Equianalgesic chart changes in italics ui health care. Jan 29, 2018 longterm opioid use often begins with treatment of acute pain. Twostep titration weans patients from iv to patch fentanyl. Opioid manager switching opioids download national pain centre. Methadone conversion factors increase with increasing dose. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Fentanyl patch dosing determination based on current opioid therapy. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Transdermal and parenteral fentanyl dosage calculations. Oct 01, 2001 challenges in pain management at the end of life.
Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3 days. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Fentanyl patch converter globalrph conversion from. 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 progresses to the point where the oral route is no longer tolerated. A safe and effective method for converting cancer patients. Typical pain doses of methadone are 1540 mgday, given in divided doses.
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. Conversion algorithm for instructions on converting from one opioid to another. Im in a hosp so i feel a little safe if something goes wrong. A friend told her about a pain patch that worked well. Converting from oral morphine to fentanyl transdermal patch. Calculate the total 24hour morphine dose or morphineequivalent. Fentanyl patch converter globalrph conversion from other. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Advice should be sought from the palliative care team. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. 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.
Find information about common, infrequent and rare side effects of fentanyl transdermal. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Equivalence between oral morphine and transdermal fentanyl. 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.
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. Equianalgesic dosing of opioids for pain management. Remember to enter all opioids the patient is taking. 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. Dr prescribed dilaudid and fentanyl patch, is this safe, don. What is the conversion from 150 mcg fentanyl patches every 3 days. Morphine milligram equivalent mme calculator nyc health. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Manage breakthrough pain with morphineshortacting opioid prn. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only.
Adapted from tarascon pocket pharmacopoeia created. 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. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Caution is advised when converting to methadone due. Both dilaudid and fentanyl can be habit forming even at prescribed doses. My orientee asked me the other day which medication was stronger, and what is the advantage of using one over the other. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Must prescribe shortacting opioid for breakthrough pain. 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. Recommendations based on data contained in the package insert. What is the conversion from 150 mcg fentanyl patches every. 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. Opioid conversions calc single agent equianalgesic globalrph.
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. Opioid oral morphine milligram equivalent mme conversion. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. 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.
Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. What are the steps for converting from morphine or. Duragesic fentanyl transdermal dosing, indications. 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. Currently, there are no empirical studies converting fentanyl to morphine. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Challenges in pain management at the end of life american. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. What is the conversion from 150 mcg fentanyl patches every 3. 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. Conversion from morphine or equivalent to fentanyl transdermal. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Conversion of intrathecal opioids to fentanyl in chronic pain.
Kornick said the research team is now looking into the best procedure for accomplishing that task. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Fentanyl patches durogesic for chronic pain nps medicinewise. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Principles of analgesic use in the treatment of acute pain and cancer pain. Patch duration of effect 48 72 hrs takes 1224 hrs before full analgesic effect of patch occurs after application. Degroote national pain centre opioid manager switching opioids download. In the recommended conversion, 1 mg of the fentanyl patch. The total daily morphine milligram equivalents mme will be displayed. Oct 19, 2004 in my icu for sedation pain management we usually use fentanyl gtts, but recently i have been seeing more dilaudid gtts.
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. It should not be used to determine doses when converting a patient from one opioid to another. Oral opioid dosing equivalents and conversions university of. Both drugs work the same way in the body to relieve pain. Common and rare side effects for fentanyl transdermal.
West of scotland chronic pain education group guidance on opioid switching. Narcotic pain relievers also can be addictive and abused. Methadone is appropriate for chronic stable pain in an opioidtolerant patient, but is usually avoided in opiatenaive patients. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Morphine milligram equivalent mme calculator instructions.
Transdermal should not be used to treat acute pain. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the. Transdermal and parenteral fentanyl dosage calculations and. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Doses listed are equivalent to 10 mg of parenteral morphine. 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. Canadian guideline for opioid use for pain appendix b8. The table is based on oral dosing for chronic noncancer pain. Patients were converted to transdermal fentanyl patches, which were changed every. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days.
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