Doctors give trusted answers on uses, effects, sideeffects, and cautions. I would think 12 mcg of fentanyl would cover 5 10325 mg of oxycodone. 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. Conversion from morphine or equivalent to fentanyl transdermal. Fentora contains fentanyl, an opioid agonist and a schedule ii controlled. Approximately 9% of the dose is recovered in the feces, primarily as metabolites. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. May 29, 2003 pain intensity, sedation, and hourly iv fentanyl requirements after conversion.
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. 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. Conversion of intrathecal opioids to fentanyl in chronic. Frail or elderly patients may need lower doses and slower titration. Efficacy and safety of a sixhour continuous overlap.
Mean values for unbound fractions of fentanyl in plasma are estimated to be between and 21%. 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. I also wonder what the conversion dose of fentanyl is for the 200mg of oc you were on prior to the patch. A safe and effective method for converting cancer patients from. Longterm opioid use often begins with treatment of acute pain. Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. For frail elderly patients, use more conservative conversion or a lower strength patch e. Dosage use only when converting another opioid to fentanyl patch.
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. Converting to transdermal fentanyl palliative care network of. If at any time the patient develops symptoms of withdrawal, return to the previous rate and consider giving an iv bolus of fentanyl. Use appropriate opioid for situation or care setting. Monitor the patient carefully for respiratory depression. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Oct 15, 2019 within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. This is the number of milligrams that actually gets into the bloodstream.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The interview forms for durotep patch, a fentanyl reservoir. It may be worth looking at that and that may well be why you are feeling nothing yet with fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. 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. So round up the calculated 5 micrograms dosage of fentanyl to 125 micrograms or a 150 microgram patch depending on whether patients pain is under good control or not. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl.
All nine patients initially reported their pain with movement as. These bidirectional differences are not captured in a traditional equianalgesic table. 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. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Conversion oral iv opioids to fentanyl transdermal each transdermal system is worn continuously for up to 72 hr see administration tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal. Fentanyl injection is prescribed to reduce pain before, during, or after surgery.
Effects of patch last for 18 24 hours after the patch is removed. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Select microgram per hour dose of transdermal fentanyl based. Dec 15, 2001 in all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. For patients stabilised on oral morphine for several weeks and who need opioid rotation, the recommended conversion is based upon a ratio of oral morphine to transdermal fentanyl of 150. After some discussion about the iv to td fentanyl conversion, he agreed and changed the prescription to oxycodone.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Changing an oral or iv opioid to transdermal fentanyl 1. Opioid equianalgesic calculator opioid switching from. What are the steps for converting from morphine or. Calculate the total 24hour morphine dose or morphineequivalent. Each of these drugs has a different halflife, side effect and safety profile, and some are better for some people, and some are more. Converting to transdermal fentanyl palliative care. A safe and effective method for converting patients from transdermal.
Dispose of the unused part of the patch safely as described in the fentanyl patch care section. 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. Oct 15, 2019 duragesic should not be used if the pouch seal is broken or if the patch is cut or damaged. Fentanyl patch converter globalrph conversion from other. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours.
When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediaterelease opioids and should prescribe no greater quantity than needed for the expected duration. Converting from oral morphine to fentanyl transdermal patch. It also is used for treating severe pain that is unrelated to surgery. Mar 28, 2016 if at any time the patient develops symptoms of withdrawal, return to the previous rate and consider giving an iv bolus of fentanyl.
In acute pain the conversion of morphine to fentanyl is 1. A safe and effective method for converting cancer patients. Fentanyl td 25mcghr patch approximately 6090mg oral morphine24hrs it is suggested that for conversions from oral morphine to fentanyl patches, the lower doses of fentanyl should be used for patients. I reminded the physician that there is no currently accepted conversion factor between iv and td fentanyl. Also, with the mislabeled allergy to codeine, we could confidently use another less potent narcotic. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Most manufacturers of fentanyl patches recommend two parallel dosage conversions. Scottish palliative care guidelines fentanyl patches. Efficacy and safety of a sixhour continuous overlap method. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Conversion of opioid analgesics to fentanyl transdermal. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion.
Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Considering fentanyl is a epidermal patch, which releases a dose of fentanyl over a 72 hour period. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. 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.
The cii rate was decreased by 50% 6 hours after application of the fentanyl. Advice should be sought from the palliative care team. Twostep titration weans patients from iv to patch fentanyl. If 2 extra doses of 15 mg sc morphine are required over the previous 24 hours, the initial syringe driver prescription will. A safe and effective method for converting patients from. Its also vital to ensure that you get full adhesion on your skin so you can correctly absorb the medicine so make sure it is sticking correctly. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sc iv 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. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued.
Discarded patches have the potential to be misused. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Patient on 50 microgramshour fentanyl patch, unable to take prn oral opioid and in last days of life. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. The fentanyl infusion dose wasdecreased inhalfsix hours after patch application, then completely stopped after 12 hours. Each duragesic patch may be worn continuously for 72 hours. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the ci rate are available by patient. 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. Fentanyl buccal tablet each tablet contains fentanyl. Converting from morphine to fentanyl can result in opioid withdrawal symptoms e.
Opioid oral morphine milligram equivalent mme conversion. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Select microgram per hour dose of transdermal fentanyl. The patch does take a while to kick in when you first put it on. 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. For delivery rates in excess of 100 mcghour, multiple systems may be used. Transdermal fentanyl patches should not be initiated in patients with unstable pain.
Original research dose conversion ratio for continuous. The fentanyl patch comes in multiples of 25 micrograms. One option that i dont like to use is switching patients over to a 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. 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. Transdermal and parenteral fentanyl dosage calculations. All transdermal patches are removed, and a continuous infusion ci delivering iv fentanyl at the same hourly rate is initiated simultaneously.
Fentanyl patches are another option, but are expensive and difficult to titrate. Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. While this makes the conversion relatively easy, patches tend to be left on longer than needed. The nine patients included in this case series were switched from transdermal to iv fentanyl for accurate dosage titration. This conversion factor should be multiplied by the number of micrograms in a given tablet or lozengetroche. Note this dose should not be decreased further as it is already conservative. Convert each number in your list to iv morphine equivalents, by using column 2.
Fentanyl citrate injection, usp is contraindicated in patients with known intolerance to the drug or other opioid agonists. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Even though you are on the lower dose, fentanyl is something like 80 times stronger than morphine. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Transdermal and parenteral fentanyl dosage calculations and.
There are many opioids and many formulations available e. Transdermal patch should be used only in opioid tolerant patients. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Fentanyl is a horrible drug and is 80 times stonger that morphine. Duragesic fentanyl transdermal dosing, indications. Conversion of intrathecal opioids to fentanyl in chronic pain. What every pharmacist should know about transdermal fentanyl. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. My pharmacist actually checks the conversion on their own.
Equianalgesic chart changes in italics ui health care. Fentanyl 50 patch 50 microgramshour 5mg to 224mg24hours. Converting to transdermal fentanyl palliative care network. Fentanyl injection sublimaze is a synthetic narcotic similar to morphine. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. 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 opiate during the conversion period. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Opioids may be all that a person needs for acute pain broken bone, sprained ankle but is never the primary treatment of any chronic pain.
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