Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Both drugs work the same way in the body to relieve pain. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Must prescribe shortacting opioid for breakthrough pain. 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. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to 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. Doses listed are equivalent to 10 mg of parenteral morphine. Equianalgesic chart changes in italics ui health care. 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 of pain severe enough to require opioids. Jan 29, 2018 longterm opioid use often begins with treatment of acute pain. The equianalgesic tables for fentanyl have been adjusted, so you can use the doses given in the conversion to transdermal fentanyl duragesic fentanylmorphine conversion tables without further adjustment.
Opioid oral morphine milligram equivalent mme conversion. Practical pain management is a remedy health media, llc web property. Principles of analgesic use in the treatment of acute pain and cancer pain. What is the conversion from 150 mcg fentanyl patches every 3. The table is based on oral dosing for chronic noncancer pain. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Opioid conversions calc single agent equianalgesic globalrph.
Methadone conversion factors increase with increasing dose. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Oral opioid dosing equivalents and conversions university of. West of scotland chronic pain education group guidance on opioid switching. Conversion of intrathecal opioids to fentanyl in chronic pain. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Transdermal and parenteral fentanyl dosage calculations and. 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.
Morphine milligram equivalent mme calculator instructions. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Methadone is appropriate for chronic stable pain in an opioidtolerant patient, but is usually avoided in opiatenaive patients. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. What is the conversion from 150 mcg fentanyl patches every 3 days. Challenges in pain management at the end of life american. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. 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 is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Canadian guideline for opioid use for pain appendix b8.
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. Calculate the total 24hour morphine dose or morphineequivalent. Typical pain doses of methadone are 1540 mgday, given in divided doses. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Duragesic fentanyl transdermal dosing, indications. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain. Advice should be sought from the palliative care team. A safe and effective method for converting cancer patients. Oct 01, 2001 challenges in pain management at the end of life. Conversion algorithm for instructions on converting from one opioid to another. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose.
Recommendations based on data contained in the package insert. Dr prescribed dilaudid and fentanyl patch, is this safe, don. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Fentanyl patches durogesic for chronic pain nps medicinewise. Select microgram per hour dose of transdermal fentanyl based. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid.
The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Narcotic pain relievers also can be addictive and abused. Patch duration of effect 48 72 hrs takes 1224 hrs before full analgesic effect of patch occurs after application. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. Converting from oral morphine to fentanyl transdermal patch. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the. It should not be used to determine doses when converting a patient from one opioid to another. Degroote national pain centre opioid manager switching opioids download. Im in a hosp so i feel a little safe if something goes wrong. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Remember to enter all opioids the patient is taking.
In the recommended conversion, 1 mg of the fentanyl patch. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Dilaudid progresses to the point where the oral route is no longer tolerated. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these. Kornick said the research team is now looking into the best procedure for accomplishing that task.
How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. Common and rare side effects for fentanyl transdermal. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. 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. Oct 19, 2004 in my icu for sedation pain management we usually use fentanyl gtts, but recently i have been seeing more dilaudid gtts. Manage breakthrough pain with morphineshortacting opioid prn. What are the steps for converting from morphine or. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing.
Patients were converted to transdermal fentanyl patches, which were changed every. Currently, there are no empirical studies converting fentanyl to morphine. 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 transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Transdermal and parenteral fentanyl dosage calculations. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. The total daily morphine milligram equivalents mme will be displayed.
A friend told her about a pain patch that worked well. Adapted from tarascon pocket pharmacopoeia created. Equianalgesic dosing of opioids for pain management. Conversion from morphine or equivalent to fentanyl transdermal. The american pain society guidelines and most pain experts recommend a dose reduction between 2550% when converting between different opioids, 9, 11 with a consideration for little or no crosstolerance reduction in patients with poorly controlled pain. Transdermal should not be used to treat acute pain. 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 pain. Anne, who disliked taking pills and was interested in the convenience of changing a patch only every 3 days, made an appointment to see her family physician to discuss the transdermal fentanyl patch.
Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Find information about common, infrequent and rare side effects of fentanyl transdermal. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3 days. Equivalence between oral morphine and transdermal fentanyl. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. What is the conversion from 150 mcg fentanyl patches every. Morphine milligram equivalent mme calculator nyc health.
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