Surprisingly, crosstolerance between opioids is often incomplete. Tablet with 5 mg hydrocodone and 500 mg acetaminophen. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Advanced opioid conversion calculator morphine equivalents. Opioid oral morphine milligram equivalent mme conversion. 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. There is a conversion between hydrocodone and fentanyl. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. This calculator should not be used to determine doses when converting a patient from one opioid to another. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
Equianalgesic chart changes in italics ui health care. 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. An alternative algorithm for dosing transdermal fentanyl. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. In addition to this i take 2 ibuprophen every 4 hours and several supplemental nerve formula and imflamatory formula supplements to help in this process. Conversion from transdermal fentanyl to hysingla er. Canadian guideline for safe and effective use of opioids. Converting from oral morphine to fentanyl transdermal patch opioid conversion tutorial. 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. Start exalgo dose at 50% of calculated daily dose q24hr. Transdermal and parenteral fentanyl dosage calculations.
Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Transdermal and parenteral fentanyl dosage calculations and. The patients calculated dose of 25 mg of oral hydromorphone is equal to 100 mg of oral morphine. 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. Hydrocodone, 20mg of oral hydrocodone, na, oral hydrocodone is roughly. For severe pain, a higher potency opioid agonist eg, hydromorphone, morphine, fentanyl can be used. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. This is particularly important if converting from longacting oral opioids or fentanyl patches. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Dose conversion in opioid rotation from continuous intravenous infusion of morphine hydrochloride injection to fentanyl patch in the management of cancer pain. Hydromorphone, like other opioids, stimulates receptors on nerves in. There is no direct conversion for fentanyl lozenge to other opioids including morphine the recommended initial dose of lozenge is 200 micrograms if pain is not relieved then the dose can be increased until effective. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Practical management of opioid rotation and equianalgesia.
Recommend an appropriate dose of transdermal fentanyl when. Equianalgesic doses contained in this chart are approximate, and should be used only. In the case of converting morphine to methadone, methadone has a relative potency of 4. Start with equivalent total daily dose of immediate release formulation and administer once daily. Exalgo hydromorphone hydrochloride dose, indications. Remember to enter all opioids the patient is taking. These dose conversions are estimated and cannot account for all individual. They all interact with specific opioid receptors such as. Start exalgo dose at 50% of calculated daily dose every 24 hours. The dose adjustment, if necessary, should be based on the amount of rescue medication needed on the second and third day after application. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Converting from oral morphine to fentanyl transdermal patch. Opioid manager switching opioids morphine equivalence table. Jannsen, the manufacturer of fentanyl patches, suggests a more conservative dosing schedule in converting to.
It is used for management of acute pain and moderatetosevere chronic pain in patients when the use of an opioid is appropriate. Oct 29, 2018 conversion ratio was defined as 24hour oral opioid dose before dischargenet iv hydromorphone dose for each patient. Dosing may be done incrementally and titrated to analgesic effect. Convert each dose into mmes by multiplying the dose by the conversion factor. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. 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. Abstral fentanyl dose, indications, adverse effects. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl patch converter globalrph conversion from other. 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.
This is especially important for fentanyl and methadone conversions. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. For moderate pain, an opioid agonist eg, hydrocodone, oxycodone. The total daily morphine milligram equivalents mme will be displayed. Proper conversion is dependent upon a variety of factors drug dosage, cross tolerance or. Morphine milligram equivalent mme calculator nyc health. Hydromorphone and hydrocodone are both semisynthetic opioids, but hydromorphone is a much stronger pain reliever about 10 times stronger than hydrocodone. For example, in converting from oral morphine to oral hydromorphone, it would be. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl patch. I am taking 12 pill of the hydromorphone and 12 pill of the hydrocodone every 4 hours and the full lorazapam 1mg every 6 hours for the extra anxiety that im already feeling. Select microgram per hour dose of transdermal fentanyl based on table 2. Morphine milligram equivalent mme calculator instructions. Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as there is. Calculate the total 24hour morphine dose or morphineequivalent.
Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. The dose of fentanyl should not be adjusted for at least 72 hours after application of the initial patch. Conversion from morphine or equivalent to fentanyl transdermal. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. Transdermal patch should be used only in opioid tolerant patients. Subsequent changes to the patch dose should occur no more than every six days. Opioid equivalence chart gloucestershire hospitals nhs. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Exalgo hydromorphone hydrochloride extended release.
Conversion from other oral hydromorphone formulations. They found that the median interquartile range conversion ratio from hmiv to hmpo was 2. Particular care is required when dealing with high doses of opiates. Duragesic fentanyl transdermal dosing, indications. It is used for management of acute pain and moderate to severe chronic pain in patients when the use of an opioid is appropriate. This is based on studies converting from morphine to fentanyl. Fentanyl patch converter globalrph conversion from. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Dose conversion tool butrans buprenorphine transdermal. Equianalgesic dosing of opioids for pain management. Round down, if necessary, to the appropriate exalgo tablet. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Oct 15, 2019 patients considered opioidtolerant 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. Canadian guideline for safe and effective use of opioids for. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. The oral dose of morphine should be reduced by 30% to 50% to prevent any risk of overdose after the conversion, since opioids do not have complete crosstolerance. Patients considered opioidtolerant 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. Opioid converter morphine equivalent calculator omni. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl.
Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. 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. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Hydromorphone hydrochloride dilaudid is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioids. Currently, there are no empirical studies converting fentanyl to morphine. Decrease new dose 3050% to allow for incomplete crosstolerance.
The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much. 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. Nov 19, 2019 an opioid tolerant patient is one who has been receiving for 1week or longer at least. 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 daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for each 25 mcghour fentanyl transdermal patch. Buprenorphine buprenex butorphanol stadol codeine fentanyl duragesic hydrocodone hydromorphone dilaudid levorphanol meperidine demerol methadone morphine nalbuphine nubain oxycodone oxycontin oxymorphone pentazocine talwin. All noninjectable fentanyl products are for opioidtolerant patients. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Per the product labeling, convert to exalgo 12 mg from oral codeine 200 mg, hydrocodone 30 mg.
For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Patients considered opioidtolerant 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. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. You should take your vicodin with it for the first 23 days. An opioid tolerant patient is one who has been receiving for 1week or longer at least. Exalgo hydromorphone hydrochloride extended release tablets. For frail elderly patients, use more conservative conversion or a lower strength patch e.
416 511 869 1474 735 860 118 1600 4 1316 833 1375 331 997 179 857 216 1446 172 317 1430 1285 18 616 67 102 1045 426 418 451 1078 146 1382 1282 1138 53 894 705 1373 804 310