Fentanyl patch equivalent dose hydromorphone

Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Calculate the total 24hour morphine dose or morphineequivalent. One method to determine the dose of the patch is to use the conversion table in the compendium of pharmaceuticals and specialties cps, which states that 60 to 4 mg of oral morphine is equivalent to a 25.

Degroote national pain centre opioid manager switching opioids download. Dosage use only when converting another opioid to fentanyl patch. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Fentanyl patch converter globalrph conversion from. Scottish palliative care guidelines fentanyl patches. Morphine milligram equivalent mme calculator nyc health. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.

Equianalgesic chart changes in italics ui health care. Hydromorphone to fentanyl patch what is the dose he has been prescribe of the fentanyl patch. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Determine equivalent daily dose of new opioid by dividing the calculated mmes of current opioid by new opioids. Morphine 200 mg daily opioid tolerant patient use for 7 day confirmed, including outpatient patch use. 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. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. 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. Methadone and tramadol, morphine dose equivalence not reliably established. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. Kato et al published in 2004 the results of their retrospective observational study of 144 patients with chronic pain of cancer origin and with difficulty tolerating oral morphine, undergoing rotation to fentanyl patch. 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 overdosage.

That is truly an astronomical dose tapering from fentanyl patches is difficult as they cant easily but reduced in. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Patients who are considered opioidtolerant are those who have been taking, for a week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Opioid equivalence chart gloucestershire hospitals. Converting from oral morphine to fentanyl transdermal patch. The primary goal of analgesia is optimizing the patients comfort. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid conversion and brand availability in canada michael g. Using the conversion of a single 25 mcghr fentanyl transdermal patch to a 12 mg extendedrelease hydromorphone tablet, calculate conversion dose and reduce by 50% to obtain the starting dose of the extendedrelease hydromorphone tablet. For example, someone taking 10 mg of morphine may be switched to 1 or 2 mg of hydromorphone. In nsw health facilities, it should only be prescribed under the. This tool also provides precise control over methadone conversions as well.

Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Manage breakthrough pain with morphineshortacting opioid prn. The total daily morphine milligram equivalents mme will be displayed. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Agreed to dose of 280mg morphine daily in 2 divided doses 140mg morphine sr twice daily 4. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Practical management of opioid rotation and equianalgesia.

Richard scott, professor emeritus in the department of sociology, shares a very personal story of the last stages of life of his beloved brother charles scott. A dose reduction of at least 50% is recommended when switching at high doses eg, oral morphine or equivalent doses of 500mg24 hours or more, in elderly or frail patients. To convert to oral morphine equivalent, multiply by. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Decrease new dose 3050% to allow for incomplete crosstolerance. 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 analgesics are considered the mainstay of pain management. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. 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. Doses in each column are considered equianalgesic and interchangeable at the. Using the conversion of a single 25 mcghr fentanyl transdermal patch to a 12 mg extendedrelease hydromorphone tablet, calculate conversion dose and reduce by 50% to obtain the starting dose of the extendedrelease hydromorphone tablet, round down if needed to available tablet strength.

These bidirectional differences are not captured in a traditional equianalgesic table. 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. Discontinue all other aroundtheclock opioid drugs when exalgo therapy is initiated. Doses should be titrated according to individual response.

Usually even in terminal cancer patients 300mcghr is the ceiling dose. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary.

After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. Converting to transdermal fentanyl palliative care. Buprenorphine buprenex butorphanol stadol codeine fentanyl duragesic hydrocodone hydromorphone dilaudid levorphanol meperidine demerol methadone morphine nalbuphine nubain oxycodone oxycontin oxymorphone pentazocine talwin. Remember to enter all opioids the patient is taking. The web page will automatically calculate the total morphine equivalents per day. Particular care is required when dealing with high doses of opiates. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Exalgo hydromorphone hydrochloride extended release. Dose equivalents and changing opioids faculty of pain. Transdermal and parenteral fentanyl dosage calculations. For some patients, however, hydromorphone may be a better first choice. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. 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.

Opioid oral morphine milligram equivalent mme conversion. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Conversion of opioid analgesics to fentanyl transdermal. Morphine milligram equivalent mme calculator instructions. Dilaudid, exalgo hydromorphone dosing, indications. Moving from the total daily oral morphine equivalent to the correct dose of transdermal fentanyl can be a challenge.

Opioid converter morphine equivalent calculator omni. Iv use even at low doses and when given very slowly may cause marked decrease. In order to increase knowledge about how best to respond to and alleviate the suffering of seriously ill patients, we have created a free training module on physician assisted death dr. All doses expressed in mg per day with exception of fentanyl transdermal, which is expressed in mcg per hour. What are the steps for converting from morphine or. Duragesic fentanyl transdermal dosing, indications. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl.

Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. However, dosing these agents may be complicated in patients with renal andor hepatic impairment. Canadian guideline for safe and effective use of opioids. Current daily dose of opioids in po morphine equivalents po morphine 60 mg po oxycodone 30 mg po hydromorphone 8 mg 25 mcghr fentanyl patch. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. This dose is not possible to provide in slowrelease morphine preparation c.

The conversion ratio of certain opioids can be dependent on the dose of the original opioid. The morphine equivalent dose med conversions calculator allows a clinician to generate an equivalent dose of morphine for a patient taking one or more common opioids. Compare fentanyl vs hydromorphone comprehensive analysis. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Select microgram per hour dose of transdermal fentanyl based on table 2.

Recommend an appropriate dose of transdermal fentanyl when. Both morphine and hydromorphone are used to treat moderate to severe pain. Patients receiving oral immediaterelease hydromorphone may be converted to exalgo by administering a starting dose equivalent to the patients total daily oral hydromorphone dose, taken once daily. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. The starting point for dose reduction from the calculated equianalgesic dose is around 2550%. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Duragesic label page 1 full prescribing information for. 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. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. They all interact with specific opioid receptors such as.