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. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Advice should be sought from the palliative care team. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
Fentanyl is available in a lozenge, iv medication and a film that dissolves on the tongue, but the easiest way to get longterm relief is through a stickon skin patch. Usually even in terminal cancer patients 300mcghr is the ceiling dose. Although intrathecal fentanyl may have systemic effects, it will act differently than if systemically administered. Fentanyl patch dosing guidelines fentanyl patches should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least fentanyl patch 25 mcg. Fentanyl patch converter globalrph conversion from. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Never use more than one patch at a time unless instructed to do so by your doctor.
Fentanyl transdermal patch 72 hour 100mcg drug medication dosage information. For use in opioidtolerant patients only duragesic contains a. Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. Muscle rigidity that can comprimise ventilations when given too rapidly or at higher doses. Oct 15, 2019 duragesic should not be used if the pouch seal is broken or if the patch is cut or damaged. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. This standard value is based on morphine and its potency, referred to as morphine milligram equivalents mme or morphine equivalent doses med. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Butrans buprenorphine transdermal dosing, indications. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours.
Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. In the case of converting morphine to methadone, methadone has a relative potency of 4. Transdermal fentanyl comes as a patch to apply to the skin. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings.
The total daily morphine milligram equivalents mme will be displayed. For example, 50 mg per day of oral morphine 25 mcgh tdf. Aug 15, 2019 fentanyl patches should be stored at room temperature, away from excess heat and moisture not in the bathroom. For example, anne used 25 mg of breakthrough oral morphine within 24 hours.
Nov 22, 2019 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 fentanyl patch is constructed like a matrix, a system based on a polyacrylate net with fentanyl that attaches directly onto the skin. An alternative algorithm for dosing transdermal fentanyl. Fentanyl patch definition of fentanyl patch by medical. Morphine equivalent dosing rxperts industry insights 3 do the math milligram morphine equivalent mme is a value assigned to opioids to represent their relative potencies. Morphine milligram equivalent mme calculator nyc health. Fentanyl duragesic patches come in six different sizes and doses, including. It has a rapid onset and its effects generally last less than two hours.
Proper disposal out of the reach or children or pets is essential. They discharged me with 2 weeks of oxycodone, pretty high dose around 120 mgday. For use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Fentanyl transdermal patch 72 hour 100mcg drug medication.
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. All im and po doses in this chart are considered equivalent to 10 mg of im morphine in analgesic effect. Fentanyl is almost 100 times more potent than morphine, but the drug is designed to deliver small amounts of fentanyl each hour over an extended period of time. Fentanyl definition is a synthetic opioid narcotic analgesic c22h28n2o with pharmacological action similar to morphine that is administered transdermally as a skin patch and in the form of its citrate c22h28n2oc6h8o7 is administered orally or parenterally as by intravenous or epidural injection. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. My md preferred fentanyl patches with low dose hydrocodone for breakthrough pain. Fentanyl actiq side effects, dosage, interactions drugs. Fentanyl is an opioid pain medication, sometimes called a narcotic fentanyl patches are a strong prescription pain medicine.
Scottish palliative care guidelines fentanyl patches. Discarded patches have the potential to be misused. The equivalences of transdermal fentanyl patches to oral morphine are shown in box 2. Placing a patch in the mouth, chewing it, or swallowing it may cause choking or overdose that may be fatal. Fentanyl is a powerful synthetic opioid approved by the fda for use as a painkiller and anesthetic. Opioid oral morphine milligram equivalent mme conversion factors1,2. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. Recent statistics indicate that health care providers wrote 259 million prescriptions for opioids in 2012, enough for every american adult to have received at least one prescription in that year. Change your patch at about the same time of day every time you change it. 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 patches are used to treat moderate to severe chronic pain around the clock fentanyl patches are used when other pain treatments such as nonopioid pain medicines or immediaterelease opioid medicines do not treat your pain well enough or you cannot tolerate them.
Use caution when prescribing to opioidexperienced patients requiring high doses of opioids ie, 80 mgday oral morphine equivalent. The patch is usually applied to the skin once every 72 hours. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. A practical guide to tapering opioids mental health. Heatpyrexia increases the absorption of fentanyl and can cause toxicity. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. Morphine milligram equivalent mme calculator instructions. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Medically, fentanyl is used by injection, as a patch on the skin. What is the maximum dose of fentanyl patches for chronic. Fentanyl interacts predominately with the opioid mureceptor.
Frail or elderly patients may need lower doses and slower titration. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Learn about the reported side effects, related class drugs, and how these medications will affect your daily lifestyle. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval.
Ionsys fentanyl iontophoretic transdermal system is a patientcontrolled iontophoretic transdermal system providing ondemand systemic delivery of fentanyl, an opioid agonist, for up to 24 hours or a maximum of 80 doses, whichever comes first. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Smartin9, there is no equivalent replacement for fentanyl transdermal duragesic. Defined daily dose ddd values are defined by the world health organization who and. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the united states. Use of higher starting doses in patients who are not opioid. Use of fentanyl patch in partial doses than the original. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Medscape analgesic dosing for duragesic fentanyl transdermal. If pain is so severe that oral pain medications no longer work, physicians may prescribe fentanyl.
The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Old patches should be folded in half so that the adhesive side adheres to itself and discarded in the pharmaceutical waste. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The extendedrelease opioid drug post quantity limits are set to encompass the usualstarting dosage range recommendations in labeling, or up to one additional dose per day above the initial. There may be limitations on how many doses you may use at once and how long you may go between doses.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Fentanyl patch protocol ventura county, california. Initial dose based on previous 24hour opioid requirement consult product literature, for evaluating analgesic efficacy and dose increments, see under chronic intractable pain not currently treated with a strong opioid analgesic, for conversion from long term oral morphine to transdermal fentanyl, see pain management with opioids under. Please use the following guideline to calculate a fentanyl patch dose increase. Frequency of patch applicationif a patient requires more than four doses of breakthrough pain medication over the 24hour period between the second and third day following patch application, a new fentanyl patch is advised. At more than 80 times more potent than morphine, fentanyl is by far the most powerful pain medication available.
To dispose of used fentanyl patches fold the patch inwards on itself so that the adhesive sides meet, and return to the dispensing pharmacy. Oral morphine milligram equivalent conversion table updated 8. 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. Quickwhat dose of the transdermal fentanyl patch duragesica is. Mme is determined by using an equivalency factor to calculate a dose of morphine that is equivalent to the ordered opioid. Duragesic patch fentanyl patch rationale for inclusion in pa. Jun 14, 2016 fentanyl is a highpotency opioid with a strength 100 times that of morphine. Changing fentanyl patches more often than every 48 hours is not recommended. The stronger the dose, the larger the patch, as more area of skin needs to be covered to ensure that more of the drug is being absorbed over the same period of time. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Oct 02, 2019 description chemical characteristics of drug substance and product.
Levys rule to convert from oral morphine to transdermal fentanyl. As can be seen, the range of daily morphine doses covered by each strength of fentanyl patch is wide, so calculating a suitable breakthrough dose of morphine is not straightforward. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. In elderly patients, dont initiate fentanyl patch at dosages above 25 mcghour unless patient is already receiving more than 5 mgday of oral morphine or equivalent. Fentanyl is the generic form of the brandname drug duragesic, a prescription opioid narcotic drug used to treat chronic, aroundtheclock pain. Transdermal and parenteral fentanyl dosage calculations and conversions objectives. Duragesic fentanyl transdermal dosing, indications. Opioid conversion calculator for morphine equivalents. Thats one reason why doctors start patients out on the lowest appropriate dosage.
Converting to transdermal fentanyl palliative care. Providers in a variety of settings now routinely see patients who are taking large doses of opioid eg, more than 100 mg of morphine equivalents. For a comparison of opioids doses, a tool was developed to equate the many different opioids into one standard value. That is truly an astronomical dose tapering from fentanyl patches is difficult as they cant easily but reduced in small increments. Check with your doctor if you have questions about this.
Oral morphine equivalent ome values are ingredient and route specific. Transdermal and parenteral fentanyl dosage calculations and. Fentanyl patch protocol never cut or trim the patch. The maximum dose is 100 microgramhr transdermal patch which needs to be changed every 72 hours. The doses available today are from 12gh, 25, 50, 75, to 100 gh. The fentanyl skin patch is only used for opioidtolerant patients. Safety of fentanyl initiation according to past opioid. You should be followed by a pain specialist closely if you require such amount of medication. Remember to enter all opioids the patient is taking. Fentora fentanyl dose, indications, adverse effects. I definitely prefer the fentanyl, no wild mood swings or sedation like the oxycodone. Wash your hands well with soap and water after disposing of the fentanyl patches. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts.
A patient is opioidtolerant if oral narcotics have already been used for severe pain. 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. As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount. Transdermal and parenteral fentanyl dosage calculations. For delivery rates in excess of 100 mcghour, multiple systems may be used. Mme is determined by using an equivalency factor to calculate a dose of morphine that is equivalent to. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. It should not be used to determine doses when converting a patient from one opioid to another. Opioid oral morphine milligram equivalent mme conversion. Converting to transdermal fentanyl palliative care network of. In the case example above, 216 mg of oral morphine per day is approximately.
Fentanyl is a highpotency opioid with a strength 100 times that of morphine. Fentanyl was initially available in 25, 50, 75 and 100. Patient presents using fentanyl patch 100 microgramhour. Apply transdermal patch to nonirritated, nonirradiated flat surface. It works by binding to opioid receptors in the brain, but it does so faster and in smaller. Converting from oral morphine to fentanyl transdermal patch. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status. Duragesic fentanyl transdermal dosing, indications, interactions. While the intrathecal goes on the local nerve endings as a local anesthetic, the systemic goes to the central nervous system through blood. Duragesic fentanyl dose, indications, adverse effects. Jul 27, 2011 fentanyl is considered a potent synthetic opioid widely used in anesthesiology, for short and longterm pain management, and for sedation. Dose equivalence and switching between opioids specialist.
Doctors give trusted answers on uses, effects, sideeffects, and cautions. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Each patch should be applied to a different skin site after removal of the previous transdermal patch. If you use fentanyl in the tablet, lozenge or ingestible film form, the drug is only to be used as needed and not on a regular dosing schedule. Dispose of the fentanyl patch by folding the adhesive side of the patch to itself, then flush the patch down the toilet. Each duragesic patch may be worn continuously for 72 hours.
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