Opioid conversions calc single agent equianalgesic. Conversion from transdermal fentanyl to hysingla er eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Simple conversion, fentanyl patch, methadone and iv infusion doses. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Fentanyl patches are another option, but are expensive and difficult to titrate. Im finding that the oxymorphone seems to have no effect for my pain. Do not use this table to convert from fentanyl transdermal system to other. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio.
Conversion from transdermal fentanyl to hysingla er. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. Patients considered opioid tolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Calculating opioid dose conversions palliative care. So very recently my doctor has prescribed me oxymorphone 10mg er, along with my other and i came to find out that oxymorphone is really expensive. If pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Morphine milligram equivalent mme calculator nyc health. Oxymorphone to fentanyl equivalent doctor answers on. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Anne, who disliked taking pills and was interested in the convenience of changing a patch only every 3 days, made an appointment to see her family physician to discuss the transdermal fentanyl patch. So i was talking to the pharmacists, and he told me that a fentanyl patch is a cheaper way to go. Equianalgesic dosing of opioids for pain management. She would like to try an immediaterelease opioid agent, hydromorphone.
Remember to enter all opioids the patient is taking. If that is case, might select a fentanyl patch as the best approach. Equianalgesic chart changes in italics ui health care. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f. This is especially important for fentanyl and methadone conversions. List of extendedrelease and longacting opioid products.
Choose either one but not both unless you require a rescue drug. Longacting and extendedrelease opioid products required to have an opioid rems. A safe and effective method for converting cancer patients. Oxycontin, xtampza er oxycodone dosing, indications. Equivalent opioid calculator equianalgesic dosage conversion calculator. Opioid conversion and brand availability in canada michael g.
Total daily dose of oxymorphone a 10 mg x 4 times d 40 mgd 2. The capsules contain microspheres formulated with oxycodone base and are supplied in strengths of 9 mg equivalent to 10 mg oxycodone hcl. Opioid equianalgesic calculator opioid switching from. Oral morphine is about 10 times more potent than oral meperidine and about twice more potent as parenteral meperidine mg for mg 30mg oral morphine. Conversion algorithm for instructions on converting from one opioid to another. What would the conversion be from 150mcgs of fentanyl. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. Xtampza er oxycodone extendedrelease capsules are an opioid agonist for oral use. 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. Because transdermal fentanyl has a delayed onset and onset of. What would the conversion be from 150mcgs of fentanyl patches every 3 days be to dilaudid hydromorhone.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. The patch is fentanyl the strongest family of opiates we have. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Morphine milligram equivalent mme calculator instructions. What is the dose of the fentanyl patch that you are applying. Is there anyone here taking both the fentanyl patch and oxymorphone. 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. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Equivalence between oral morphine and transdermal fentanyl. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Im prescribed both oxymorphone 40mg er 80mg every 12 hours and 10mg ir 20mg every 8 hours.
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. These bidirectional differences are not captured in a traditional equianalgesic table. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. A common question is how to change a patient from oral morphine to a fentanyl patch. Please followup with your provider in working out the best possible pain management for you. Patients using both fentanyl patches and oxymorphone. Opioid conversion calculator for morphine equivalents. Introduction a variety of published conversion tables exist to provide clinicians a rough guide for making calculations when switching between different opioid routes or preparations. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Listed below are methods for common conversions using standard published conversion ratios. 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. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient.
I too use the fentanyl 75mcg patch along with the oxycodone. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a. Fentanyl patches are indicated in patients with stable pain who have difficulty swallowing, unacceptable side effects with oral morphine or other opiates e. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. Methadone has been associated with disproportionate numbers of overdose deaths relative to the frequency with which it is prescribed for chronic pain, due in part to its long and variable halflife. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. The patch will take a little while to get in to your system. Converting from oral morphine to fentanyl transdermal patch. A practical guide to tapering opioids mental health.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms contin, oramorph sr, roxanol, msir 10 30. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Fentanyl patch converter globalrph conversion from. This calculator should not be used to determine doses when converting a patient from one opioid to another. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Titrate liberally and rapidly to analgesic effect during first 24 hours. The examples assume a change in drug or route at a time of stable pain control using equianalgesic.
The equianalgesic chart indicates that 20 mg of oral oxycodone is equal to 30. The total daily morphine milligram equivalents mme will be displayed. Determine mmes of oxycodone oxycodone conversion factor 1. 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.
Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Recent statistics indicate that health care providers wrote 259 million prescriptions for opioids in 2012, enough for every american adult to have received at least one prescription in that year. Meperidine should be used for acute dosing only and not used for chronic pain management meperidine has a short halflife and a toxic metabolite. Program utilizes 20mg for shortterm dosing and 3 mg for chronic dosing. Opioid conversion calculator morphine equivalents advanced. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Opioid therapy conversion needs to be very conservative, because opioid overdose can lead to respiratory depression and may be fatal. Opioid oral morphine milligram equivalent mme conversion.
For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Transdermal and parenteral fentanyl dosage calculations. There are many conversion tables available through the internet and doctors also use theconversion method when finding the right dose for you. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics.
Online calculator to convert equianalgesic doses of opioid narcotic analgesics. In the case of converting morphine to methadone, methadone has a relative potency of 4. Oral opioid dosing equivalents and conversions university of. It should not be used to determine doses when converting a patient from one opioid to another. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Patches in the last days of life leave the buprenorphine or fentanyl patch in situ. Fentanyl is one of the strongest pain meds on the market and it will take a high dose to reach the equivalency. Providers in a variety of settings now routinely see patients who are taking large doses of opioid eg, more than 100 mg of morphine. Conversions with methadone methadone is inexpensive and effective in certain patient populations.
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