Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Twostep titration weans patients from iv to patch fentanyl. Do not use this tool to convert from one opioid to a different opioid. Transdermal and parenteral fentanyl dosage calculations. Opioid conversions calc single agent equianalgesic. 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. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl 20 mcgmlincreasing sedation poss score 3 or rass conversion ratio of certain opioids can be dependent on the dose of the original opioid. If you are converting a patient to or from fentanyl i. Opioid conversions calc single agent equianalgesic globalrph.
Calculate the total 24hour morphine dose or morphineequivalent. 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. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. 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. For frail elderly patients, use more conservative conversion or a lower strength patch e. Cr 18 mg q12h is being switched to fentanyl patches. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Converting to transdermal fentanyl palliative care network. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral morphine equivalent 36 x 5 180 mg morphine24 hrs. In an inpatient setting, rescue doses can be provided iv every 1530 minutes.
What are the steps for converting from morphine or. 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 brand names of fentanyl include. Opioid switching using equivalence tables page 1 of 5. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. They all interact with specific opioid receptors such as.
Conversion of intrathecal opioids to fentanyl in chronic pain. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. Converting to transdermal fentanyl palliative care. Canadian guideline for safe and effective use of opioids for. 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. Degroote national pain centre opioid manager switching opioids download. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Stop long acting oral morphine after applying patch.
If converting from oral to iv hydromorphone, use a conversion ratio of 7. 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. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Mar 09, 2012 since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. Start with equivalent total daily dose of immediate release formulation and administer once daily. The following source was used for morphine equivalent conversion factors per mg of opioid. Canadian guideline for safe and effective use of opioids. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Opioid converter morphine equivalent calculator omni. Select microgram per hour dose of transdermal fentanyl based. What is the conversion from 150 mcg fentanyl patches every.
Currently, there are no empirical studies converting fentanyl to morphine. Converting from oral morphine to fentanyl transdermal patch. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. Decrease new dose 3050% to allow for incomplete crosstolerance. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. Select microgram per hour dose of transdermal fentanyl based on table 2. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. Morphine milligram equivalent mme calculator nyc health. Dailymed dilaudid hydromorphone hydrochloride injection.
Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
It may be 812h or longer after putting on the first patch before pain relief is experienced. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sc iv. Conversion of opioid analgesics to fentanyl transdermal. Your equation would look like this based on conversion table. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. What are the steps for converting from morphine or equivalent to. Dec 15, 2001 demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients.
Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Look up the fda prescribing information for transdermal fentanyl reference 1, pp 2930. Changing an oral or iv opioid to transdermal fentanyl 1. 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 pethidine po hydrocodone. Dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Conversion from other oral hydromorphone formulations. Transdermal fentanyl is approximately 80 times as potent as morphine. 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. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. There are differences in the literature regarding opioid conversion ratios. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
This is based on studies converting from morphine to fentanyl. In the case of converting morphine to methadone, methadone has a relative potency of 4. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Conversion from morphine or equivalent to fentanyl transdermal. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h. Dilaudid, exalgo hydromorphone dosing, indications. Convert the iv dose to the equianalgesic oral morphine dose using a ratio of. Effects of patch last for 18 24 hours after the patch is removed. Equianalgesic chart changes in italics ui health care. Convert the oral morphine dose to transdermal fentanyl.
The amount of residual drug in the patients system must be accounted for. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Oct 01, 2018 dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Note this dose should not be decreased further as it is already conservative. Fentanyl patch converter globalrph conversion from other. Parenteral hydromorphone is 20 times as potent as oral morphine. Fentanyl patch converter globalrph conversion from. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl.
Converting to transdermal fentanyl palliative care network of. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Opioid oral morphine milligram equivalent mme conversion. An alternative algorithm for dosing transdermal fentanyl for. Dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Dosage use only when converting another opioid to fentanyl patch. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses.
Once i had the dilaudid, about 6 hours after i took the 10ml. Conversion of intrathecal opioids to fentanyl in chronic. Recommend an appropriate dose of transdermal fentanyl when. Advanced opioid conversion calculator morphine equivalents. What is the conversion from 150 mcg fentanyl patches every 3. 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. How strong is dilaudid for pain compared to percocet. Start exalgo dose at 50% of calculated daily dose every 24 hours. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl.
Quickwhat dose of the transdermal fentanyl patch duragesica is. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Opioids opiates are a group of analgesic drugs, used primarily for pain management. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. 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. Oxycodone solution for injection is available in 10mgml and 50mgml strengths.
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