In acute pain the conversion of morphine to fentanyl is 1. Duration of action is for iv intermittent, imsc, and po routes. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Duragesic label page 1 full prescribing information for use.
We used the equianalgesic chart from wikipedia to build the opioid conversion calculator. Decrease new dose 3050% to allow for incomplete crosstolerance. Use the dosing and conversion chart for opioid analgesics to convert original. In the case of converting morphine to methadone, methadone has a relative potency of 4. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. After some discussion about the iv to td fentanyl conversion, he agreed and changed the prescription to oxycodone. Convert the oral morphine dose to transdermal fentanyl. These dose conversions are estimated and cannot account for all individual. Opioid converter morphine equivalent calculator omni. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Select microgram per hour dose of transdermal fentanyl based. Approximately 9% of the dose is recovered in the feces, primarily as metabolites. Patients then can be switched from intravenous iv to transdermal fentanyl. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion.
At this dose, the patient was mentally alert, with good pain relief, and was able to walk independently at home with no exacerbation of opioid side effects. For delivery rates in excess of 100 mcghour, multiple systems may be used. It conversion ratio, eventual it fentanyl dose, and iv. Converting to transdermal fentanyl palliative care network. Transdermal and parenteral fentanyl dosage calculations. Conversion oral iv opioids to fentanyl transdermal each transdermal system is worn continuously for up to 72 hr see administration 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.
Due to the small molecule structure and high lipid solubility, fentanyl could be a good choice for transdermal use. Nov 22, 2019 do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. 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. Appropriate transdermal system dosage adjustments should be based on the daily dose of supplementary opioids, using the ratio of 45 mgday of oral morphine to a 12. 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. No studies directly investigating dose equivalence between morphine injection continuous iv administration and the transdermal fentanyl patch have been. Fentanyl patches durogesic for chronic pain nps medicinewise. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Convert the iv dose to the equianalgesic oral morphine dose using a ratio of. Caution is advised when converting to methadone due. A safe and effective method for converting cancer patients. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sc iv 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. Calculate the total 24hour morphine dose or morphineequivalent. The usual dose for surgical premedication in adults is 0. Mean values for unbound fractions of fentanyl in plasma are estimated to be between and 21%. What every pharmacist should know about transdermal. Original research dose conversion ratio for continuous. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Fentanyl citrate fentanyl citrate dose, indications. A safe and effective method for converting cancer patients from. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. 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.
Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Describe how to transition between intravenous iv fentanyl. Also, with the mislabeled allergy to codeine, we could confidently use another less potent narcotic. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl sublingual spray subsysr at 100 mcg. If pain is stable the patient may be considered for conversion to a fentanyl patch. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin.
May 09, 2016 there are a variety of conversion tables out there, depending exactly which one you use you get a slightly different answer. Calculate the total daily dose of the original opioid add longacting and rescue doses. Abstral fentanyl dose, indications, adverse effects. I reminded the physician that there is no currently accepted conversion factor between iv and td fentanyl. Converting from oral morphine to fentanyl transdermal patch. Morphine to fentanyl patch conversion each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Advice should be sought from the palliative care team. 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.
Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii. Duragesic patches are intended for transdermal use on intact skin only. Oct 15, 2019 within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. Dose conversion in opioid rotation from continuous intravenous. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor. Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. Converting to transdermal fentanyl palliative care network of. Thus, we could not convert the fentanyl patches to methadone syrup. Conversion oral iv opioids to fentanyl transdermal each transdermal system is worn continuously for up to 72 hr see administration 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. Changing an oral or iv opioid to transdermal fentanyl 1.
Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. At maximum concentration fentanyl td produces drug levels approximately equal to those attained by intravenous infusion at the same rate per hour. Duragesic fentanyl dose, indications, adverse effects. 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.
Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. If fentanyl tp was used as the basic prescribed drug, fentanyl was given orally or in suppository form in a. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. Iv direct administration has shorter duration of action restricted to treatment of drug or bloodinduced rigors and postoperative shivering note that this table is unidirectional for morphine to fentanyl patch conversion only.
May 05, 2014 fentanyl is a low molecular weight synthetic opioid, with high potency analgesic effect in intravenous route injection. 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. According to iv doses, fentanyl is considered to have 50 to 100 times the potency of morphine. Initial fentanyl transdermal dosage use only when converting another. Conversion from morphine or equivalent to fentanyl transdermal. Transdermal fentanyl patches versus patientcontrolled. For frail elderly patients, use more conservative conversion or a lower strength patch e. Here is a table of substance dosage and potency, related to 10 mg of intravenously administered morphine. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1.
Titrate the dose based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application. Fentanyl injection is prescribed to reduce pain before, during, or after surgery. Duragesic label page 1 full prescribing information for. Fentanyl injection sublimaze is a synthetic narcotic similar to morphine. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. 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. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. What every pharmacist should know about transdermal fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Converting from fentanyl given by iv infusion or via a pca device. Highdose fentanyl patch for cancer pain american board. Currently, there are no empirical studies converting fentanyl to morphine.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Conversion of intrathecal opioids to fentanyl in chronic. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. See fentanyl information below for initiating patch and patch to po dosing. It may be 812h or longer after putting on the first patch before pain relief is experienced. If you are in serious pain and cant wait hours for it to kick in you can put a heating pad on the fentanyl patch, the heat releases the fentanyl from the patch alot quicker, there for reducing the waiting period substantialy.
Discarded patches have the potential to be misused. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. Note this dose should not be decreased further as it is already conservative. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Converting to transdermal fentanyl palliative care. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 im iv. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. It conversion ratio reached to give superior vas from previous it opioid. Opioid oral morphine milligram equivalent mme conversion. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status. Use the dosing and conversion chart for opioid analgesics to convert from an oral to iv dose. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. 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.
Using this conversion guideline, 100mg of morphine will convert to a 50mcghr dose, however the fda guidance suggests 100mg should convert to a 25mcg dose. Scottish palliative care guidelines fentanyl patches. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. Fentanyl patches should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least fentanyl patch 25 mcg. Actiq, fentora fentanyl transmucosal dosing, indications. Transdermal and parenteral fentanyl dosage calculations and. Right now i happen to have the mgh critical care handbook on my desk so ill use that.
Oct 15, 2019 duragesic should not be used if the pouch seal is broken or if the patch is cut or damaged. Fentanyl injection can be injected into muscle intramuscular or into veins intravenous. An alternative algorithm for dosing transdermal fentanyl. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 im iv morphine 10 to 22 2337 3852 5367. Each transdermal system is worn continuously for up to 72 hr see administration. Use appropriate opioid for situation or care setting.
Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. In the 3 weeks before the patients death, the dose reached. For example, when administered as a prolonged infusion, hydrophobic epidural opioids such as fentanyl will reach plasma levels similar to iv infusions. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Duragesic fentanyl transdermal dosing, indications, interactions. It also is used for treating severe pain that is unrelated to surgery. 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. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of.
It usually includes information on the dosage, relative potency, and halflives, compared to morphine. What are the steps for converting from morphine or. Select microgram per hour dose of transdermal fentanyl based on table 2. Equianalgesic chart changes in italics ui health care. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Iv use even at low doses and when given very slowly may cause marked decrease. When administered directly into the intrathecal space, hydrophilic opioids are more likely to bind specific receptors in the dorsal horn, where.
These are maximum doses in relation to converting someone already on opioids. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Each duragesic patch may be worn continuously for 72 hours. Upon system removal, 17 hours or more are required for a 50% decrease in serum fentanyl concentrations. 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. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Do not increase the duragesic dose for the first time until at least 3 days after the initial application. Convert iv fentanyl to iv morphine first following above steps 2.
677 880 754 1433 783 1280 1486 349 386 278 1239 922 561 562 1415 1369 1518 1285 1273 674 1190 769 674 186 256 833 349 142 44 536 783 1254 172 453 1334 528 857 119