Fentanyl transdermal system fentanyl transdermal system. The american pain society guidelines and most pain experts recommend a dose reduction between 2550% when converting between different opioids, 9, 11 with a consideration for little or no crosstolerance reduction in patients with poorly controlled pain. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Each butrans patch is intended to be worn for 7 days. This calculator should not be used to determine doses when converting a patient from one opioid to another. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. It is safer to underestimate a patients 24hour oral oxycodone dosage and provide rescue medication e. In the case of converting morphine to methadone, methadone has a relative potency of 4.
Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. Select microgram per hour dose of transdermal fentanyl based on table 2. Opioid oral morphine milligram equivalent mme conversion. Transdermal patch should be used only in opioid tolerant patients. 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. I just started the fentanyl patch 25mgs and the doctor refilled my norco at the same 6 per day dosage. Ive been on norco 10mgs 6 to 7 times a day for 6 years. Fentanyl patch protocol ventura county, california. A safe and effective method for converting cancer patients. Selecting yes will convert the first drug listed fentanyl i.
If you are converting a patient to or from fentanyl i. Fentanyl transdermal system patches are available in 8 different dosage strengths and patch. Remember to enter all opioids the patient is taking. Equianalgesic dosing of opioids for pain management. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Duragesic fentanyl transdermal dosing, indications. Fentanyl is one of the strongest pain meds on the market and it will take a high dose to reach the equivalency. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Because transdermal fentanyl has a delayed onset and onset of.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. It should not be used to determine doses when converting a patient from one opioid to another. Fentanyl transdermal system contains a high concentration of a potent schedule ii opioid agonist, fentanyl.
Initiate dosing using xtampza er 9 mg orally every 12 hours with food. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoral r at 100 mcg. Butrans is for transdermal use on intact skin only. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. 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. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. Transdermal and parenteral fentanyl dosage calculations. Do not use table 2 to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl transdermal system. Fentanyl transdermal system exposes users to risks of addiction, abuse, and misuse, which can lead to overdose and. Opioid conversions calc single agent equianalgesic. Converting from oral morphine to fentanyl transdermal patch. Because steadystate plasma concentrations are approximated within 3 days, opana er dosage adjustments, preferably at increments of 510 mg every 12 hours, may be done every 3 to 7 days.
If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. Advice should be sought from the palliative care team. Determine mmes of oxycodone oxycodone conversion factor 1. The total daily morphine milligram equivalents mme will be displayed. For a single dose, 10 mg iv morphine 60 mg oral morphine. Calculating total daily dose of opioids for safer dosage cdc. Round up or down based on patient factors and available patch sizes. Fentanyl transdermal system can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The amount of residual drug in the patients system must be accounted for. 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.
There are many conversion tables available through the internet and doctors also use theconversion method when finding the right dose for you. 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. Although there has been no systematic assessment of such conversion, start with a conservative conversion. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Fentanyl patch converter globalrph conversion from. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Ive always had a high tolerance, so the high dosage has never changed. 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. Fentanyl transdermal system contains fentanyl, a schedule ii controlled substance with a high potential for abuse similar to other opioids including morphine, hydromorphone, methadone, oxycodone, and oxymorphone. Caution is advised when converting to methadone due to variability. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch.
Fentora fentanyl dose, indications, adverse effects. For delivery rates in excess of 100 mcghour, multiple systems may be used. If the level of pain increases, attempt to identify the source of increased pain, while adjusting the opana er dose to decrease the level of pain. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
Oxycontin, xtampza er oxycodone dosing, indications. Opioid conversion calculator for morphine equivalents. There are no established conversion ratios for conversion from other opioids to xtampza er defined by clinical trials. Advanced opioid conversion calculator morphine equivalents. Starting dose will range from 75 mcg once daily or every 12 hours to 300 mcg every 12 hours depending on the patients prior opioid experience and risk for abuse potential. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Oral opioid dosing equivalents and conversions university of. Oral morphine is about 10 times more potent than oral meperidine and about twice more potent as parenteral meperidine mg for mg 30mg oral morphine.
Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. This is especially important for fentanyl and methadone conversions. Calculate the total 24hour morphine dose or morphineequivalent. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Morphine milligram equivalent mme calculator instructions. Opioid conversion calculator morphine equivalents advanced. Morphine milligram equivalent mme calculator nyc health. Im hesitating on listing how its done, but theres a million tek posts about this on df, so here goes. Fentanyl accumulates to form a depot in the skin below the.
I too use the fentanyl 75mcg patch along with the oxycodone. Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals. Ive got pain in neck, lower back, and well, all over. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Duragesic label page 1 full prescribing information for. After 50% dose reduction for incomplete crosstolerance, reduce dose again by 50% for. 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.
Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. See our opioid conversion algorithm for instructions on converting from one opioid to another. Equianalgesic chart changes in italics ui health care. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours.