This calculator should not be used to determine doses when converting a patient from one opioid to another. Conversion ratios may vary and the figures below are a. Fentanyl patch abuse methods the strongest opioid out there. Conversion of opioid analgesics to fentanyl transdermal. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Each butrans patch is intended to be worn for 7 days.
Opioid conversion chart approximate guidelines only. It is intended to take at least 12 hours until it absorbs. Opioid metabolism and excretion do differ among the opioids. It is important to remember that use of a transdermal fentanyl patch should only be initiated for patients already taking opioids, as the equianalgesic conversion of a 25. The conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion. Opioid conversion table hop16091451 croni ain anaeen tooli. Once the conversion has occurred, the dose of new opioid should be titrated carefully.
Remember to enter all opioids the patient is taking. Opioid converter morphine equivalent calculator omni. All opioid analgesic patches, including both fentanyl and buprenorphine patches, must be prescribed by brand and applied at the correct dosing interval to ensure that patients are not left in pain if too long an interval and that patches are not used wastefully if too short an interval. The total daily morphine milligram equivalents mme will be displayed. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. They all interact with specific opioid receptors such as.
In other words, the conversion factor not accounting for days of use would be 6025 or 2. Pharmaceutical fentanyl is a synthetic opioid pain reliever, approved for treating severe pain, typically advanced cancer pain. Its also often prescribed in lollipop form for the very same reason. Fentanyl patch converter globalrph conversion from. Fentanyl patches are only intended for use on the skin so that the drug can be distributed slowly. It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse and abuse in the united states. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Fentanyl patches are another option, but are expensive and difficult to titrate. In the iv form fentanyl is often used in icus for pain control due to its rapid onset of action and due to the minimal histamine release associated with fentanyl in comparison to morphine. Converting from oral morphine to another strong oral opioid e. Opioid conversion and brand availability in canada michael g. If the form does not start downloading in 10 seconds, please click here. Symptom control and anticipatory prescribing last days of. This dose is not possible to provide in slowrelease morphine. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. In renal impairment gfr opioids of choice are oxycodone posc, fentanyl and buprenorphine patches. Clinical pharmacist, university of new mexico hospitals. Four strategies for managing opioidinduced side effects. The first tdf product on the market was the branded.
Morphine milligram equivalent mme calculator nyc health. Opioid conversion calculator morphine equivalents advanced. Converting from oral morphine to fentanyl transdermal patch. Equianalgesic chart changes in italics ui health care. If the patient has a fentanyl or buprenorphine patch leave this in place and prescribe the appropriate sc prn dose of morphine dosing example. 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. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl.
Opioid oral morphine milligram equivalent mme conversion. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Two of the most common fentanyl patch abuse methods are chewing fentanyl patches and smoking the gel inside fentanyl. Methadone and fentanyl are generally safe and considered good options in patients with renal insufficiency. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Only in exceptional circumstances should the buprenorphine or fentanyl patch be removed and the equivalent opioid dose given in a syringe driver, and only. Each individual patient should be titrated to optimum pain control weak opioids 4 hourly dosing schedule 12 hourly dosing schedule 72 hour dosing schedule transdermal patch 24 hour dosing schedule 4 hourly morphine 4 hourly oxycodone 12 hourly morphine 12 hourly oxycodone 3 days fentanyl.
Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. The amount of residual drug in the patients system must be accounted for. Fentanyl is also available as a sustained release transdermal patch which when. Schedule 8 schedule 11 medication management points to consider when prescribing and using the transdermal opioid patches transdermal fentanyl patch. To outline the recommended dosing conversion from opioid, benzodiazepine, and alphaagonist continuous infusions to methadone. For mild pain, the starting regimen should be a nonsteroidal antiinflammatory drug nsaid or acetaminophen.
Opioid conversion table american academy of family. Converting to transdermal fentanyl palliative care. Conversion from morphine or equivalent to fentanyl transdermal. For moderate pain, an opioid agonist eg, hydrocodone. Fentanyl transdermal total daily morphine dose orally buprenorphine transdermal 30mg 12 microgramhour 288microgramday 12mg 5 microgramhour 7 day butrans patch 120microgramday 60mg 25 microgramhour 600microgramday 24mg 10 microgramhour 7. Considering patient has not been compliant recently, in. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Due to crosstolerance, when switching from one opioid to another, the starting dose of the new opiod should be 50% to 67% of. Fentanyl patch 100mcghour 360mg morphine 24 hours consider dose reduction of 20% a.
Calculate the total 24hour morphine dose or morphineequivalent. Transdermal patch should be used only in opioid tolerant patients. For opioid equivalent dose conversion in end of life care please refer to palliative care. Divide the total 24hr dose of oral po morphine by the potency ratio for the oral opioid which you are converting to. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Their product information stresses that conservative conversion values used for converting to fentanyl patches may result in drug overdosage if used to convert from patches to other opioids, highlighting the danger of a simplistic use of conversion tables. Canadian guideline for safe and effective use of opioids. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. Opioid oral morphine milligram equivalent mme conversion factors1,2.
The mme conversion factor for fentanyl buccal tablets, sublingual tablets, and lozengestroche is 0. If patch must be removed or falls off at any point, request a replacement patch from pharmacy to complete duration of therapy. Scottish palliative care guidelines fentanyl patches. Opioid analgesic risk evaluation and mitigation strategy rems. 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. Transdermal and parenteral fentanyl dosage calculations. There are many opioids and many formulations available e.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Thank you for downloading opioid manager switching opioid form. Opioid equivalent doses guidance approximate excluding. Morphine po 300mgday that, until recently, controlled her pain well. Opioid conversion ratios guide to palliative care practice. What are the steps for converting from morphine or. Morphine milligram equivalent mme calculator instructions. When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete crosstolerance. Conversion guide for opioid to transdermal fentanyl from to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch 12 hour controlled release cr long acting oral opioid apply the patch at the same time as administering the final 12 hour cr dose.
Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. 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. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine. Severe chronic pain which can be adequately managed only with opioid analgesics. Select microgram per hour dose of transdermal fentanyl based. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. For frail elderly patients, use more conservative conversion or a lower strength patch e. Fentanyl 25 patch 25microgramshour 30mg to 4mg24hours fentanyl 50 patch 50 microgramshour 5mg to 224mg24hours fentanyl 75 patch 75 microgramshour 225mg to 314mg24hours. Enteral methadone to expedite fentanyl discontinuation and prevent opioid. Transdermal dosage use only when converting another opioid to fentanyl patch. Opioids opiates are a group of analgesic drugs, used primarily for pain management. The table is based on oral dosing for chronic noncancer pain. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors.