Opioids opiates are a group of analgesic drugs, used primarily for pain management. As you can clearly see, a 100mcg patch is at least double the amount you would need. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. It should not be used to determine doses when converting a patient from one opioid to another. The table is based on oral dosing for chronic noncancer pain. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Patches conversion doses 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 fentanyl 100 patch 100 microgramshour 315mg to 404mg24hours transtec 52. Butrans contains buprenorphine, a schedule iii controlled substance. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Opioid converter morphine equivalent calculator omni. Opioid conversion calculator for morphine equivalents.
Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Advanced opioid conversion calculator morphine equivalents. 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. Fentanyl patch converter globalrph conversion from other opiates. This calculator should not be used to determine doses when converting a patient from one opioid to another. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice. What are the steps for converting from morphine or. 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. Fentanyl patch dosing determination based on current opioid therapy.
For patients previously taking oral mme 160 mg, consider an alternate analgesic. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Transdermal and parenteral fentanyl dosage calculations. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Calculate the total 24hour morphine dose or morphineequivalent. Fentanyl parenteral patch sliding scale conversion fentanyl mcghr x 24hr morphine po mg 25. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Butrans exposes users to the risks of opioid addiction, abuse, and misuse.
Fentanyl buccal or sl tablets, or lozengetroche5 mcg. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. The total daily morphine milligram equivalents mme will be displayed. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Remember to enter all opioids the patient is taking. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose.
Oxycontin, xtampza er oxycodone dosing, indications. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Opiate bioavailability and response are highly variable. 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. Opioid oral morphine milligram equivalent mme conversion. Conversion from morphine or equivalent to fentanyl transdermal. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Levys rule to convert from oral morphine to transdermal fentanyl. Calculates total daily morphine milligram equivalents. 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.
Opioid conversion calculator morphine equivalents advanced. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Select microgram per hour dose of transdermal fentanyl based on table 2. 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. Morphine milligram equivalent mme calculator nyc health. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Morphine milligram equivalent mme calculator instructions. Duragesic label page 1 full prescribing information for. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Recommend an appropriate dose of transdermal fentanyl when.
Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. Literature suggests for a 24 hour morphine dose of 604mg you would need a 25mcg fentanyl patch. Converting to transdermal fentanyl palliative care. Fentanyl patch converter globalrph conversion from. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Stop long acting oral morphine after applying patch. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid opiate equianalgesia conversion calculator hospital palliative care service 68 logical fentanyl patch placement chart palliation of pain. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment.
Morphine milligram equivalents mme calculator mdcalc. Opioid equivalence chart gloucestershire hospitals nhs. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. If i were you and truly considering patch, i wouldnt start any higher than a 50mcg. Do not use this tool to convert from one opioid to a different. All patients should be titrated no more frequently than every 4 days, and dosed in q12h intervals.
If you are converting a patient to or from fentanyl i. Transdermal fentanyl patches should not be initiated in patients with unstable pain. There is no dose equivalence between fentanyl lozenges and other opioid formulations. This is especially important for fentanyl and methadone conversions. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. A safe and effective method for converting cancer patients. Converting from oral morphine to fentanyl transdermal patch. So you would be right around a starting patch of 50mcg. Scottish palliative care guidelines fentanyl patches. Opioid conversion ratios guide to palliative care practice.
Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. 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. 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. C the conversion table is unidirectional only and should only be used to convert adult patients from their current oral or parenteral opioid analgesic to the approximate fentanyl transdermal patch for use in chronic pain. Fentanyl accumulates to form a depot in the skin below the. They all interact with specific opioid receptors such as. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. The chemical name is nphenyln12phenylethyl4piperidinyl propanamide. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
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