There is currently no accepted conversion factor or process to convert iv push to td fentanyl. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Recommend an appropriate dose of transdermal fentanyl when. Stop long acting oral morphine after applying patch. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Thats some bad stuff to get off of and there is no easy way that i have found. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the ci rate. A safe and effective method for converting cancer patients. Mean values for unbound fractions of fentanyl in plasma are estimated to be between and 21%. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
Both drugs work the same way in the body to relieve pain. Apply to intact, nonhairy skin on the upper trunk or upper arm. A safe and effective method for converting patients from transdermal. The fentanyl patch comes in multiples of 25 micrograms. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose.
But what is a fentanyl transdermal patch and what are the side effects. What are the steps for converting from morphine or. Oral morphine milligram equivalent conversion table updated 8. Dosage use only when converting another opioid to fentanyl patch. Fentanyl is a horrible drug and is 80 times stonger that morphine. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. 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 pain. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.
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. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. A safe and effective method for converting patients from. Changing an oral or iv opioid to transdermal fentanyl 1. Duragesic fentanyl transdermal system releases fentanyl from the reservoir at a nearly constant amount per unit time. All nine patients initially reported their pain with movement as. 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. Select microgram per hour dose of transdermal fentanyl based. Duragesic fentanyl transdermal dosing, indications. It takes around 20 range 27 hours for the plasma fentanyl concentration to decrease by 50% 414.
It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. Transdermal and parenteral fentanyl dosage calculations and. Intravenous fentanyl should only be administered by health care professionals trained in anesthesiology who are familiar with the respiratory effects of potent opioids. Pain intensity, sedation, and hourly iv fentanyl requirements after conversion. Narcotic pain relievers also can be addictive and abused. Converting to transdermal fentanyl palliative care. Twostep titration weans patients from iv to patch fentanyl. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. In contrast, the newer generic patch by mylan lacks a reservoir, with the fentanyl instead being suspended in a gel matrix within the. Fentanyl moves in the direction of the lower concentration at a rate. Transdermal and parenteral fentanyl dosage calculations. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain.
It is an opioid pain medicine also known as a narcotic drug used to treat severe pain. 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. The actual fent is locked within the plastic matrix of the patch. Duragesic label page 1 full prescribing information for use. Equianalgesic chart changes in italics ui health care. What every pharmacist should know about transdermal. Dailymed fentanyl transdermal patch, extended release. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Conversion of intrathecal opioids to fentanyl in chronic. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a. 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. The heat will cause the fent to be released rather quickly, in the same way that applying a hand warmer to your a worn patch speeds up the release, while the alcohol acts as a very efficient medium to transfer the released fent as.
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. The nine patients included in this case series were switched from transdermal to iv fentanyl for accurate dosage titration. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Converting to transdermal fentanyl palliative care network.
You maybe looking to buy fentanyl patch 25 or 50 mcghr, we have every dosage 12, 37. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. In australia fentanyl patches come in five different strengths. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Fentanyl conversion table patch strength microgram total quantity of fentanyl equivalent. 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. Fentanyl patches durogesic for chronic pain nps medicinewise. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Converting from oral morphine to fentanyl transdermal patch. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice on removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting.
Because of fentanyls strength doses are measured in micrograms mg. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice. Conversion of opioid analgesics to fentanyl transdermal. If pain is stable the patient may be considered for conversion to a fentanyl patch. 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. The original system, duragesic, has a reservoir which contains fentanyl in a fluid state. Scottish palliative care guidelines fentanyl patches. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. It may be 812h or longer after putting on the first patch before pain relief is experienced.
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. Duragesic label page 1 full prescribing information for. Converting from fentanyl given by iv infusion or via a pca device. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Advice should be sought from the palliative care team.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Convert the oral morphine dose to duragesic there are two methods. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. In other words, the conversion factor not accounting for days of use would be 6025 or 2. If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. It conversion ratio, eventual it fentanyl dose, and iv. Abstral fentanyl dose, indications, adverse effects. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. What every pharmacist should know about transdermal fentanyl. 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. Opioid oral morphine milligram equivalent mme conversion. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows.
A safe and effective method for converting cancer patients from. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to. In the case of converting morphine to methadone, methadone has a relative potency of 4. 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. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Converting to transdermal fentanyl palliative care network of. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Previous case reports describe intravenous iv injection after the extraction of liquid fentanyl from this reservoir 27. Fentanyl patch converter globalrph conversion from. Efficacy and safety of a sixhour continuous overlap method.
After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. 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. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. Fentanyl patch converter globalrph conversion from other. Efficacy and safety of a sixhour continuous overlap.
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. 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. Fentanyl patch 25 50 mcghr and more huge discounts. 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. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. After discontinuing a fentanyl patch, fentanyl levels fall gradually. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis.
It conversion ratio reached to give superior vas from previous it opioid. My own guide on extracting nongel fentanyl patches. Approximately 9% of the dose is recovered in the feces, primarily as metabolites. 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. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. 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. Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor. 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. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication.