Opioid oral morphine milligram equivalent mme conversion. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. Duragesic fentanyl transdermal system cii pain patch. Duragesic dose was calculated based on the opioid analgesic requirement from the previous 24 hours, with titration every 72 hours as necessary. Calculate the total 24hour morphine dose or morphineequivalent. Discarded patches have the potential to be misused.
These dose conversions are estimated and cannot account for all individual. Duragesic patch and absorption of a potentially fatal dose of fentanyl. This tool does not contain all of the important safety information needed to prescribe butrans. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications. Sublimaze fentanyl dosing, indications, interactions.
If currently receiving opiates, convert dosage to fentanyl equivalents and administer an equipotent dose. Describe how to transition between intravenous iv fentanyl. 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. 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. Jan 29, 2018 longterm opioid use often begins with treatment of acute pain. Duragesic label page 1 full prescribing information for. Especially not without first closely supervising hisher reaction to iv fentanyl andor a long course of treatment with other first line analgesics both opiate and nonopiate. Oral morphine milligram equivalent conversion table updated 8. The duragesic transdermal system patch is used for the management of persistent, moderate to severe chronic pain in opioidtolerant patients when a continuous, aroundtheclock opioid analgesic is needed for an extended period of time.
What are the steps for converting from morphine or. Transdermal and parenteral fentanyl dosage calculations. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine. Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Duragesic fentanyl transdermal dosing, indications, interactions. 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. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii. Doses of shortacting opioids for breakthrough pain should be 10 to 20% of the total daily dose given every 1 to 4 hours as needed.
In general, the 12 mcgh dose, which allows for smaller dose. Duragesic should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least duragesic 25 mcg. A list of important tips for using this patch is also included. Following the patch, a flavoured lollipop of fentanyl citrate mixed with inert fillers was introduced in 1998 under the brand name of actiq, becoming the first quickacting formation of fentanyl for use with chronic breakthrough pain. Table 2 should not be used to convert from duragesic to other therapies because this conversion to duragesic is conservative. Duragesic label page 3 description duragesic fentanyl transdermal system is a transdermal system providing. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Iv use even at low doses and when given very slowly may cause marked decrease.
The methadone conversion table indicates that a conversion factor for a domed of 360mg equals 8. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Aug 12, 2019 if analgesia is insufficient during the first application only, the durogesic dtrans patch may be replaced after 48 hours with a patch of the same dose, or the dose may be increased after 72 hours. The patients current dose of 240 mg per day of oral oxycodone is equal to 360 mg per day of oral morphine. Opioid withdrawal symptoms are possible in some patients after conversion or dose adjustment. Select microgram per hour dose of transdermal fentanyl based. The initial dosage your healthcare provider recommends will mostly depend on the type and dose of the other opioids you have been taking. Converting from fentanyl given by iv infusion or via a pca device. Convert the oral morphine dose to transdermal fentanyl.
Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. The transdermal system should be pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges. Each initial duragesic dose is highly individualized. Brand names include duragesic transdermal patch, actiq lollipops, fentora effervescent buccal tablets, and oromucosal abstral. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Longterm opioid use often begins with treatment of acute pain. Converting from oral morphine to fentanyl transdermal patch.
Duragesic patch dose duragesic patches are fentanyl transdermal systems that deliver extremely potent pain medication to patients via patches placed on the skin. Advice should be sought from the palliative care team. Duragesic fentanyl dose, indications, adverse effects. Fentanyl patch converter globalrph conversion from. Duragesic patch fentanyl patch rationale for inclusion in pa. Scottish palliative care guidelines fentanyl patches. Durogesic dtrans 12 mcghr transdermal patch summary of product characteristics. Transdermal and parenteral fentanyl dosage calculations and. Initial fentanyl transdermal dosage use only when converting another. Do not initiate treatment with duragesic in opioid nontolerant patients see contraindications 4 the recommended starting dose when converting from other opioids to duragesic is intended to minimize the potential for overdosing patients with the first dose. Mar 10, 2015 120mg of oral morphine every 8 hours is equal to 360mg per day of oral morphine 24hr period. Route onset peak duration fentanyltransdermal fenta.
Converting to transdermal fentanyl palliative care. Each transdermal system is worn continuously for up to 72 hr see administration. See the detailed instructions for use for information about how to apply and dispose of the duragesic patch. Fentanyl patch converter globalrph conversion from other. Recommend an appropriate dose of transdermal fentanyl when. A safe and effective method for converting cancer patients from. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. These bidirectional differences are not captured in a traditional equianalgesic table. Duragesic patches have a boxed warning regarding the abuse potential, fatal respiratory depression even in opioid tolerant patients, accidental exposure, cytochrome p450 3a4 interaction. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sc iv 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. If pain is stable the patient may be considered for conversion to a fentanyl patch. This emedtv page describes these factors and offers some general duragesic dosing guidelines.
Conversion from morphine or equivalent to fentanyl transdermal. Dose conversion in opioid rotation from continuous intravenous. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Refer to appendix e for opioid dose considerations. Duragesic label page 1 full prescribing information for use. Equianalgesic chart changes in italics ui health care. There is a nasal spray under the brand name lazanda. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. If pain is stable the patient may be considered for conversion to a. Is a fentanyl 100 mcg patch and a duragesic 100mcg patch the. Is a fentanyl 100 mcg patch and a duragesic 100mcg patch. Converting to transdermal fentanyl palliative care network of. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Side effects of duragesic fentanyl transdermal, warnings. Converting to transdermal fentanyl palliative care network. After a set of successful clinical trials, duragesic fentanyl patches were introduced into medical practice. Side effects of duragesic fentanyl transdermal, warnings, uses. 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. Moderate consider a reduced dose of fentanyl with frequent monitoring for respiratory depression and sedation if concurrent use of cobicistat is necessary.
Fenint24 was an openlabel, multicenter, singlearm, nonrandomized study in patients age 2 to 12 years. Before prescribing duragesic, your healthcare provider will take into account several factors. Iv infusion, where the apparent halflife is approximately 7 range 312 hours. Fentanyl patches durogesic for chronic pain nps medicinewise. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. I am a new member and started with the brand name of the duragesic patch.
To convert patients to another opioid, remove the transdermal fentanyl patch and titrate the. During dose titration, additional shortacting opioids should be. Duragesic patches are intended for transdermal use on intact skin only. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. I had been taking percocet and put the patch on right away. 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. Patients then can be switched from intravenous iv to transdermal fentanyl. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Breakthrough opioids can be given as frequently as every 1 hour for oral doses or every 15 minutes if iv assuming normal renalhepatic function. Buprenorphine transdermal delivery system butrans, ciii. Parenteral dose po dos iv subcutaneous morphine 10 mg 1 20 30 mg hydromorphone 2 2 mg 4 mg fentanyl 100 mcg 0. Apply duragesic exactly as prescribed by your healthcare provider. Conversion oral iv opioids to fentanyl transdermal each transdermal system is worn continuously for up to 72 hr see administration tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal.
Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. We had a discussion here not too long ago and we did a conversion from oxy and hydro to the 25ughr patch. Fentanyl is the generic name for a synthetic opioid medication developed in the 1960s. Durogesic dtrans 12 mcghr transdermal patch summary of. Conversion of opioid analgesics to fentanyl transdermal. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. The larger the dose of fentanyl delivered, the larger the patch as of the skins surface area has to be covered to ensure that. The patients domed of 360 mg is equal to 30 mg of methadone daily. If cobicistat is discontinued, consider increasing the fentanyl dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. The cdc mme conversion factor to calculate morphine milligram equivalents of methadone is 3.
Fentanyl duragesic side effects, withdrawal and faqs. Made by orthomcneil, duragesic patches are nearly 100 more potent than morphine and can provide up to 72 hours 3 days of pain relieve when used as directed. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. Duragesic fentanyl transdermal dosing, indications. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. So, you use that and add 15mg for your breakthrough dose and there you have it. No studies directly investigating dose equivalence between morphine injection continuous iv administration and the transdermal fentanyl patch have been. Equianalgesic dosage conversion calculator neurology opioid equianalgesic calculator. Duragesic patches typically come in the following doses. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status.
Duragesic fentanyl transdermal system is available in generic form. 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 conversion ratio of certain opioids can be dependent on the dose of the original opioid. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. A strong prescription pain medicine that contains an opioid narcotic that is used tomanage pain severe enough to require daily aroundtheclock, longterm treatment with an opioid,in people who are already regularly using. The interval between iv antagonist doses should be carefully chosen because of the possibility of renarcotisation after the patch is removed. Stronger dosed duragesic patches may be available for particularly severe cases of chronic pain. Use the lowest dose possible for the shortest time needed. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic.
258 522 981 1280 1521 1546 604 1185 1216 1064 1325 351 954 777 1003 1265 386 1059 370 1007 362 485 597 541 1388 1569 1254 210 229 211 465 499 985 1058 1371 1400 1039 1070 879 1321 955