Meperidine is not a recommended drug in a palliative care setting and is to be avoided. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Conversion from other oral opioids to oral oxymorphone. So far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. The patch will take a little while to get in to your system. You have determined he is an appropriate candidate for a longacting regimen and decide to convert him to extended release oxycodone. Conversion algorithm for instructions on converting from one opioid to another.
Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Advanced opioid conversion calculator morphine equivalents. 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. Fentanyl transdermal system contains fentanyl, a substance with a high potential for abuse similar to other opioids including hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Dose equivalence and switching between opioids specialist. Morphine milligram equivalent mme calculator nyc health. The total daily morphine milligram equivalents mme will be displayed.
This is especially important for fentanyl and methadone conversions. All this leads to potential od and death, let alone the reality of spiking your tolerance. Fentanyl remove fentanyl from your drug comparison. Apr 24, 2012 so far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. Although there has been no systematic assessment of such conversion, start with a conservative conversion. For moderate pain, an opioid agonist eg, hydrocodone. Compare fentanyl vs oxymorphone comprehensive analysis by.
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. The following source was used for morphine equivalent conversion factors per mg of opioid. Equianalgesic dosing of opioids for pain management. In the case of converting morphine to methadone, methadone has a relative potency of 4. The patch is fentanyl the strongest family of opiates we have. Conversion back from prior opioid divides by the conversion factor shown in. Converting from oral morphine to fentanyl transdermal patch. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg morphine sulfate ir 4 tablets x 15mg 60mg 60mg. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to.
Im finding that the oxymorphone seems to have no effect for my pain. S when converting from 30 to 80 mg of morphine equivalents daily dose, first taper to 30 mg oral morphine equivalents, then start with the 10 mcghr patch. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Administer onehalf of the patients total daily po oxycodone dose as once every 12 hours conversion from fentanyl transdermal. Conversion tables show that the oral to parenteral ratio for morphine is 3. Nov 07, 2019 each fentanyl transdermal system patch is sealed in its own protective blister. Fentanyl patches are another option, but are expensive and difficult to titrate. Currently, there are no empirical studies converting fentanyl to morphine. Oral opioid dosing equivalents and conversions university of. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Oxymorphone to fentanyl equivalent doctor answers on. Recommend an appropriate dose of transdermal fentanyl when. Remember to enter all opioids the patient is taking. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients.
My doctor offered oxymorphone 10 mg er or fentanyl patches 25 mcghr as alternatives. Jan 29, 2018 methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. May 08, 2015 approximately 90% of fentanyl is converted to norfentanyl in the liver by cyp3a4, and the other 10 % is excreted unchanged by the kidney. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. After discontinuing a fentanyl patch, fentanyl levels fall gradually. Oxymorphone 10 mg pr 1 mg codeine 200 mg mg the conversion ratio of 10 mg parenteral morphine 30 mg oral morphine is based on clinical experie nce in patients with chronic pain. Patient presents using fentanyl patch 100 microgramhour. Fentanyl patch converter globalrph conversion from. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency.
The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Side effects of duragesic fentanyl transdermal, warnings, uses. Patients who experience serious adverse effects should have patches removed immediately and should be monitored for at least 24 hours after the patch is removed 412. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg. My pharmacist actually checks the conversion on their own.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Equianalgesic chart changes in italics ui health care. Refractory cachexia is associated with increased plasma. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic 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. The patch does take a while to kick in when you first put it on. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414. Many patients were on combinations of different immediate release and sustained release combinations of opioid medication.
Determine equipotent dose using published potency tables. Opioid oral morphine milligram equivalent mme conversion. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. Do not use this table to convert from fentanyl transdermal system to other opioid. It is not recommended for people who have never been prescribed opioidtype pain relief before, and deaths have been reported from improper dosing. Sep 12, 20 is there anyone here taking both the fentanyl patch and oxymorphone. Do not use this tool to convert from one opioid to a different opioid. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Canadian guideline for safe and effective use of opioids for. The second change was he took me off norco 10 325 12 tabs every 6 hours max of 8 a day and put me on percocet 10 325 1 tab every 4 hours max of 6 a day. Following a 72hour patch application, the mean fentanyl halflife ranges from 20 to 27 hours. Oxymorphone 1 10 rectal adjust dose in renal impairment due to the potency of oxycontin, it is recommended to use the conversion factor table when converting to oral oxycodone to avoid overestimating the dose. They were on a variety of full agonist opioids, including predominantly oxycodone n 12, hydromorphone n 4, oxymorphone n 2, fentanyl n 6, methadone n 5, and morphine n 6. Morphine milligram equivalent mme calculator instructions.
Opioid conversion table wiley jun 2015 hydrocodone fentanyl patch mcghr to oral convert oral morphine total daily dose to oral methadone as per the conversion ratios above. Transdermal and parenteral fentanyl dosage calculations. The conversion of 10 mg parenteral morphine 60 mg oral morphine is based on a potency study in acute pain. Conversion back from prior opioid divides by the conversion factor shown in the table below. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Approximately 90% of fentanyl is converted to norfentanyl in the liver by cyp3a4, and the other 10 % is excreted unchanged by the kidney. 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. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. A safe and effective method for converting cancer patients.
I would think 12 mcg of fentanyl would cover 5 10 325 mg of oxycodone. Oxycontin, xtampza er oxycodone dosing, indications. This is based on studies converting from morphine to fentanyl. Fentanyl can be easily extracted from the patch and used as an injection, smoked or snorted some patches are easier to crack than others, but the truth remains that you can concentrate the dose from a patch and get it to you blood stream faster. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch. Fentanyl patch protocol ventura county, california. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Even though you are on the lower dose, fentanyl is something like 80 times stronger than morphine. Durogesic dtrans 25 mcghr transdermal patch summary of. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
Oct 15, 2019 patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. 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. 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. Opioid equivalence chart gloucestershire hospitals. Each fentanyl transdermal system patch has a clear plastic release liner that can be. Morphine immediaterelease tablets, oral solutionk,l.
Do not remove the fentanyl transdermal system patch from the blister until you are ready to use it see figure f. Duragesic label page 1 full prescribing information for use. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. For a single dose, 10 mg iv morphine 60 mg oral morphine. Dilaudid canadian monograph recommends parenteral starting dose of 2 mg. Peel off both parts of the release liner from the patch. Prior authorization protocol duragesic fentanyl transdermal. Is there anyone here taking both the fentanyl patch and oxymorphone. This calculator should not be used to determine doses when converting a patient from one opioid to another. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours.
Advice should be sought from the palliative care team. Im prescribed both oxymorphone 40mg er 80mg every 12 hours and 10mg ir 20mg every 8 hours. Fentanyl patch converter globalrph conversion from other. Transdermal fentanyl is approximately 80 times as potent as morphine. You should take your vicodin with it for the first 23 days. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Per the product labeling, oral oxymorphone 10 mg er is approximately equivalent to hydrocodone 20 mg or oxycodone 20 mg. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Per the product labeling, oral oxymorphone 10 mg er is approximately equivalent to hydrocodone 20 mg or appendix c. For mild pain, the starting regimen should be a nonsteroidal antiinflammatory drug nsaid or acetaminophen. I have pain from an 8 level back fusion from an accident. Pain intensity on a scale of 0 10, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch.
There is a conversion between hydrocodone and fentanyl. 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. If you respond well to the short acting form of it and can afford a brand name med, it may be a good oral med option for you. Oral morphine milligram equivalent conversion table updated 8.
Wait 18 hours after patch removed, then initiate conservative dose of approximately 10 mg once every 12 hours oxycodone controlledrelease for each 25 mcghour. Conversion from highdose fullopioid agonists to sublingual. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. Patients using both fentanyl patches and oxymorphone opana. 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.694 702 1473 543 331 628 985 481 154 543 934 656 808 370 1008 1191 1463 833 736 104 925 246 1575 1396 753 1060 1118 550 1099 744 495 190 1033 901