Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. 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. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Fentanyl actiq side effects, dosage, interactions drugs. 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. Fentanyl and fentanyl analogs are increasingly entering the drug supply as counterfeit tablets or substituted for prevention and treatment of neonatal pain view in chinese ventilated infants treated with fentanyl compared with controls but there were no differences in clinical outcomes between the fentanyl and placebotreated groups. Fentanyl patch, transdermal 72 hours side effects by. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
Standards and guidelines for the use of transdermal opioids in palliative care july 2014 3 patients may experience opioid withdrawal symptoms e. Converting to transdermal fentanyl palliative care network. An alternative algorithm for dosing transdermal fentanyl for. This is because the majority of opioid is entering the cns. 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. It is one of dozens of opioids contributing to dependencies, substance use disorders, overdoses and deaths happening across the country. Do not use this tool to convert from one opioid to a different opioid.
Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. She would like to try an immediaterelease opioid agent, hydromorphone. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. In 2016, over 20,000 overdose fatalities were linked to fentanyl. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Fentanyl is almost 100 times more potent than morphine, but the drug is designed to deliver small amounts of fentanyl each hour over an extended period of time. Round up to and begin treatment with transdermal fentanyl using a patch size of 50 gh.
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. Initial dose based on previous 24hour opioid requirement consult product literature, for evaluating analgesic efficacy and dose increments, see under chronic intractable pain not currently treated with a strong opioid analgesic, for conversion from long term oral morphine to transdermal fentanyl, see pain management with opioids under. Duragesic label page 1 full prescribing information for. 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. Fentanyl patch converter globalrph conversion from other. Advanced opioid conversion calculator morphine equivalents. Duragesic label page 1 full prescribing information for use. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Compare butrans vs fentanyl headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. 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. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. 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.
Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Converting to transdermal fentanyl palliative care. Fentanyl transdermal system patch information, side effects.
The conversion ratio of certain opioids can be dependent on the dose of the original opioid. 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. Opioid conversion tips changing to another oral opioid question. Fentanyl is among the deadliest drugs currently available. Addressing adverse effects from opioids if the ae is not managed symptomatically and persists for more than one week, switch to another opioid. Duragesic fentanyl transdermal dosing, indications. A fentanyl taper seeks to avoid withdrawal symptoms by allowing the central nervous system to adapt to the drugs absence on its own. Morphine milligram equivalent mme calculator nyc health. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. Transdermal and parenteral fentanyl dosage calculations. 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. Adjust dosing to achieve patient comfort with minimal side effects. Fentanyl patch, transdermal 72 hours side effects by likelihood and severity.
The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Stop long acting oral morphine after applying patch. Patient is receiving a total of 5 mg of parenteral hydromorphone in a. Fentanyl transdermal system patch information, side. 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. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Morphine milligram equivalent mme calculator instructions. The medline database was searched with terms cancer pain, opioid rotation, opioid switching, opioid ratio, opioid conversion ratio, and opioid equianalgesia for the major opioids morphine, oxycodone, fentanyl, and hydromorphone and the intravenous, subcutaneous, oral, and transdermal administration routes. Fentanyl is a synthetic manmade opioid that is similar to morphine. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. If experienced, these tend to have a severe expression. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The following source was used for morphine equivalent conversion factors per mg of opioid.
In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. 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. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. 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. Fentanyl transdermal system contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. Practical management of opioid rotation and equianalgesia. Pain and symptom management pain management 2017 3 3. Duragesic fentanyl transdermal system is available in generic form. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.
The chemical structure of fentanyl is slightly different from that of heroin. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. Remember to enter all opioids the patient is taking. 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.
Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Fentanyl is also available as a sustained release transdermal patch which when. Fentanyl was originally synthesized as a powerful analgesic pain reliever, and it is. In the case of converting morphine to methadone, methadone has a relative potency of 4. 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. Scottish palliative care guidelines fentanyl patches. Side effects of duragesic fentanyl transdermal, warnings. Side effects of duragesic fentanyl transdermal, warnings, uses. While the goal is to stop fentanyl use, doing so without a buffer period subjects the entire body to unnecessary and painful side effects. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Conversion from transdermal fentanyl to oral hydromorphone extendedrelease. An alternative algorithm for dosing transdermal fentanyl. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs.
Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Transdermal and parenteral fentanyl dosage calculations and. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl may also cause severe, possibly fatal, breathing problems. Converting from oral morphine to fentanyl transdermal patch. Opioid switching using equivalence tables page 1 of 5. Initiate therapy 18 hours following removal of the transdermal fentanyl patch, starting dose should be determined using the conversion. The total daily morphine milligram equivalents mme will be displayed. Fentanyl patch converter globalrph conversion from. Start with equivalent total daily dose of immediate release formulation and administer once daily. Conversion from other oral hydromorphone formulations.
Recommend an appropriate dose of transdermal fentanyl when. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Start exalgo dose at 50% of calculated daily dose every 24 hours. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. Adverse effect intervention constipation stepwise escalation of regular oral stimulant or osmotic laxative on opioid initiation. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. 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. You wish to convert the therapy to transdermal fentanyl.
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