Common questions and answers about fentanyl and hydromorphone. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. Duragesic label page 1 full prescribing information for. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. 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 brand names of. Recommend an appropriate dose of transdermal fentanyl when. Please select conversion type buprenorphine patch mcghr topical codeine mg oral endone oxycodone ir mg oral fentanyl mcg subcutaneous fentanyl mg buccal fentanyl patch mcghr topical hydromorphone cr mg oral hydromorphone ir mg oral hydromorphone ir mg subcutaneous morphine mg oral morphine mg subcutaneous norspan patch. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. An alternative algorithm for dosing transdermal fentanyl. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo.
Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. 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. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day. 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.
Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Transdermal and parenteral fentanyl dosage calculations. Approximate breakthrough doses recommended for fentanyl transdermal patcha breakthrough should be 10% of the total daily opioid dose patch strength mcghour oral morphine immediate release mg oral hydromorphone immediate release mg oral oxycodone immediate release mg 12 5 1 2. Calculate the total 24hour morphine dose or morphineequivalent. 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. For patients under this age consult with a pain or palliative care specialist. What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone. Stop long acting oral morphine after applying patch. Opioid conversion ratios guide to palliative care practice 2016.
Opioid converter morphine equivalent calculator omni. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain. She would like to try an immediaterelease opioid agent, hydromorphone. If switching from a fentanyl patch to any other strong opioid by any other route, specialist.
Advanced opioid conversion calculator morphine equivalents. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Conversion of intrathecal opioids to fentanyl in chronic. Oral hydromorphone is about 47 times as potent as oral morphine. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Duragesic label page 1 full prescribing information for use. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Converting to transdermal fentanyl palliative care. In other words, the conversion factor not accounting for days of use would be 6025 or 2. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator.
Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. And just fyi hydromorphone is also known as dilaudid. Feb 17, 2020 conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. 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. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Decrease new dose 3050% to allow for incomplete crosstolerance. Do not use this tool to convert from one opioid to a different opioid. Opioid conversion ratios guide to palliative care practice. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Canadian guideline for safe and effective use of opioids for. An alternative algorithm for dosing transdermal fentanyl for.
Converting from various opioids to an equianalgesic dose of oral morphine. You wish to convert the therapy to transdermal fentanyl. Opioid oral morphine milligram equivalent mme conversion. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
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. 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. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Converting from oral morphine to fentanyl transdermal patch. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. How long before the fentanyl patch to absorb into the system and starts to. Another commonly used conversion is to equate 100 mg of oral morphine to a 25. For this reason the date of birth field is mandatory. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. They all interact with specific opioid receptors such as. Select microgram per hour dose of transdermal fentanyl based.
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. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Parenteral hydromorphone is 20 times as potent as oral morphine. Converting from oral morphine mg24 hr to equianalgesic doses of various opioids over 24 hr.
Oral morphine milligram equivalent conversion table updated 8. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Start exalgo dose at 50% of calculated daily dose every 24 hours. For frail elderly patients, use more conservative conversion or a lower strength patch e. Select microgram per hour dose of transdermal fentanyl based on table 2.
Conversion from morphine or equivalent to fentanyl transdermal. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Opioid manager switching opioids morphine equivalence table. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The fentanyl patch is 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 patients considered opioidtolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Opioid conversion tips changing to another oral opioid question.
Canadian guideline for safe and effective use of opioids. Converting to transdermal fentanyl palliative care network. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. In one alternative method, breitbard recommends using 2 mg of oral morphine as equivalent to 1. The following source was used for morphine equivalent conversion factors per mg of opioid. Fentanyl patch converter globalrph conversion from. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old.
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. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. What are the steps for converting from morphine or. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Morphine milligram equivalent mme calculator nyc health. Scottish palliative care guidelines fentanyl patches. After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. In the case of converting morphine to methadone, methadone has a relative potency of 4. Fentanyl patch converter globalrph conversion from other. Conversion from other oral hydromorphone formulations. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Have studied some and know that conversion can be tricky and is less toxic to liver have stage 2 cirrhosis, so hoping it will be the right decision.