What are the steps for converting from morphine or. Patients then can be switched from intravenous iv to transdermal fentanyl. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Opioid converter morphine equivalent calculator omni. Each transdermal system is worn continuously for up to 72 hr see administration. Fentanyl patch converter globalrph conversion from. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. The fentanyl infusion dose wasdecreased inhalfsix hours after patch application, then completely stopped after 12 hours. 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. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. 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.
Scottish palliative care guidelines fentanyl patches. The older reservoir patches were labelled according to the amount of fentanyl contained in the patch 2. Fencino 12 microgramshour transdermal patch summary of. The opioid conversion calculator tells you equivalent doses of analgesic drugs, such as morphine, fentanyl or tramadol. Transdermal fentanyl is approximately 80 times as potent as morphine. Fentanyl is a strong, synthetic manmade narcotic that is similar to morphine. For frail elderly patients, use more conservative conversion or a lower strength patch e. 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.
Highdose fentanyl patch for cancer pain american board. Nomura et al used the same method, but shortened the conversion. Converting to transdermal fentanyl palliative care network of. Total doses of 50 to 100 mcgkg iv or im, administered with oxygen and a muscle relaxant but without the use of additional anesthetic agents may be sufficient based on dosing in children 2 to 12 years of age. Convert the oral morphine dose to transdermal fentanyl. For fasttracking and early extubation following major surgery, total fentanyl doses are limited to 10 to 15 mcgkg. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. Fencino doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application.
Efficacy and safety of a sixhour continuous overlap. Fentanyl duragesic patches come in six different sizes and doses, including. The fentanyl skin patch is only used for opioidtolerant patients. Fentanyl patch protocol ventura county, california. Describe how to transition between intravenous iv fentanyl. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Advanced opioid conversion calculator morphine equivalents.
Convert iv fentanyl to iv morphine first following above steps 2. Abstral fentanyl dose, indications, adverse effects. In one alternative method, breitbard recommends using 2 mg of oral morphine as equivalent to 1. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. If the patient was previously on 100 mcg hr of fentanyl, ill make the prn bolus 50 mcg of fentanyl iv. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. 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. 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 overdosage. Advice should be sought from the palliative care team. 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. Original research dose conversion ratio for continuous. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of.
Calculate the total 24hour morphine dose or morphineequivalent. Iv infusion, where the apparent halflife is approximately 7 range 312 hours. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. A safe and effective method for converting cancer patients. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Discarded patches have the potential to be misused. The amount of residual drug in the patients system must be accounted for. Discontinuing fentanyl infusion 30 to 60 minutes prior to the end of surgery will usually allow adequate ventilation upon emergence from anesthesia.
Stop long acting oral morphine after applying patch. The fentanyl patch is constructed like a matrix, a system based on a polyacrylate net with fentanyl that attaches directly onto the skin. In a twoyear carcinogenicity study conducted in rats, fentanyl was not associated with an increased incidence of tumors at subcutaneous doses up to 33 mcgkgday in males or 100 mcgkgday in females 0. In two paediatric studies, the required fentanyl transdermal patch dose was calculated conservatively. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. I like to have a prn fentanyl bolus available for the nurse to administer if the patient begins to experience withdrawal. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. For patients that require more than 100 mcghour, several transdermal systems may be used. No studies directly investigating dose equivalence between morphine injection continuous iv administration and the transdermal fentanyl patch have been. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 im iv morphine 10 to. Doses should be titrated according to individual response.
Initial fentanyl transdermal dosage use only when converting another. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. These are maximum doses in relation to converting someone already on opioids. Changing an oral or iv opioid to transdermal fentanyl 1. Converting to transdermal fentanyl palliative care. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. If pain is stable the patient may be considered for conversion to a fentanyl patch. Duragesic fentanyl transdermal dosing, indications, interactions. 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. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people.
Duragesic fentanyl transdermal dosing, indications. 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. Recommend an appropriate dose of transdermal fentanyl when. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Opioid oral morphine milligram equivalent mme conversion. Dose conversion in opioid rotation from continuous intravenous. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Kornick et al12 used a 12 hour conversion method in 15 patients with cancer pain. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery.
Iv use even at low doses and when given very slowly may cause marked decrease. Use of fentanyl patch in partial doses than the original. Fentanyl is considered a potent synthetic opioid widely used in anesthesiology, for short and longterm pain management, and for sedation. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. 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. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. The stronger the dose, the larger the patch, as more area of skin needs to be covered to ensure that more of the drug is being absorbed over the same period of time. Another commonly used conversion is to equate 100 mg of oral morphine to a 25. This is based on studies converting from morphine to fentanyl. Dose conversion ratio of fentanyl intravenous infusion and fentanyl patches 219 in clinical practice, a dose conversion ratio of 1.
Check with your doctor if you have questions about this. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Ive read the horrific descriptions of the withdrawals and im coming unglued about this whole thing, as i asked my pain management doctor not to put me on these things in the first place. Under the conditions of the assay, there was no evidence for fentanyl induced adverse effects on embryofetal development at doses up to 0. Caution is advised when converting to methadone due. Duragesic label page 1 full prescribing information for. Durogesic dtrans 75 mcghr transdermal patch summary of. Note that this table is unidirectional for morphine to fentanyl patch conversion only. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.
Select microgram per hour dose of transdermal fentanyl based on table 2. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. A patient is opioidtolerant if oral narcotics have already been used for severe pain. 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. Equianalgesic chart changes in italics ui health care. Some experts describe fentanyl doses of 30 to 100 mcgkg iv for cardiac surgery. High dose fentanyl as an adjunct to general anesthesia is rarely used, but is still described in the manufacturer label. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Discover omni 41 chemistry 31 construction 50 conversion 34 ecology 17 everyday life 61 finance 152. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. Converting from oral morphine to fentanyl transdermal patch. But, im terrified about coming off and having no more meds in my system.
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. 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. Eight to 12 hours after patch placement, concentrations approximate those achieved with equivalent intravenous doses of fentanyl. Transdermal td fentanyl is a self adhesive skin patch which provides continuous systemic delivery during the 72 hour application period. The fentanyl infusion can usually be rapidly tapered off after 1 or 2 doses of methadone have been given. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Currently, there are no empirical studies converting fentanyl to morphine. A safe and effective method for converting cancer patients from. Sublimaze fentanyl dosing, indications, interactions. Converting from fentanyl given by iv infusion or via a pca device. Please note that because this allowance has been made based on the typical dosage of one fentanyl patch per 3 days, you should first change all days supply in your prescription data to follow this standard, i. Do not use table 2 to convert from duragesic to other therapies because this conversion to duragesic is. Fentanyl actiq side effects, dosage, interactions drugs.
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