However, variation among patients in bioavailability of. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Oxycontin, xtampza er oxycodone dosing, indications. Transdermal patch should be used only in opioid tolerant patients. There is no direct conversion for fentanyl lozenge to. Must prescribe shortacting opioid for breakthrough pain. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Equianalgesic chart changes in italics ui health care. In conversion from transdermal fentanyl to oxycodone er, for each 25 mcghour transdermal dose, substitute 10 mg oxycodone er every 12 hours. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. Opioid conversion to hysingla er hydrocodone bitartrate cii. 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. Hi, what would be the approx correct equivalency for switching from using 100mcg duragesic patch to ms contin pills what mg dosage should the pills be at to equal the patch. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. There is no direct conversion for fentanyl lozenge to other opioids including morphine. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. 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. Round up or down based on patient factors and available patch sizes. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl treatment.
Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Select microgram per hour dose of transdermal fentanyl. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. The patch dosage form of duragesic12 actually delivers 12. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts.
Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Remember to enter all opioids the patient is taking. This is my 1st post so ill give a little background. Doses of oxycodone er should be initiated 18 hours after the removal of the fentanyl patch. Transdermal and parenteral fentanyl dosage calculations. Dec 15, 2001 the cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Discontinue all other aroundtheclock opioid drugs when ms contin therapy is initiated. Fentanyl to ms contin conversion pain management medhelp. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate.
Practical pain management is a remedy health media, llc. Morphine milligram equivalent mme calculator nyc health. Opioid oral morphine milligram equivalent mme conversion. Opioid conversion ratios guide to palliative care practice 2016. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. Switched from fentanyl patch 15mcg to mscontin 15mg. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Conversion of opioid analgesics to fentanyl transdermal. Some experts use this conversion in cancer patients. What to do with oxycodone, ms contin, and fentanyl. There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. The following source was used for morphine equivalent conversion factors per mg of opioid.
For frail elderly patients, use more conservative conversion or a lower strength patch e. Each butrans patch is intended to be worn for 7 days. Transdermal and parenteral fentanyl dosage calculations and. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. I thought the weird flu like symptoms might be a result of the new drug, but apparently it has to be withdrawal from the morphine. Opioid oral morphine milligram equivalent mme conversion factors1,2. Determine doses when converting a patient from one opioid to another. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. Long acting strong opiates oxycontin, ms contin, fentanyl patch should be started once pain is controlled on short acting preparations.
It should not be used to determine doses when converting a patient from one opioid to another. The tablet strength closest to the calculated dose is 30 mg. Simple conversion, fentanyl patch, methadone and iv infusion doses. What are the steps for converting from morphine or. And suggesting these seems to be such an awful thing to do, so compare that to what a fentanyl patch would be. So, can someyou please tell swim what the common dose of each of these is. Canadian guideline for safe and effective use of opioids for. Oxycodone is available as immediate release capsules 5mg, 10mg and 20mg. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain.
Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. I did that because it says it takes the patch 8 hours to work. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Equianalgesic dosing of opioids for pain management. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. Calculate an opioid starting dose for an opioidnaive patient. Buprenorphine transdermal delivery system butrans, ciii. Opioid conversion ratios guide to palliative care practice 2016 352016 2016. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis.
Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. The next opiate step would be a long acting oral med oxycontin or ms contin. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative. Opioid dose equivalence calculation of oral morphine equivalent daily dose omedd omedd mg current opioid dose x conversion factor current opioid conversion factor propietary names oral swallowed preparations note.
Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Fentanyl is a horrible drug and is 80 times stonger that morphine. I am currently trying to come down on the daily narcotic meds i take and am taking oxycodone 34 xs daily, lyrica 200 mg 34 xs daily and ambien cr 12. Oxycontin, ms contin, fentanyl patch should be started once pain is controlled on shortacting preparations. Because it may be difficult to determine analgesic need using a controlledrelease product, it is recommended to initiate therapy with immediaterelease products. The table is based on oral dosing for chronic noncancer pain. The next step is to convert 240 mg of oral oxycodone to the daily oral morphine.
Bedside teaching opiate conversion stacie levine md. A safe and effective method for converting cancer patients. Divide the total daily dose by the dosing frequency of the target opioid ms contin is dosed q12 hours 2 doses per day 225mg 2 112. The total daily morphine milligram equivalents mme will be displayed. Calculate opioid dose adjustments and opioid starting doses. Modified release formulations are marked mr morphine mgday 1 anamorph, kapanol mr, ms contin.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Opioid conversion calculator for morphine equivalents. Opioid conversion ratios guide to palliative care practice. These bidirectional differences are not captured in a traditional equianalgesic table.
See fentanyl information below for initiating patch and patch to po dosing. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. My question is, if im going to the right dosage of fentanyl patch which is 25 milligrams every 72 hours from, 60 milligrams of ms contin. Switching from 100mcg duragesic patch to ms contin or. Do not use this tool to convert from one opioid to a different opioid. Converting shortacting ir longacting er for wellcontrolled, chronic pain patients may still be experiencing a recurrence of pain before the next scheduled dose. Switching to ms contin, do not need to convert total daily dose of ms contin 225mg step 4.
Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg. Alternative oral, rectal and transdermal opioid products are shown below. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Select microgram per hour dose of transdermal fentanyl based. Conversion algorithm for instructions on converting from one opioid to another.
Kral safely discontinuing opioid analgesics 4 any withdrawal symptoms. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. 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. Google scholar lichtor jl, sevarino fb, and joshi gp. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. This is especially important for fentanyl and methadone conversions. Avinza, kadian, ms contin, oxycontin, opana er, duragesic, and embeda are not indicated as an asneeded prn analgesic.
Never start an opioid naive patient on longacting medications. When switching patients to a different opioid agent, equivalence tables are used to estimate an equipotent dose of the target opioid. Oral morphine milligram equivalent conversion tablei. 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. When rotating opioids in a patient with cancer or with escalating pain needs, i suggest a more aggressive conversion, using a shortacting agent for breakthrough. Conversion from morphine or equivalent to fentanyl transdermal. 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.
Canadian guideline for safe and effective use of opioids. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Patch duration of effect 48 72 hrs takes 1224 hrs before full analgesic effect of patch occurs after application. Common questions and answers about convert duragesic to oxycontin. In the case of converting morphine to methadone, methadone has a relative potency of 4. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Converting from oral morphine to fentanyl transdermal patch. As bridge therapy to prevent withdrawal symptoms when converting from highdose full muagonist opioid analgesics to highdose 832 mgd. I felt a lot more like myself but i persoanlly don. A few questions first off, i feel like the starting doses of each of these medications one pill patch is less than the common dose. The mme conversion factor for fentanyl patches is based on the assumption that one milligram of parenteral fentanyl is equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour day. Proper storage of patches and disposal of used fentanyl patches is necessary to prevent accidental exposurerisk of death by others.
Scottish palliative care guidelines fentanyl patches. Opioid switching using equivalence tables page 1 of 5. Never start an opiate naive patient on long acting medications. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. After the patient has been stabilized, the tapering regimen may be implemented table 3. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its. Ms contin morphine sulfatecontrolledrelease package insert. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. In other words, the conversion factor not accounting for days of use would be 6025 or 2. After 72 hours, approximately 40% of fentanyl remains in the patch.
Morphine to fentanyl patch conversion each 2 mg po morphine approximately equivalent to 1 mcg hr fentanyl patch e. This tool does not contain all of the important safety information needed to prescribe butrans. Conversion from transdermal fentanyl to hysingla er. August 20 gippsland region palliative care consortium.
Oral morphine milligram equivalent conversion table updated 8. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. 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. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. In these last 20 years ive used these longacting opioids. Fentanyl buccal or sl tablets, or lozengetroche5 mcg. All doses expressed in mg per day with exception of fentanyl. Calculate the total 24hour morphine dose or morphineequivalent. Currently, there are no empirical studies converting fentanyl to morphine. Advice should be sought from the palliative care team.
What are the steps for converting from morphine or equivalent to. Ms camilla young, mcn coordinator ms lyn watson, nurse representative, education subgroup. Didnt know where else to put this, but i was recently switched from morphine 60mg er to the fentanyl duragesic patch. If a patient has not been on an equivalent of 6090mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch.