According to the manufacturer, 50% of the patients in clinical trials required a dose increase. 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. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The texas prescription monitoring program is an electronic database that tracks controlled substance prescriptions. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Fentanyl iontophoretic transdermal system for acutepain management after orthopedic surgery. When available, patient controlled analgesia pca pumps should be used, per iv if access available, and per sq if no iv access is available. 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.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Opioid conversion table instructions convert all iv medications to iv morphine convert iv morphine to po morphine 1. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Converting from oral morphine to fentanyl transdermal patch. Opioid conversions calc single agent equianalgesic globalrph. Morphine milligram equivalent mme calculator instructions. 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. 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. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. Transdermal and parenteral fentanyl dosage calculations. Aug 10, 2011 fin they gave me dilaudid it helped a little.
Note that this table is unidirectional for morphine to fentanyl patch conversion only. Iv drugs in order of choice are morphine, dilaudid, fentanyl, and sq drugs in order of choice are morphine, dilaudid. Guidelines for adult patients intravenous pca orders. Put your fav opiate hydromorphone, fentanyl, tramadol, sufentanil,etc. Transdermal fentanyl is approximately 80 times as potent as morphine. These bidirectional differences are not captured in a traditional equianalgesic table. When available, patientcontrolled analgesia pca pumps should be used, per iv if access available, and per sq if no iv access is available. A 25 ugh patch is approximately equal to 50 to 75 mg of oral morphine over 24 h.
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. Remember to enter all opioids the patient is taking. May 01, 2020 conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. In the case of converting morphine to methadone, methadone has a relative potency of 4. 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. For frail elderly patients, use more conservative conversion or a lower strength patch e. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
July 2019 supportive institute upmc palliative and. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Twostep titration weans patients from iv to patch fentanyl. Select microgram per hour dose of transdermal fentanyl. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily.
Conversion tables listed an equivalent dose of fentanyl q1 hour, but they could not figure out how this related to the fact that the fentanyl patch is changed q72h. When converting from pca administration, add the total amount of opioid that the patient received in. Conversion does not apply when switching from fentanyl patch to morphine use extreme caution. Fentanyl patch converter globalrph conversion from other. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose.
It can help identify patients who may be misusing prescription opioids or. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Sickle cell pain crisis guidlines virginia premier. The total daily morphine milligram equivalents mme will be displayed. The mechanisms of analgesia for intrathecal opioids result from a.
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 po diamorphine po diamorphine sciv. There are many opioids and many formulations available e. Use conversion support systems to calculate correct doses of opioids to help prevent problems with conversions from oral, iv and transdermal routes of administration. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. A safe and effective method for converting cancer patients. They all interact with specific opioid receptors such as. And just fyi hydromorphone is also known as dilaudid. What are the steps for converting from morphine or. Use patientcontrolled analgesia pca to reduce the risk of oversedation. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. 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. This is based on performing a morphine to fentanyl conversion. Currently, there are no empirical studies converting fentanyl to morphine.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Being unskilled in using tables, they would not use them, fearful of making a mistake and potentially killing a patient. Im in a hosp so i feel a little safe if something goes wrong. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Opioid conversion tips changing to another oral opioid question. Since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Recommend an appropriate dose of transdermal fentanyl when.
Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Kornick said that demand boluses of fentanyl, equivalent to 50 to 100 percent of the final hourly infusion rate, remained available for selfadministration by intravenous patientcontrolled analgesia for 24 hours following application of the patch. Opioid equianalgesic calculator opioid switching from. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sciv mg po mg comments morphine 10 30a codeine 120 sc only 200 metabolized to morphine fentanyl patch see table below useful when po pr routes not an option fentanyl 0.
When removing a patch, remember the analgesic effect can still last up to 24 hours buprenorphine is a partial muagonist ceiling dose for analgesia buprenorphine 20mcg patch is approximately equivalent to 15mcg fentanyl patch or. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Transdermal and parenteral fentanyl dosage calculations and. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. The 4 hr limit includes both the continuous basal infusion and patient boluses. Dilaudid, exalgo hydromorphone dosing, indications.
Duragesic fentanyl transdermal dosing, indications. How lipophilic the drug is, as well as in part by its molecular weight, and possibly structure, affect meningeal permeability. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Opioid conversions calc single agent equianalgesic.
Patient is receiving a total of 5 mg of parenteral hydromorphone in a 24hour period via a pca pump. Doses should be reduced in patients over 70 years, and in patients with severely compromised physical status. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. In this open multicenter study, 88 patients with abdominal, thoracic and orthopedic procedures were converted from iv pca morphine to oxycontin. The joint commission provides hospitals guidance for better. Usual starting infusion rate would be morphine 1 2 mghr, fentanyl 1025 mcghr, hydromorphone 0. I highly recommend ivpca patient controlled analgesia infusion pump commonly seen in post surgery recovery rooms. She would like to try an immediaterelease opioid agent, hydromorphone. Transdermal fentanyl patches versus patientcontrolled. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. It may be 812h or longer after putting on the first patch before pain relief is experienced. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. The amount of residual drug in the patients system must be accounted for.
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. This study was designed to use a conservative conversion factor cf for iv morphine to oral oxycontin because of the rapidly decreasing pain in the postoperative period. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Oct 19, 2004 dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Opioid oral morphine milligram equivalent mme conversion. Dr prescribed dilaudid and fentanyl patch, is this safe, don. 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.
What is the conversion from 150 mcg fentanyl patches every. This is based on studies converting from morphine to fentanyl. Fentanyl patch conversion 25mcghour topically exchanged every 72 hours equivalent to. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
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. May 05, 2014 fentanyl iontophoretic transdermal system for acutepain management after orthopedic surgery. 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. The goal is to convert this to oral morphine for discharge. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Determine the 24hour oral dose of narcotics by adding up the amount of controlledrelease per 24hour and the average amount of breakthroughs used in a 24 to 48 hour period. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl.
However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Morphine milligram equivalent mme calculator nyc health. The equianalgesic conversion ratio for iv to epidural to intrathecal opioids varies depending upon the meningeal permeability of the opioid in question. Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid.
I highly recommend iv pca patient controlled analgesia infusion pump commonly seen in post surgery recovery rooms. Opioid conversion ratios guide to palliative care practice. Fentanyl patch converter globalrph conversion from. Based on level of pain control at the time of conversion poor pain control 100% moderate pain control 75% excellent pain control 50% fentanyl conversion not to be used for acute pain management oral morphine 50100mg 24 hours fentanyl 25 mcg hour patch oraltransdermal availability of commonly prescribed opioids tramadol 50mg tablets. Select microgram per hour dose of transdermal fentanyl based.