Efficacy and safety of a sixhour continuous overlap method. Approximately 9% of the dose is recovered in the feces, primarily as metabolites. Transdermal patch should be used only in opioid tolerant patients. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the ci rate. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Convert the iv dose to the equianalgesic oral morphine dose using a ratio of.
Select microgram per hour dose of transdermal fentanyl based. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. So by applying the patch with the last dose of the oral morphine the chances of increasing pain during the drug transition can be avoided. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. I did a conversion once when i found a table online and was shocked to find out that the 100mcg patches i was on are equivalent to over 200 mgs of oxycodone. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Intravenous fentanyl should only be administered by health care professionals trained in anesthesiology who are familiar with the respiratory effects of potent opioids. Transdermal and parenteral fentanyl dosage calculations. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 im iv morphine 10 to 22 2337 3852 5367. 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. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off.
Opioid conversion ratios guide to palliative care practice. Fentanyl injection sublimaze is a synthetic narcotic similar to morphine. Like other opioids, fentanyl attaches to the brains opioid receptors to. 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. 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. 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.
After discontinuing a fentanyl patch, fentanyl levels fall gradually. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Recommend an appropriate dose of transdermal fentanyl when. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. Conversion of intrathecal opioids to fentanyl in chronic. The nine patients included in this case series were switched from transdermal to iv fentanyl for accurate dosage titration. Duragesic fentanyl transdermal system releases fentanyl from the reservoir at a nearly constant amount per unit time. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Convert the oral morphine dose to duragesic there are two methods.
Because of fentanyls strength doses are measured in micrograms mg. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a. Converting from fentanyl given by iv infusion or via a pca device. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. It also is used for treating severe pain that is unrelated to surgery. Mar 28, 2016 if at any time the patient develops symptoms of withdrawal, return to the previous rate and consider giving an iv bolus of fentanyl. Duragesic fentanyl transdermal dosing, indications. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed.
The physician in ags case incorrectly concluded that ag would be a good candidate for td fentanyl because he had been given 3 doses of iv push fentanyl. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Fentanyl is a horrible drug and is 80 times stonger that morphine. Duragesic label page 1 full prescribing information for use. A safe and effective method for converting patients from. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Pain intensity, sedation, and hourly iv fentanyl requirements after conversion. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414. When used as directed, fentanyl can be administered via an injection, worn as a transdermal patch or taken as a lozenge. Conversion of intrathecal opioids to fentanyl in chronic pain. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only.
Equianalgesic chart changes in italics ui health care. So round up the calculated 5 micrograms dosage of fentanyl to 125 micrograms or a 150 microgram patch depending on whether patients pain is under good control or not. Convert each number in your list to iv morphine equivalents, by using column 2. Within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. Advice should be sought from the palliative care team. This is the number of milligrams that actually gets into the bloodstream. Oct 15, 2019 within 72 hours of iv fentanyl administration, approximately 75% of the dose is excreted in urine, mostly as metabolites with less than 10% representing unchanged drug. Changing an oral or iv opioid to transdermal fentanyl 1. Converting from oral morphine to fentanyl transdermal patch. In other words, the conversion factor not accounting for days of use would be 6025 or 2. While this makes the conversion relatively easy, patches tend to be left on longer than needed.
Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. A safe and effective method for converting cancer patients from. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Feb 17, 2020 fentanyl transdermal system contains fentanyl, an opioid agonist, and 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. Fentanyl patch converter globalrph conversion from. Abstral fentanyl dose, indications, adverse effects. In addition, use of anesthetic doses of iv fentanyl requires a specialized care setting where an opiate antagonist, oxygen, and controlled respiration facilities are present. 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.
I had the cheap mylan patches flat and not jell filled so i ended up cutting them so i. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Fentanyl patch protocol ventura county, california. Dosage use only when converting another opioid to fentanyl patch. Effects of patch last for 18 24 hours after the patch is removed. It conversion ratio, eventual it fentanyl dose, and iv.
In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Duragesic label page 1 full prescribing information for. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Transdermal and parenteral fentanyl dosage calculations and. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Converting to transdermal fentanyl palliative care network. Fentanyl conversion table patch strength microgram total quantity of fentanyl equivalent. Efficacy and safety of a sixhour continuous overlap. 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. Patients who experience serious adverse effects should have patches removed immediately and should be monitored for at least 24 hours after the patch is removed 412.
Fentanyl moves in the direction of the lower concentration at a rate. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to. Fentanyl patch converter globalrph conversion from other. Fentanyl injection is prescribed to reduce pain before, during, or after surgery. Fentanyl patches durogesic for chronic pain nps medicinewise. Fentanyl may also be prescribed to people with chronic pain who have an opioid tolerance. Twostep titration weans patients from iv to patch fentanyl. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose.
It may be 812h or longer after putting on the first patch before pain relief is experienced. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Quickwhat dose of the transdermal fentanyl patch duragesica is. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. All nine patients initially reported their pain with movement as.
Fentanyl accumulates to form a depot in the skin below the. Both drugs work the same way in the body to relieve pain. What every pharmacist should know about transdermal. Opioid oral morphine milligram equivalent mme conversion. Thats some bad stuff to get off of and there is no easy way that i have found. 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. Converting to transdermal fentanyl palliative care. A safe and effective method for converting patients from transdermal. What are the steps for converting from morphine or. Stop long acting oral morphine after applying patch. Phoenixa twostep approach to converting patients from intravenous fentanyl to transdermal patches can prevent occurrence of breakthrough pain episodes. 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.
Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to. Efficacy and safety of a sixhour continuous overlap method for. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. One option that i dont like to use is switching patients over to a fentanyl patch. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. There is currently no accepted conversion factor or process to convert iv push to td fentanyl. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. 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. Converting to transdermal fentanyl palliative care network of. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. In australia fentanyl patches come in five different strengths. Like other opioids, fentanyl attaches to the brains opioid receptors to block pain signals in the body.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Mean values for unbound fractions of fentanyl in plasma are estimated to be between and 21%. A safe and effective method for converting cancer patients.
After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. It conversion ratio reached to give superior vas from previous it opioid. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl is a strong, synthetic manmade narcotic that is similar to morphine.
Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. Dailymed fentanyl transdermal patch, extended release. Conversion oraliv 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. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Fentanyl transdermal system contains fentanyl, an opioid agonist, and 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. Apply to intact, nonhairy skin on the upper trunk or upper arm. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent.
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