Morphine milligram equivalent mme calculator nyc health. The patients domed of 360 mg is equal to 30 mg of methadone daily. Fentanyl patch converter globalrph conversion from. When new opioids or doses are introduced, it is important to dose very carefully to avoid potential overdose. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. 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. 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. Zohydro er hydrocodone bitartrate dose, indications. Converting to transdermal fentanyl palliative care network of. Converting from oral morphine to fentanyl transdermal patch.
You should take your vicodin with it for the first 23 days. Norco hydrocodone acetaminophen is a good option to treat pain when overthecounter medicines havent worked, but it can lead to dependence and tolerance if taken for a long time. 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. It is widely accepted that morphine and hydrocodone. Many health care professionals dont realize how strong a.
What every pharmacist should know about transdermal. 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. Canadian guideline for safe and effective use of opioids. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment.
Opioid oral morphine milligram equivalent mme conversion. If regimen includes more than 1 opioid, sum converted totals. 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. Transdermal and parenteral fentanyl dosage calculations. Recommend an appropriate dose of transdermal fentanyl when. Calculate the total daily doses of the prior opioids, then using conversion factor, determine total daily extendedrelease hydrocodone dose. A shortacting opioid, such as hydrocodone 5 mg every 4 hours, should be added. The fentanyl patch is indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate patients considered opioidtolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at. In the case of converting morphine to methadone, methadone has a relative potency of 4. This calculator should not be used to determine doses when converting a patient from one opioid to another. Duragesic fentanyl transdermal dosing, indications. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. Opioid conversion calculator for morphine equivalents.
Convert each dose into mmes by multiplying the dose by the conversion factor. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. This is particularly important if converting from longacting oral opioids or fentanyl patches. Determine equivalent daily dose of new opioid by dividing. Palliative care lowered my hydrocodone to 5325mg 3 times a day and started me on a 12mcghr fentanyl transdermal patch.
An alternative algorithm for dosing transdermal fentanyl for. This is the only thing that would even touch the terrible pain in my back. The following source was used for morphine equivalent conversion factors per mg of opioid. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Duragesic fentanyl transdermal dosing, indications, interactions. Conversion from transdermal fentanyl to hysingla er. I definitely prefer the fentanyl, no wild mood swings or sedation like the oxycodone. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. If your prescribed dose is for more than one patch, make sure the edges of the patches do not touch or overlap.
Dose equivalence and switching between opioids specialist. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Methadone has been associated with disproportionate numbers of overdose deaths relative to the frequency with which it is prescribed for chronic pain, due in part to its long and variable halflife. It is important to know that once a fentanyl patch is removed, 17 hours or more are required for a 50% decrease in fentanyl concentrations. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h. Transdermal patch should be used only in opioid tolerant patients.
If you are converting a patient to or from fentanyl i. There is a conversion between hydrocodone and fentanyl. Hydrocodone conerstion to fentanyl patches 12mc pamh1955. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Practical management of opioid rotation and equianalgesia. Proper conversion is dependent upon a variety of factors drug dosage, cross tolerance or. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Tablet with 5 mg hydrocodone and 500 mg acetaminophen. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. 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.
They discharged me with 2 weeks of oxycodone, pretty high dose around 120 mgday. Currently, there are no empirical studies converting fentanyl to morphine. I have been on 45 vicodin 500s for about 2 months after being off them for years. Jannsen, the manufacturer of fentanyl patches, suggests a more conservative dosing schedule in converting to. I have break through pain, and have been on a pretty high dose of hydrocodone fir a couple of years now. Duragesic label page 1 full prescribing information for. Recommended dose conversion to fentanyl from other opioids. This is especially important for fentanyl and methadone conversions. Equianalgesic chart changes in italics ui health care. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Fentanyl patch protocol ventura county, california.
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 from the morphine was gone. Reduce the calculated daily hydrocodone dose by 25%. Opioid equivalence chart gloucestershire hospitals nhs. Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. 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 half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Opioid oral morphine milligram equivalent mme conversion factors1,2. Particular care is required when dealing with high doses of opiates.
Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The methadone conversion table indicates that a conversion factor for a domed of 360mg equals 8. Stop long acting oral morphine after applying patch. 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. The patients current dose of 240 mg per day of oral oxycodone is equal to 360 mg per day of oral morphine. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. My md preferred fentanyl patches with low dose hydrocodone for breakthrough pain. Due to this many practitioners advise to wait at least 12 to 24 before initiating any new opioids. Medscape analgesic dosing for duragesic fentanyl transdermal, frequencybased. How to switch from fentanyl to hydrocodone pharmacistanswers. 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. 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.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Divide the 24hour hydrocodone requirements into 2 equal doses given po every 12 hours. Advanced opioid conversion calculator morphine equivalents. This is based on studies converting from morphine to fentanyl. Proper conversion is dependent upon a variety of factors drug dosage, crosstolerance or. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Do not use this tool to convert from one opioid to a different opioid. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed.
Oxycontin, xtampza er oxycodone dosing, indications. When converting from one opioid to another, the initial dose depends on the relative potency. Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present. An alternative algorithm for dosing transdermal fentanyl. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch. In other words, the conversion factor not accounting for days of use would be 6025 or 2. These dose conversions are estimated and cannot account for all individual. Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as there is. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. All doses expressed in mg per day with exception of fentanyl.
1126 487 722 58 1381 590 298 1505 580 360 1158 691 706 341 1315 951 1343 1334 408 485 1078 1343 1157 143 80 1072 185 175 315 658 1203 779 1209 640 397 394 714