Iv drugs in order of choice are morphine, dilaudid, fentanyl, and sq drugs in order of choice are morphine, dilaudid. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Opioid switching using equivalence tables saskatchewan. In order to increase knowledge about how best to respond to and alleviate the suffering of seriously ill patients, we have created a free training module on physician assisted death dr. It should not be used to determine doses when converting a patient from one opioid to another. 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. Richard scott, professor emeritus in the department of sociology, shares a very personal story of the last stages of life of his beloved brother charles scott. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. What is the conversion from 150 mcg fentanyl patches every 3. The cii rate was decreased by 50% 6 hours after application of the fentanyl. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed. Thank you for downloading opioid manager switching opioid form. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine.
Usual starting infusion rate would be morphine 1 2 mghr, fentanyl 1025 mcghr, hydromorphone 0. Guidelines for adult patients intravenous pca orders. These bidirectional differences are not captured in a traditional equianalgesic table. 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. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Dilaudid hydromorphone and fentanyl are narcotic pain relievers prescribed to patients for the treatment and management of severe chronic pain, for example, pain related to cancer. Opioid conversion ratios guide to palliative care practice. Select microgram per hour dose of transdermal fentanyl based. Opioid equianalgesic calculator opioid switching from. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
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. Remember to enter all opioids the patient is taking. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. There are many opioids and many formulations available e.
Converting to transdermal fentanyl palliative care. Narcotic equivalence converter narcotic route dose. Can a patient be given dilaudid by iv while on a fentanyl patch. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Surprisingly, crosstolerance between opioids is often incomplete. She would like to try an immediaterelease opioid agent, hydromorphone. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Twostep titration weans patients from iv to patch fentanyl. Degroote national pain centre opioid manager switching opioids download. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. 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.
Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Opioid converter morphine equivalent calculator omni. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The total daily morphine milligram equivalents mme will be displayed.
Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. In the case of converting morphine to methadone, methadone has a relative potency of 4. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Conversion of intrathecal opioids to fentanyl in chronic pain. The patch is fentanyl the strongest family of opiates we have. Transdermal and parenteral fentanyl dosage calculations. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario.
Both drugs work the same way in the body to relieve pain. Fentanyl patches are another option, but are expensive and difficult to titrate. 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. Calculate the total 24hour morphine dose or morphineequivalent.
Equianalgesic dosing of opioids for pain management. Opioids opiates are a group of analgesic drugs, used primarily for pain management. They all interact with specific opioid receptors such as. Narcotic pain relievers also can be addictive and abused. Do not use this tool to convert from one opioid to a different opioid.
There are differences in the literature regarding opioid conversion ratios. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. Oral morphine milligram equivalent conversion table updated 8. Opioid conversion and brand availability in canada. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. 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. Dr prescribed dilaudid and fentanyl patch, is this safe, don. Conversion of opioid analgesics to fentanyl transdermal.
Adapted from tarascon pocket pharmacopoeia created. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. The following source was used for morphine equivalent conversion factors per mg of opioid. The table is based on oral dosing for chronic noncancer pain. Round up or down based on patient factors and available patch sizes.
For frail elderly patients, use more conservative conversion or a lower strength patch e. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. When available, patientcontrolled analgesia pca pumps should be used, per iv if access available, and per sq if no iv access is available. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Morphine milligram equivalent mme calculator nyc health.
Fentanyl patch dosing determination based on current opioid therapy. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain. Opioid conversion calculator for morphine equivalents. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative.
Conversion from morphine or equivalent to fentanyl transdermal. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Equianalgesic chart changes in italics ui health care. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Duragesic fentanyl transdermal dosing, indications. Im in a hosp so i feel a little safe if something goes wrong. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent. Canadian guideline for safe and effective use of opioids for.
A safe and effective method for converting cancer patients. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Opioid oral morphine milligram equivalent mme conversion. Opioid conversion tips changing to another oral opioid question. And just fyi hydromorphone is also known as dilaudid.
If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3. 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 4 hr limit includes both the continuous basal infusion and patient boluses.
Converting from oral morphine to fentanyl transdermal patch. 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. If you prefer to not use the rounded off conversion, the full. 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. You wish to convert the therapy to transdermal fentanyl. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Fentanyl patch converter globalrph conversion from other. A 33% dose reduction from the calculated dose of 100 mg is equal to 67 mg of oral morphine per day. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Fentanyl patch converter globalrph conversion from. What are the steps for converting from morphine or. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. Transdermal and parenteral fentanyl dosage calculations and.
Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. 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. 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.
Canadian guideline for safe and effective use of opioids. Kornick said the research team is now looking into the best procedure for accomplishing that task. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. For this reason the date of birth field is mandatory. If the form does not start downloading in 10 seconds, please click here. Sickle cell pain crisis guidlines virginia premier. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Some experts use this conversion in cancer patients. Conversion of intrathecal opioids to fentanyl in chronic. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. 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.
Currently, there are no empirical studies converting fentanyl to morphine. Titrate liberally and rapidly to analgesic effect during first 24 hours. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain.
Recommendations based on data contained in the package insert. Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. The patch will take a little while to get in to your system. Dilaudid and fentanyl have the same mechanism of action they work the same way in relieving and stopping pain. An alternative algorithm for dosing transdermal fentanyl. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. 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. Morphine milligram equivalent mme calculator instructions. Oral opioid dosing equivalents and conversions university of.