Conversion of opioid analgesics to fentanyl transdermal. By the time i got the rx filled an the patch on me that was about 4 hours ago most of the nice releive i got from the morphine was gone. Duragesic label page 3 description duragesic fentanyl transdermal system is a transdermal system providing continuous systemic delivery of fentanyl, a potent opioid analgesic, for 72 hours. Oxycontin, xtampza er oxycodone dosing, indications. The prescribing information for fentanyl patches strongly advises against using any kind of conversion chart. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral. Morphine milligram equivalents mme calculator mdcalc. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment. There is a conversion between hydrocodone and fentanyl.
The patch does take a while to kick in when you first put it on. Conversion from transdermal fentanyl to hysingla er. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Norco hydrocodone acetaminophen is a good option to treat pain when overthecounter medicines havent worked, but it can lead to dependence and tolerance if taken for a long time. Even though you are on the lower dose, fentanyl is something like 80 times stronger than morphine.
In the case of converting morphine to methadone, methadone has a relative potency of 4. An alternative algorithm for dosing transdermal fentanyl. 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. However and again only your physician can do the correct conversion based on your opiate history. You should take your vicodin with it for the first 23 days. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. The patch will take a little while to get in to your system. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. All conversions except methadone are made by first calculating the morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. A safe and effective method for converting cancer patients. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Fentanyl patch converter globalrph conversion from other.
Opioid oral morphine milligram equivalent mme conversion factors1,2. Fentanyl patch converter globalrph conversion from. I would think 12 mcg of fentanyl would cover 5 10325 mg of oxycodone. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Duragesic label page 1 full prescribing information for use. Depends a lot on the strength of the fentenyl patch. Thus, we have to pay careful attention to switch from oral oxycodone to fentanyl patch for fear of insufficient pain control or overdose.
The first tdf product on the market was the branded. Fentanyl transdermal system contains fentanyl, an opioid agonist, and is indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. Aug 12, 2019 following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Not to be used to determine dosage for converting one opioid to another or for converting between fentanyl products. The patch is fentanyl the strongest family of opiates we have. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. The fentanyl patch is indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate patients considered opioidtolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone.
This is especially important for fentanyl and methadone conversions. I saw my doc today and she put my on fentanyl transdermal system 12mcghr. Transdermal fentanyl is approximately 80 times as potent as morphine. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Transdermal and parenteral fentanyl dosage calculations and. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. Stop long acting oral morphine after applying patch. Is it ok to take hydrocodone 10mg until the other starts to work. Opioids dosage conversion on the app store itunes 8 oct 2014 opioids by norris.
Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Decrease new dose 3050% to allow for incomplete crosstolerance. Hydrocodone vs duragesic patch it began when i fell from a second story balcony and messed up my back. Transdermal fentanyl is approximately 80 times as potent as. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. This dose is not possible to provide in slowrelease morphine preparation c. Methadone has been associated with disproportionate numbers of overdose deaths relative to the frequency with which it is prescribed for chronic pain, due in part to its long and variable halflife. Opioid conversion calculator morphine equivalents advanced. Oct 08, 2014 the equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h. Advanced opioid conversion calculator morphine equivalents. Conversion of my oxycodone to fentanyl pain management. I have read many different equianalgesic conversion tables but most are just calculated guesses. Before i left the office she was kind enough to relieve my discomfort witha 10mg shot of morphine to cover the transition time.
Agreed to dose of 280mg morphine daily in 2 divided doses 140mg morphine sr twice daily 4. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Oct 27, 2019 hydrocodone is most commonly converted to morphine in a 1. Canadian guideline for safe and effective use of opioids for. This is based on studies converting from morphine to fentanyl. Buy hydrocodone online without prescription, breakthrough pain. Converting from oral morphine to fentanyl transdermal patch. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Calculates total daily morphine milligram equivalents.
Hydrocodone is most commonly converted to morphine in a 1. As a result of continued absorption of fentanyl from the skin depot after removal of the patch, the halflife of fentanyl after transdermal administration is about 2 to 3fold longer than intravenous administration. Oral morphine milligram equivalent conversion table updated 8. Canadian guideline for safe and effective use of opioids. Following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours. Transdermal patch should be used only in opioid tolerant patients. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as.
Hydrocodone 510 mg q 46 hr 60 min 2 hr 46 hr 4 hr oxycodone 510 mg q 46 hr. Morphine milligram equivalent mme calculator nyc health. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Opioid conversion to hysingla er hydrocodone bitartrate cii. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Since then i have had a couple car accidents and really screwed up my neck so about 9 months ago i had a 3 level cervical disc fusion and discectomy, on c3c4, c4c5 and c5c6. Opioid switch from low dose of oral oxycodone to transdermal.
Do not use morphine equivalence charts to convert from duragesic to other therapies because conversions to duragesic are conservative. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. A shortacting opioid, such as hydrocodone 5 mg every 4 hours, should be fentanyl patch to oxycodone conversionconverting from oral morphine to fentanyl transdermal patch opioid for moderate pain, an opioid agonist eg, hydrocodone, oxycodone can be used. But the pain is still pretty bad, so i was just today prescribed the fentanyl patch which is longer. Opioid conversions based on equianalgesia potency for all of the common opioids hydrocodone, oxycodone, morphine, etc. 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. Remove the transdermal fentanyl patch and 18 hours later initiate hydrocodone extendedrelease capsules at 10 mg every 12 hours for each 25 mcghr fentanyl transdermal patch. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
Durogesic dtrans 12 mcghr transdermal patch summary of. Do not use this tool to convert from one opioid to a different opioid. How to switch from fentanyl to hydrocodone pharmacistanswers. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Equianalgesic chart changes in italics ui health care. 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. This calculator should not be used to determine doses when converting a patient from one opioid to another. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Again, this chart should not be used to convert from fentanyl to an oral opioid but it gives you a general frame of reference. The equivalent dose of fentanyl patch to oral oxycodone was not definite in our study, though an initial conversion from 1020 mgday of oral oxycodone to 12. Due to crosstolerance, when switching from one opioid to another, the starting dose of the. Select microgram per hour dose of transdermal fentanyl based on table 2. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. It is widely accepted that morphine and hydrocodone are fairly similar, almost identical in terms of potency.
The table is based on oral dosing for chronic noncancer pain. Opioid oral morphine milligram equivalent mme conversion. The following source was used for morphine equivalent conversion factors per mg of opioid. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a. Hydrocodone conerstion to fentanyl patches 12mc addiction. Currently, there are no empirical studies converting fentanyl to morphine.
Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Hello, i have been taking norco 10mg, 45 times a day for about 3 months for chronic pain, legally prescribed of course norco is just hydrocodone like vicodin, but without so much tylenol. Transdermal and parenteral fentanyl dosage calculations. Dec 15, 2001 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.
A conversion chart says 50mg of oxycodone a day converts to approximately 25. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. 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. The data upon which the conversions are based are summarized in the table below. Calculate the total 24hour morphine dose or morphineequivalent. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. My pharmacist actually checks the conversion on their own.
1561 1264 575 811 556 744 656 266 627 725 962 1024 1051 897 670 1436 631 89 150 420 1390 553 1041 1466 1155 1381 994 523 462 729 855 1056 1107 1335 1294 660 757