They all interact with specific opioid receptors such as. Opioid conversions calc single agent equianalgesic. Conversion from other oral hydromorphone formulations. Canadian guideline for safe and effective use of opioids for.
Oct 19, 2004 dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Mar 21, 20 the medication fentanyl in the original patch is the same medication as the generic patch made by watson. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Fentanyl patch conversions package insert recommendations.
Dose conversion tool butrans buprenorphine transdermal. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. 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. You might also be interested in our dosage, paracetamol, and ibuprofen calculators, or steroid converter. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sciv. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Morphine milligram equivalent mme calculator instructions. Fentanyl 50 mcg ml 1500 mcg in 30 ml 10 25 mcg 8 15 minutes 400 800 mcg hydromorphone 0. If you are converting a patient to or from fentanyl i.
Remember to double check the results before administering any drugs to your patients. Transdermal and parenteral fentanyl dosage calculations and. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. The fentanyl patch duragesic is used for people who have stable, chronic pain and require strong pain medication. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. 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. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio.
In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain brand names of. The amount of residual drug in the patients system must be accounted for. Downsides constipation is a common side effect of dilaudid hydromorphone and may require the use of laxatives or stool softeners. Butrans buprenorphine transdermal system ciii is indicated for the management of pain severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. Guidelines for adult patients intravenous pca orders.
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. 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 pain. Decrease new dose 3050% to allow for incomplete crosstolerance. The following source was used for morphine equivalent conversion factors per mg of opioid. It should not be used to determine doses when converting a patient from one opioid to another. Morphine milligram equivalent mme calculator nyc health. Opioid oral morphine milligram equivalent mme conversion. Why would my primary care doc want to go straight from 60 mgday of morphine er to a fentanyl patch instead of dilaudid. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
And just fyi hydromorphone is also known as dilaudid. Transdermal fentanyl is approximately 80 times as potent as morphine. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po. Duragesic fentanyl transdermal dosing, indications. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Effects of patch last for 18 24 hours after the patch is removed. For example the conversion ratios of oral to parenteral morphine ranged from 3. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Start with equivalent total daily dose of immediate release formulation and administer once daily. Opioids opiates are a group of analgesic drugs, used primarily for pain management. In the case example above, 216 mg of oral morphine per day is. 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.
Transdermal and parenteral fentanyl dosage calculations. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Sometimes people with stable pain are switched to a fentanyl patch, which lasts even longer. Opioid conversions calc single agent equianalgesic globalrph. Conversion from morphine or equivalent to fentanyl transdermal. Converting to transdermal fentanyl palliative care network of. A safe and effective method for converting cancer patients. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. 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. Calculate the total 24hour morphine dose or morphineequivalent. The total daily morphine milligram equivalents mme will be displayed. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. How strong is dilaudid for pain compared to percocet.
Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The fentanyl patch equivalent dose duragesic for comparison purposes is. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. Canadian guideline for safe and effective use of opioids. Converting from oral morphine to fentanyl transdermal patch. In other words, the conversion factor not accounting for days of use would be 6025 or 2. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. 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. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr.
For oral dilaudid hydromorphone the equivalent dose would be between 7580mgs. Butrans contains buprenorphine, a schedule iii controlled substance. The duragesic fentanyl patch provides longterm pain relief and lowers the number of times you need to take pain medications each day. Do not use this tool to convert from one opioid to a different opioid. Fentanyl conversion not to be used for acute pain management oral morphine 50100mg 24 hours fentanyl 25 mcg hour patch oraltransdermal availability of commonly prescribed opioids. Equivalence between oral morphine and transdermal fentanyl. Oral morphine milligram equivalent conversion table updated 8.
Primary doctor will be in best position to answer the question. Hydromorphone 2mg, 4mg tablets 3mg suppositories fentanyl transdermal patches. Advanced opioid conversion calculator morphine equivalents. Select microgram per hour dose of transdermal fentanyl based on table 2. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Opioid converter morphine equivalent calculator omni. There are many opioids and many formulations available e. Do not use this table to convert from fentanyl transdermal system to other opioid. Start exalgo dose at 50% of calculated daily dose every 24 hours. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
For frail elderly patients, use more conservative conversion or a lower strength patch e. When the patent expired the manufacturer making the gereric version calls the patch fentanyl transdermal system. Dilaudid liquid and tablets hydromorphone hydrochloride. Morphine dose equivalence not reliably established. Opioid conversion ratios guide to palliative care practice. Opioid conversion calculator for morphine equivalents. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Doses listed are equivalent to 10 mg of parenteral morphine. These bidirectional differences are not captured in a traditional equianalgesic table. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. The medication fentanyl in the original patch is the same medication as the generic patch made by watson. If youre a patient, consult a physician instead of modifying your therapy by yourself. Dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Dilaudid, exalgo hydromorphone dosing, indications. 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.
Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present. 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 patch converter globalrph conversion from. This might explain the experience of switching to more and more. Opiate conversion is conducted basing on relative drug potency in equianalgesic charts. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Equianalgesic chart changes in italics ui health care. Currently, there are no empirical studies converting fentanyl to morphine.
The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Dilaudid morphine conversion doctors answer your questions. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. The patch i am looking at this moment is made by watson laboratories, corona, ca. What is the conversion from 150 mcg fentanyl patches every.
Oral dosage extendedrelease for conversion from transdermal fentanyl patch adults calculate the total daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and. This is based on studies converting from morphine to fentanyl. Hydromorphone oral tablet is a prescription drug thats available as the brandname drugs dilaudid immediate release and exalgo extended release. Transdermal patch should be used only in opioid tolerant patients. What is the conversion from 150 mcg fentanyl patches every 3 days to dilaudid. What is the conversion from 150 mcg fentanyl patches every 3. The major discovery is that the classic opioids like morphine, oxycodone, fentanyl, and dilaudid hydromorphone break down into metabolites that are hyperalgesic, that is, molecules that can actually cause pain when they accumulate under conditions of chronic administration. Recommend an appropriate dose of transdermal fentanyl when. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc.
It should only be used once a person has been on another opioid for several days and the pain is well managed. Remember to enter all opioids the patient is taking. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
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