain or pain from surgery. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Calculate an opioid starting dose for an opioidnaive patient. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people.
Fentanyl interacts predominately with the opioid mureceptor. Fentanyl transdermal may also be used for purposes not listed in this medication guide. Opioid conversion and brand availability in canada. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Determine doses when converting a patient from one opioid to another.
A safe and effective method for converting cancer patients. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Morphine milligram equivalent mme calculator instructions. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Converting from oral morphine to fentanyl transdermal patch. They all interact with specific opioid receptors such as. Conversion from morphine or equivalent to fentanyl transdermal.
Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Duragesic label page 1 full prescribing information for. 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 cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Converting to transdermal fentanyl palliative care. 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.
Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Opioids opiates are a group of analgesic drugs, used primarily for pain management. 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 pethidine. Multiply the amount of each drug by its bioavailability column 4, to get a smaller number. Fentanyl patch converter globalrph conversion from. 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. Canadian guideline for safe and effective use of opioids. Opioid conversion table hop16091451 croni ain anaeen tooli. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor.
Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. This is especially important for fentanyl and methadone conversions. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete crosstolerance. The trust pain group has been informed of a number of situations where strong opioids and in particular fentanyl patches have been prescribed inappropriately. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose.
This is the number of milligrams that actually gets into the bloodstream. Calculate opioid dose adjustments and opioid starting doses. Safety of fentanyl initiation according to past opioid. Opioid metabolism and excretion do differ among the opioids. Opioid conversion calculator for morphine equivalents. Practical pain management is a remedy health media, llc. Opioid oral morphine milligram equivalent mme conversion factors1,2. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Scottish palliative care guidelines fentanyl patches. For delivery rates in excess of 100 mcghour, multiple systems may be used. Always ensure that an old patch has been removed before a new patch is applied. Transdermal and parenteral fentanyl dosage calculations. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. Opioid converter morphine equivalent calculator omni.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. It should not be used to determine doses when converting a patient from one opioid to another. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Opioid equivalence chart gloucestershire hospitals nhs. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. The total daily morphine milligram equivalents mme will be displayed. Advanced opioid pain management converter updated advanced opioid pain. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Calculates total daily morphine milligram equivalents.
Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. What are the steps for converting from morphine or. There are many opioids and many formulations available e. Opioid withdrawal symptoms nausea, vomiting, diarrhea, anxiety, shivering are possible so a gradual downward titration is advised. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Fentanyl 25 patch 25microgramshour 30mg to 4mg24hours fentanyl 50 patch 50 microgramshour 5mg to 224mg24hours fentanyl 75 patch 75 microgramshour 225mg to 314mg24hours. 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. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Opioid conversion table american academy of family. Opioid conversion calculator morphine equivalents advanced.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Opioids switching with transdermal systems in chronic. The transdermal fentanyl patch in these patients was replaced by a 52. 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. Morphine milligram equivalents mme calculator mdcalc. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The method used for transdermal patch switching was to replace the first opioid patch with the alternative one, deducting 50% from the dose calculated according to equianalgesic tables. This calculator should not be used to determine doses when converting a patient from one opioid to another. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. Fentanyl transdermal skin patch uses, side effects. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval.
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