Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch. Titrate the dose based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application. Canadian guideline for safe and effective use of opioids. It should not be used to determine doses when converting a patient from one opioid to another. The methadone conversion table indicates that a conversion factor for a domed of 360mg equals 8. I am on a slow detox from sixty milligrams of methadone and would like to attempt the remainder of my detox using the duragesic patch. Neither nor any other party involved in the preparation or publication of this site shall be liable for any special. 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 52. Calculate the dose of fentanyl from the conversion chart given here or seek advice. Equianalgesic chart changes in italics ui health care. 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. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings.
The cdc mme conversion factor to calculate morphine milligram equivalents of methadone is 3. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. I have been on methadone maintenance for six years and would like to know if the duragesic patch would be an okay alternative to methadone. It blocks certain opiate receptors and acts as a analgesic or pain medicine. In other words, the conversion factor not accounting for days of use would be 6025 or 2. In the case of converting morphine to methadone, methadone has a relative potency of 4. Use this table to find the calculated 24hour morphine dose and the corresponding recommended initial duragesic dose. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to. Opioid switching from transdermal fentanyl to oral. Butrans buprenorphine transdermal dosing, indications. Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f. Scottish palliative care guidelines fentanyl patches. No it is not drive from opium, opium is a natural occurring plant that produces, among other things, heroin. 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.
Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Do not apply extra patches to make up for a missed dose. Opioid oral morphine milligram equivalent mme conversion. The patients domed of 360 mg is equal to 30 mg of methadone daily. Durogesic dtrans 25 mcghr transdermal patch summary of. Rapid switching between transdermal fentanyl and methadone in. This tool does not contain all of the important safety information needed to prescribe butrans. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure.
Principles of opioid management fraser health authority. Converting to transdermal fentanyl palliative care. Extreme caution is necessary when switching from high doses of other. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. My question pertains to combining transdermal fentanyl duragesic patch with either methadone or other shortacting opioids for breakthrough pain, cancerous or noncancerous. Buprenorphine transdermal delivery system butrans, ciii. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Opioid conversion and brand availability in canada michael g. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose.
Morphine dose equivalence not reliably established. We had a discussion here not too long ago and we did a conversion from oxy and hydro to the 25ughr patch. The highest available btds strength of 20 mcgh may be equianalgesic to an oral medd of 3655 mg, whereas the product information states that the 20 mcgh patch may not provide adequate analgesia for. The amount of residual drug in the patients system must be accounted for. 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. Methadone has a long halflife and can accumulate in the plasma. Fentanyl patch protocol ventura county, california. Fentanyl patch converter globalrph conversion from. Opioid withdrawal symptoms are possible in some patients after conversion or dose adjustment. Butrans is for transdermal use on intact skin only. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect. Deaths due to an overdose of fentanyl have occurred when.
Duragesic transdermal patch is contraindicated in outpatient or day surgeries because there is no opportunity for proper dose titration, in the management of mild or intermittent pain, for use as an as needed analgesic, and in patients who require opioid analgesia for a short period of time. Department of health and human services, higher dosage, higher risk, why is it important to calculate the total daily dosage of opioids, how much is 50 or 90 mmeday for commonly prescribed opioids, how should the total daily dose of. Refer to table 2 for the range of 24hour oral morphine doses that are recommended for conversion to each duragesic dose. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. If it is almost time to put on your next patch, wait until then to apply a new patch and skip the one you missed. Opioid conversion calculator for morphine equivalents. Transdermal and parenteral fentanyl dosage calculations.
Calculating total daily dose of opioids for safer dosage, centers for disease control and prevention, cdc, u. Recommend an appropriate dose of transdermal fentanyl when. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a generous dose of common sense. Do not increase the duragesic dose for the first time until at least 3 days after the initial application. Opioid conversion calculator morphine equivalents advanced. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The equianalgesic dose of methadone compared to other opioids is extremely variable with chronic dosing. Durogesic dtrans 25 mcghr transdermal patch summary of product characteristics.
Recommend an appropriate dose of transdermal fentanyl when switching from other opioids, including rescue opioid dosing. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on singledose studies, and there is substantial individual variation in response. This is especially important for fentanyl and methadone conversions. Although specific dose adjustments on the basis of advanced. Accidental exposure to even one dose of duragesic, especially in children, can result in a fatal overdose of fentanyl. If you forget to wear or change a patch, put one on as soon as you can. Duragesic label page 1 full prescribing information for.
We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Conversion from methadone to butrans close monitoring is of particular importance when converting from methadone to other opioid agonists. Parenteral fentanyl is indicated for perioperative. Calculating total daily dose of opioids for safer dosage. Buprenorphine transdermal was evaluated in an openlabel clinical trial in pediatric patients aged 716 yr requiring continuous, aroundtheclock opioid treatment for moderatetosevere chronic pain.
Duragesic fentanyl dose, indications, adverse effects. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. Duragesic fentanyl transdermal dosing, indications. What are the steps for converting from morphine or.
An alternative algorithm for dosing transdermal fentanyl. 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. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoralr at 100 mcg. Opioid plasma concentrations during a switch from transdermal. Combining duragesic patches with other pain medications. Fentanyl patches were removed and the first of three daily doses of methadone was started. The maximum recommended acetaminophen dose is 4000 mg or 12 x percocet tabs per 24 hrs. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to overdose or death. Patch strengths can be combined to provide an appropriate dose. A study conducted with the duragesic patch in elderly patients. Decrease new dose 3050% to allow for incomplete crosstolerance. Conversions with methadone methadone is inexpensive and effective in certain patient populations. Converting from oral morphine to fentanyl transdermal patch. Based on the estimated 24hour equivalent morphine, hydromorphone or oxycodone dose.
Calculating mme for methadone in clinical practice often involves a slidingscale approa ch whereby the conversion factor increases with increasing dose since the conversion factor of 3 for methadone could underestimate mme for a given patient. Conversion of opioid analgesics to fentanyl transdermal. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Serious or lifethreatening breathing problems that can lead to death can. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Close monitoring is of particular importance when converting from methadone to other opioid agonists. So, you use that and add 15mg for your breakthrough dose and there you have it.
See chart a1 fentanyl transdermal patch equianlagesic conversion. Equivalence between oral morphine and transdermal fentanyl. Each butrans patch is intended to be worn for 7 days. Manage breakthrough pain with morphineshortacting opioid prn. Choose a suitable patch matrix patch allows titration in smaller increments.
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