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. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor. There is no dose equivalence between fentanyl lozenges and other opioid formulations. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Morphine milligram equivalent mme calculator instructions.
Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to. Fentanyl 25 patch 25microgramshour 30mg to 4mg24hours fentanyl 50 patch 50 microgramshour 5mg to 224mg24hours fentanyl 75 patch 75 microgramshour 225mg to 314mg24hours. One important safety issue, and a factor under the control of prescribers, is the recommendation that firsttime users of the fentanyl patch have adequate prior exposure to opioids. For delivery rates in excess of 100 mcghour, multiple systems may be used. Opioid conversion table hop16091451 croni ain anaeen tooli. The patient should avoid exposure to excessive heat e. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. The total daily morphine milligram equivalents mme will be displayed. Determine doses when converting a patient from one opioid to another. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine. Fentanyl interacts predominately with the opioid mureceptor. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Safety of fentanyl initiation according to past opioid. These mubinding sites are discretely distributed in the human brain, 5 spinal cord, and other tissues.
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. Opioid conversion table american academy of family. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20%. Advanced opioid pain management converter updated advanced opioid pain. This is the number of milligrams that actually gets into the bloodstream. An old patch can continue to release the drug and cause an overdose. Opioid converter morphine equivalent calculator omni.
Conversion guide for opioid to transdermal fentanyl from to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch 12 hour controlled release cr long acting oral opioid apply the patch at the same time as administering the final 12 hour cr dose. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Calculate the total 24hour morphine dose or morphineequivalent. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Multiply the amount of each drug by its bioavailability column 4, to get a smaller number. A safe and effective method for converting cancer patients. What are the steps for converting from morphine or. This calculator should not be used to determine doses when converting a patient from one opioid to another. Please use the following guideline to calculate a fentanyl patch dose increase. Practical pain management is a remedy health media, llc.
Converting from oral morphine to fentanyl transdermal patch. Duragesic label page 1 full prescribing information for. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Morphine milligram equivalent mme calculator nyc health. When converting from one opioid to another, the initial dose depends on the relative potency. Transdermal and parenteral fentanyl dosage calculations. Fentanyl transdermal skin patch uses, side effects. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. This is especially important for fentanyl and methadone conversions. Always ensure that an old patch has been removed before a new patch is applied.
Conversion from morphine or equivalent to fentanyl transdermal. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Fentanyl transdermal may also be used for purposes not listed in this medication guide. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. 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 daily. Remember to enter all opioids the patient is taking. Calculate an opioid starting dose for an opioidnaive patient. The method used for transdermal patch switching was to replace the first opioid patch with the alternative one, deducting 50% from the dose calculated according to equianalgesic tables. Some of the opioid receptors in the brain that fentanyl binds to also help control. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch.
The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. 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. Fentanyl transdermal is not for treating mild or occasional pain or pain from surgery. There are many opioids and many formulations available e. The transdermal fentanyl patch in these patients was replaced by a 52. Opioid conversions based on equianalgesia potency for all of the common opioids hydrocodone, oxycodone, morphine, etc. Opioid conversion and brand availability in canada. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Calculate opioid dose adjustments and opioid starting doses. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. 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. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Fentanyl is an opioid pain medicine that is used to treat moderate to severe chronic pain around the clock. The trust pain group has been informed of a number of situations where strong opioids and in particular fentanyl patches have been prescribed inappropriately.
Opioid metabolism and excretion do differ among the opioids. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Opioids switching with transdermal systems in chronic. When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete crosstolerance. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Calculates total daily morphine milligram equivalents. It should not be used to determine doses when converting a patient from one opioid to another. Opioid conversion ratios guide to palliative care practice. 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. Fentanyl patch converter globalrph conversion from. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects. 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 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioid conversion calculator for morphine equivalents. They all interact with specific opioid receptors such as. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Canadian guideline for safe and effective use of opioids.
This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. When using this chart, calculate the total daily dose of morphine. Morphine milligram equivalents mme calculator mdcalc. Converting to transdermal fentanyl palliative care. Opioid equivalence chart gloucestershire hospitals nhs. 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.
Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Opioid oral morphine milligram equivalent mme conversion. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Scottish palliative care guidelines fentanyl patches.
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