Fentanyl patch conversion to

Scottish palliative care guidelines fentanyl patches. Advice should be sought from the palliative care team. In the case of converting morphine to methadone, methadone has a relative potency of 4. Thats some bad stuff to get off of and there is no easy way that i have found. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Follow the information that comes with fentanyl transdermal patch for throwing out doses that are not needed.

Fentanyl patches durogesic for chronic pain nps medicinewise. If pain is stable the patient may be considered for conversion to a fentanyl patch. The transdermal system is pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. Canadian guideline for safe and effective use of opioids for. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. Duragesic fentanyl transdermal dosing, indications. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. They also cant be titrated as quickly, and make oversedation more complicated to deal with due to a depot effect. Refer to your local formulary see effentora and pecfent medicine information sheets. Transdermal and parenteral fentanyl dosage calculations. The fentanyl skin patch is only used for opioidtolerant patients. 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.

Frail or elderly patients may need lower doses and slower titration. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. The objective of the current case series was to evaluate and describe the safety and effectiveness of a method for converting hospitalized patients with cancerrelated pain from iv to transdermal fentanyl. The fentanyl infusion dose wasdecreased inhalfsix hours after patch application, then completely stopped after 12 hours. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Do not use this tool to convert from one opioid to a different opioid. An alternative algorithm for dosing transdermal fentanyl for. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Select microgram per hour dose of transdermal fentanyl based. Converting from fentanyl given by iv infusion or via a pca device.

Canadian guideline for safe and effective use of opioids. The following source was used for morphine equivalent conversion factors per mg of opioid. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Conversion from morphine or equivalent to fentanyl transdermal. Dose equivalents and changing opioids faculty of pain.

Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. How should conversion from oral morphine to fentanyl. Efficacy and safety of a sixhour continuous overlap.

Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. Calculate the total 24hour morphine dose or morphineequivalent. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. A safe and effective method for converting cancer patients from. Narcotic pain relievers also can be addictive and abused. Duragesic label page 1 full prescribing information for. Oct 15, 2019 duragesic should not be used if the pouch seal is broken or if the patch is cut or damaged. Fentanyl is a horrible drug and is 80 times stonger that morphine. 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. Scottish palliative care guidelines fentanyl sublingual. How should conversion from oral morphine to fentanyl patches. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch.

Threedaytype transdermal fentanyl patch conversion by rapid. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Currently, there are no empirical studies converting fentanyl to morphine. Each duragesic patch may be worn continuously for 72 hours. Converting to transdermal fentanyl palliative care. Oral morphine milligram equivalent conversion table updated 8. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Opioid conversion and brand availability in canada. When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Fentanyl patch converter globalrph conversion from other. Opioid oral morphine milligram equivalent mme conversion. 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.

How should conversion from oral morphine to fentanyl patches be carried out. A locked box or area may help keep fentanyl transdermal patch safe. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Converting from oral morphine to fentanyl transdermal patch. While this makes the conversion relatively easy, patches tend to be left on longer than needed.

This tool does not contain all of the important safety information needed to prescribe butrans. Remember to enter all opioids the patient is taking. Twostep titration weans patients from iv to patch fentanyl. Nomura et al used the same method, but shortened the conversion period to six hours, and the dose was cut in half three hours after patch placement. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. 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. Morphine milligram equivalent mme calculator instructions. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The total daily morphine milligram equivalents mme will be displayed. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. Opioids opiates are a group of analgesic drugs, used primarily for pain management. 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.

Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Opioid converter morphine equivalent calculator omni. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. Duragesic label page 1 full prescribing information for use. The fentanyl transdermal system patch is used for the management of persistent, moderate to severe chronic pain in opioidtolerant patients when a continuous, aroundtheclock opioid analgesic. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. Fentanyl patches scottish palliative care guidelines. There are many opioids and many formulations available e. Morphine milligram equivalent mme calculator nyc health.

There is no direct conversion ratio between morphine and transmucosal fentanyl. Fentanyl patches are another option, but are expensive and difficult to titrate. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Threedaytype transdermal fentanyl patch conversion by rapid titration method with shortacting oral oxycodone. Most nhs boards have only approved one or two rapid acting fentanyl products for use in their area. The table is based on oral dosing for chronic noncancer pain. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Fentanyl patch converter globalrph conversion from. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches.

Transdermal and parenteral fentanyl dosage calculations and. Dec 22, 2019 store fentanyl transdermal patch in a safe place where children cannot see or reach it, and where other people cannot get to it. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Equianalgesic chart changes in italics ui health care. 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. John smith, a terminally ill lung cancer patient has pain that is well controlled on. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Apr 26, 2020 conversion from morphine or equivalent to fentanyl transdermal. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action.

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. According to the manufacturer, 50% of the patients in clinical trials required a dose increase. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. For delivery rates in excess of 100 mcghour, multiple systems may be used. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Converting to transdermal fentanyl palliative care network. C the conversion table is unidirectional only and should only be used to convert adult patients from their current oral or parenteral opioid analgesic to the approximate fentanyl transdermal patch for use in chronic pain. The conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion. Kornick said the research team is now looking into the best procedure for accomplishing that task. What are the steps for converting from morphine or.

Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Fentanyl accumulates to form a depot in the skin below the. Converting to transdermal fentanyl palliative care network of. Conversion of opioid analgesics to fentanyl transdermal. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. 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. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. They all interact with specific opioid receptors such as. One option that i dont like to use is switching patients over to a fentanyl patch. Duragesic patches are intended for transdermal use on intact skin only. 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.

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. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. Opioid conversion ratios guide to palliative care practice. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Dosage use only when converting another opioid to fentanyl patch. Check with your doctor if you have questions about this. An alternative algorithm for dosing transdermal fentanyl. Considering patient has not been compliant recently, in addition to recent weight loss indicating cachexia, reducing the dose to a 100mcg patch applied topically every 72 hours and assess response is recommended. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Both drugs work the same way in the body to relieve pain.

Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. I did a conversion once when i found a table online and was shocked to find out that the 100mcg patches i was on are equivalent to over 200 mgs of oxycodone. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. In renal impairment gfr fentanyl and buprenorphine patches. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Select microgram per hour dose of transdermal fentanyl.

Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl may also cause severe, possibly fatal, breathing problems. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. This guideline is for the use of abstral a dispersible, sublingual fentanyl tablet available as 100, 200, 300, 400, 600, 800 micrograms. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl.