Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Conversion from morphine or equivalent to fentanyl transdermal. Opioid switch from low dose of oral oxycodone to transdermal. Fentanyl patch converter globalrph conversion from other. Recommend an appropriate dose of transdermal fentanyl when. Tablet with 5 mg hydrocodone and 500 mg acetaminophen. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. A shortacting opioid, such as hydrocodone 5 mg every 4 hours, should be added. Where dose equivalence is expressed as a range, use the value that produces. Residual effects from discontinued longacting formulations should also be assessed before. This calculator, which is based roughly on information provided by. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Fentanyl patch converter globalrph conversion from.
Fentanyl taper schedule how to taper off fentanyl patch. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Duragesic fentanyl transdermal dosing, indications. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Calculate the total 24hour morphine dose or morphineequivalent. Fentanyl patches durogesic for chronic pain nps medicinewise. By the time i got the rx filled an the patch on me that was about 4 hours ago most of the nice releive i got.
Nov 20, 2019 in a fentanyl transdermal system clinical trial, patients were converted from their prior opioid to fentanyl transdermal system using table 1 as a guide for the initial fentanyl transdermal system dose. From norco to fentanyl patches pain management medhelp. Will i need more than the two norcos per day directly after application of the patch due to the time it takes for the fentanyl to hit the system. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. You should take your vicodin with it for the first 23 days. 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. 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.
Fentanyl duragesic patches come in six different sizes and doses, including. Here, we investigated if early phase opioid switch from low dose of oral oxycodone to transdermal fentanyl matrix patch provided any benefits for patients with thoracic malignancy and stable cancerrelated pain. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. 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. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response. However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Depends a lot on the strength of the fentenyl patch. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. A safe and effective method for converting cancer patients. There are many risks associated with quitting the drug, or any opioid, cold turkey, so tapering is a safer. Duragesic patches are intended for transdermal use on intact skin only.
Dec 22, 2019 longterm or regular use of opioid drugs like fentanyl transdermal patch may lead to dependence. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on singledose studies, and there is substantial individual variation in response. Opioid conversion to hysingla er hydrocodone bitartrate cii. This is based on studies converting from morphine to fentanyl. These dose conversions are estimated and cannot account for all individual. Longterm or regular use of opioid drugs like fentanyl transdermal patch may lead to dependence.
In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg. Talk to your doctor before you lower the dose or stop fentanyl transdermal patch. Lowering the dose or stopping fentanyl transdermal patch all of a sudden may cause a. Analysis of fertility parameters in both studies indicated that an intravenous dose of fentanyl up to 0. Opioid oral morphine milligram equivalent mme conversion. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Oral morphine milligram equivalent conversion table updated 8. Each fentanyl transdermal system is worn continuously for up to 72 hours see dosage and administration 2. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. 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. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours.
Caution is advised when converting to methadone due. Advice should be sought from the palliative care team. Lowering the dose or stopping fentanyl transdermal patch all of a sudden may cause a greater risk of withdrawal or other severe problems. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Abstral fentanyl dose, indications, adverse effects. Opioid conversion calculator morphine equivalents advanced. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Equivalence between oral morphine and transdermal fentanyl.
This is based on performing a morphine to fentanyl conversion. 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. Currently, there are no empirical studies converting fentanyl to morphine. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. There is a conversion between hydrocodone and fentanyl. Significant amounts of fentanyl continue to be absorbed from the skin for. Opioid conversion and brand availability in canada michael g. I prefer the fentanyl patch because it is all pain med fentanyl is a pure opiate agonist, like morphine, where as butrans depends on a medication that is part agonist part partial agonist. This is especially important for fentanyl and methadone conversions. Here, we investigated if early phase opioid switch from low dose of oral oxycodone to. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. It seems to weaken on the third day, so i use the hydrocodone, but it beats being tied to the very tight. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary.
Recommended dose conversion to fentanyl from other opioids. Equianalgesic chart changes in italics ui health care. This is based on performing a morphine to fentanyl. I definitely prefer the fentanyl, no wild mood swings or sedation like the oxycodone. Transdermal patch should be used only in opioid tolerant patients.
An alternative algorithm for dosing transdermal fentanyl for. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Hydrocodone is most commonly converted to morphine in a 1. The effectiveness and safety of switch from oral oxycodone to fentanyl patch is little known. Medscape analgesic dosing for duragesic fentanyl transdermal, frequencybased. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg.
Dosing table for opioids conversion from fentanyl patches to parenteral hydrocodone 1 mg oral is equal to morphine 1 mg oral fentanyl patch dose mcghr. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Decrease new dose 3050% to allow for incomplete crosstolerance. Advanced opioid conversion calculator morphine equivalents. Again, this chart should not be used to convert from fentanyl to an oral opioid but it gives you a general frame of reference.
Conversion from transdermal fentanyl to hysingla er. Fentanyl injection is prescribed to reduce pain before, during, or after surgery. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Particular care is required when dealing with high doses of opiates. 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. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. My md preferred fentanyl patches with low dose hydrocodone for breakthrough pain. Fentanyl is the generic form of the brandname drug duragesic, a prescription opioid narcotic drug used to treat chronic, aroundtheclock pain. Oral opioid dosing equivalents and conversions university of. How to switch from fentanyl to hydrocodone pharmacistanswers.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Select microgram per hour dose of transdermal fentanyl based on table 2. Physicians put their patients on a fentanyl taper schedule to help them ease off of fentanyl. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
Fentanyl buccal or sl tablets, or lozengetroche5 mcg. 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. I have researched quite a bit and i have found the conversion. Converting from oral morphine to fentanyl transdermal patch. Stop long acting oral morphine after applying patch.
Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Oct 27, 2019 again, this chart should not be used to convert from fentanyl to an oral opioid but it gives you a general frame of reference. Demand boluses of iv fentanyl equivalent in dosage to 50100% of. If a patient with chronic pain is on meperidine, convert patient to an. The patch will take a little while to get in to your system. Remove the transdermal fentanyl patch and 18 hours later initiate hydrocodone extendedrelease capsules at 10 mg every 12 hours for each 25 mcghr fentanyl transdermal patch. This tool does not contain all of the important safety information needed to prescribe butrans. It also is used for treating severe pain that is unrelated. Typical oral q4h doses of shortacting opioids shown as equivalents to morphine.
Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Opioid conversions based on equianalgesia potency for all of the common opioids hydrocodone, oxycodone, morphine, etc. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Transdermal and parenteral fentanyl dosage calculations. In a fentanyl transdermal system clinical trial, patients were converted from their prior opioid to fentanyl transdermal system using table 1 as a guide for the initial fentanyl transdermal. Select microgram per hour dose of transdermal fentanyl based on. I have researched quite a bit and i have found the conversion tools to try to understand what a like for like i am dealing with, but i really dont understand the charts.
Hydrocodone conerstion to fentanyl patches 12mc addiction. Transdermal and parenteral fentanyl dosage calculations and. All doses expressed in mg per day with exception of fentanyl. The patch is fentanyl the strongest family of opiates we have. Fentanyl actiq side effects, dosage, interactions drugs. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. When switching to methadone, the starting dose should be 10% to 25% of the. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to.
Hydrocodone is most commonly converted to morphine in a. Fentanyl injection sublimaze is a synthetic narcotic similar to morphine. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Duragesic label page 1 full prescribing information for use.
68 177 656 902 138 1027 1052 1180 1106 783 1482 608 176 1402 602 1292 914 790 532 376 1030 1083 271 83 194 133 1231 86 173 752 1157 465 162 235 1496 591 1063 1482 20 866 1396 1167