Determining the appropriate initial fentanyl patch size. Opioid oral morphine milligram equivalent mme conversion. 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. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Abstral fentanyl dose, indications, adverse effects. Patients must be instructed to stop the use of actiq and dispose of. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. When prescribing, do not convert patients on a mcg per mcg basis from actiq. Subsys fentanyl sublingual spray is an opioid agonist, available as a sublingual spray designed to deliver doses of 100, 200, 400, 600, 800, 1200 and 1800 mcg of fentanyl.
Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Adjust doses as appropriate see dosage and administration. The chemical name of fentanyl is nphenyln12phenylethyl4piperidinylpropanamide. Transdermal fentanyl is formulated as both a gelcontaining reservoir and a drug inadhesive matrix patch see sidebar.
Swab down the pair of scissors and use them to cut the fentanyl patch into evenly sized pieces. Converting from actiq doses of 600, 800, or 1200 mcg, initiate titration with 200 mcg. Additional pharmacological effects of fentanyl include anxiolysis, euphoria. Deaths have occurred in opioid nontolerant patients. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. A while ago, before i was on anything except percocet, my doc gave me a scipt for 30 200mcg pops, in. For patients converting from an actiq dose of 600 to 1200 mcg, start abstral at 200 mcgdose and titrate using multiples of 200 mcg. Medscape breakthrough cancer pain dosing for actiq, fentora fentanyl. In the case of converting morphine to methadone, methadone has a relative potency of 4. 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. Both dilaudid and fentanyl can be habit forming even at prescribed doses. These should be used in conjunction with the summary of product characteristics for the fentanyl patch being used. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses.
Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Patient a is deriving good pain relief from oxycodone 5 mg plus acetaminophen 325 mg, 2 tablets every 4 hours, but would prefer not to take medication every 4 hours. 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. The goals of the tirf rems access program are to mitigate the risk of misuse, abuse, addiction, overdose and serious complications due to medication errors by. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. The risk of respiratory depression persists beyond patch removal due to continued drug absorption.
Duragesic label page 1 full prescribing information for. 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. Preventing inappropriate conversion between fentanyl products. Contains fentanyl, a potent opioid analgesic with a rapid onset of action do not confuse with alfentanil. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. When prescribing, do not convert patients on a mcg per mcg basis from any other oral transmucosal fentanyl product to actiq. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Caution should be exercised when converting from a different opioid to fentanyl, as initial dose overestimation may lead to fatal overdose in opioidtolerant patients. This is my 1st post so ill give a little background. Substitutes and alternatives to duragesic fentanyl for uses like cancer pain, pain after surgery and chronic pain. Fentanyl citrate is the citrate salt of fentanyl, a synthetic opioid related to the phenylpiperidines with analgesic and anesthetic properties. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf.
Transdermal and parenteral fentanyl dosage calculations. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Converting tofrom transdermal fentanyl return to fast facts index. Because of its potency, it is reserved for the most severe types of pain, including cancer pain. Scottish palliative care guidelines fentanyl sublingual. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Fentanyl buccal tablet each tablet contains fentanyl. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Titrate dose over consecutive episodes of breakthrough pain, as needed.
Known by its brand names actiq, duragesic, sublimaze, and ionsys, fentanyl is a highly potent, synthetic opioid analgesic. For patients converting from actiq 1600 mcg, start abstral 400 mcgdose and titrate using multiples of 400 mcg. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Converting from oral morphine to fentanyl transdermal patch. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. The only exception is for actiq and its generic equivalents, which are approved for cancer. Opioid conversion guidelines gippsland region palliative. Comparative doses of oral morphine and transdermal fentanyl are given in tables 1 and 2. Actiq fentanyl citrate oral transmucosal lozenge fda. Duragesic fentanyl transdermal dosing, indications, interactions. Approved risk evaluation and mitigation strategies rems.
Converting to transdermal fentanyl palliative care. Fentanyl may also be prescribed to people with chronic pain who have an opioid tolerance. 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. 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. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be. Fentanyl like morphine is a strong mopioid receptor agonist. Actiq, fentora fentanyl transmucosal dosing, indications. Current actiq dose 400, 600, 800, or 1200 mcg, initial abstral dose 200 mcg. This fast fact and concept is a brief outline of clinical information designed for attending physicians to use during teaching rounds or as the starting point for a conference. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. Importance of proper patient selection, dosing, and potential for abuse. There are no conversion directions available for patients on any other fentanyl products, other than actiq.
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. An alternative algorithm for dosing transdermal fentanyl. Subsys is not bioequivalent with other fentanyl products. Do not abruptly discontinue fentanyl patch it is unknown at what dose level the fentanyl transdermal may be. Duragesic fentanyl transdermal dosing, indications. Morphine milligram equivalents mme calculator mdcalc. Fentanyl exerts its analgesic effect by selectively binding to the muopioid receptor in the central nervous system cns, thereby mimicking the effects of endogenous opiates. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. For patients being converted from actiq, prescribers must use the initial dosing recommendations for patients on actiq table below table 1. Try not to let the fentanyl come into contact with your skin. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Do this before you remove the protective liner from the patch. The initial dose of subsys is always 100 mcg with the only exception of patients already using actiq.
Transmucosal immediate release fentanyl tirf products. Switching from 100mcg duragesic patch to ms contin or. Both drugs work the same way in the body to relieve pain. There is a conversion between hydrocodone and fentanyl. Tirf rems access education program materials and knowledge. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Tirf medicines contain fentanyl, an opioid agonist and a schedule ii controlled substance, with an abuse liability similar to other opioid analgesics. Prescribing and dispensing tirf medicines only to appropriate patients, which includes use only in opioidtolerant patients. A safe and effective method for converting cancer patients. Side effects of duragesic fentanyl transdermal, warnings. Do not convert patients on a mcg per mcg basis from other fentanyl products. Opioid morphine equivalent conversion factors1 cms. Fentanyl moves in the direction of the lower concentration at a rate.
Fentanyl patch converter globalrph conversion from. Opioid conversion ratios guide to palliative care practice. 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. Preventing inappropriate conversion between tirf medicines. 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. Current actiq dose 1600 mcg, initial abstral dose 400 mcg. How should conversion from oral morphine to fentanyl. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. 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. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Calculates total daily morphine milligram equivalents.