My pain management doctor wants to go up on dosage of patch, but i would like to know what other patches are available other than morphine and fentanyl. Opioid conversion table american academy of family. A friend told her about a pain patch that worked well. The total daily morphine milligram equivalents mme will be displayed. There are differences in the literature regarding opioid conversion ratios.
Every 10mg of morphine is like 1mg of diluadid and ever 10mg of morphine is like taking 5mg of oxycodone or. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. These bidirectional differences are not captured in a traditional equianalgesic table. Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral.
A safe and effective method for converting cancer patients. Canadian guideline for safe and effective use of opioids for. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Meptazinol meptid 200mg 4mg to 8mg oxycodone 10mg 20mg pethidine oral 50mg 5mg to 6. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Thank you for downloading opioid manager switching opioid form. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain. Pain management for the geriatric patient geriatrics grand rounds. Oral morphine milligram equivalent conversion table updated 8. Parenteral hydromorphone is 20 times as potent as oral morphine. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid conversions calc single agent equianalgesic. The calculation of opioid conversion is a crucial step in intensive care and is. 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.
Dilaudid, exalgo hydromorphone dosing, indications. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Addressing adverse effects from opioids if the ae is not managed symptomatically and persists for more than one week, switch to another opioid. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. The table is based on oral dosing for chronic noncancer pain. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. Remember to enter all opioids the patient is taking. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Fourthline oral and injectable analgesic for moderate to severe opioid responsive pain in patients unable to tolerate oral morphineoxycodone, subcutaneous diamorphinemorphine or oxycodone due to persistent side effects for example sedation, confusion, hallucinations, itch. Opioid oral morphine milligram equivalent mme conversion factors1,2. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose.
Meperidine is not a recommended drug in a palliative care setting and is to be avoided. 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. Compare fentanyl vs hydromorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Canadian guideline for safe and effective use of opioids. To convert to oral morphine equivalent, multiply by.
Fentanyl patch converter globalrph conversion from other. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. 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. Pain and symptom management pain management 2017 3 3. And just fyi hydromorphone is also known as dilaudid.
The amount of residual drug in the patients system must be accounted for. Adverse effect intervention constipation stepwise escalation of regular oral stimulant or osmotic laxative on opioid initiation. What is the conversion from 150 mcg fentanyl patches every. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. After maybe 6 months to a year of taking the hydromorphone you probably could then get a prescription for fentanyl if you still neededwanted it since by then your body would be opiate tolerant. Conversion from other oral hydromorphone formulations to exalgo. Ivs fentantyl is included in this table to assist with opioid rotation from fentanyl where patients are admitted to olh s on ivs fentanyl. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. 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. So if you remember i converted your total daily dose of fentanyl to oxycontin and it came out to be 210 mg of oxycontin. If the form does not start downloading in 10 seconds, please click here. Hydromorphone oral tablet is a prescription opioid medication thats used to treat severe pain that isnt controlled by other opioid drugs.
Hydromorphone 4 mg po q2h prn breakthrough pain, using on average 6 doses. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. First, convert any opioid in use to its equivalent amount of morphine in mgday. How many morphine 15mg would equal one dillaudid 4mg answers. Currently, there are no empirical studies converting fentanyl to morphine. It would take just over 2, morphine to hydromorphone ration of conversion i 10. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied.
It now makes perfect sense to me why you are in so much pain on the fentanyl. Opioid conversion equianalgesicdose parenteral oral morphine 10mg 30mg hydromorphone 1. The narcotic analgesic converter is based on the following table. There are many opioids and many formulations available e.
How to calculate equivalent morphine dosage when changing the method of administration. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Exalgo hydromorphone hydrochloride extended release. Opioid conversion and brand availability in canada michael g. Morphine milligram equivalent mme calculator instructions. 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.
Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Transdermal and parenteral fentanyl dosage calculations. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl. Start exalgo dose at 50% of calculated daily dose every 24 hours. Opioid converter morphine equivalent calculator omni. Codeine 46 h 3 h im iv sc 120 mg po 200 mg fentanyl 12 h 1. Btw, hydromorphone wont cause rebound headaches so you dont have to worry about taking it daily, it is an extremely clean medication with an extremely low sideeffect profile and.
What is the conversion from 150 mcg fentanyl patches every 3 days to. How long before the fentanyl patch to absorb into the system and starts to. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. 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. They all interact with specific opioid receptors such as. Opioids opiates are a group of analgesic drugs, used primarily for pain management. What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Percocet contains oxycodone 5mg acetaminophen 325mg. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Compare fentanyl vs hydromorphone comprehensive analysis by. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are. Opioid oral morphine milligram equivalent mme conversion. Equianalgesic chart changes in italics ui health care. Hydromorphone 2mg, 4mg tablets 3mg suppositories fentanyl transdermal patches. 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. Transdermal and parenteral fentanyl dosage calculations and. That is 150 mg of oxycontin less than what you were taking through fentanyl vs. Opioid conversions calc single agent equianalgesic globalrph. Opioid conversion and brand availability in canada. 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. Its available as both a generic drug and as the brand.
Oral opioid dosing equivalents and conversions university of. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Start with equivalent total daily dose of immediate release formulation and administer once daily. Monitor the patient carefully for respiratory depression. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor. Converting from oral morphine to fentanyl transdermal patch.
What is the conversion from 150 mcg fentanyl patches every 3. Opioid switching using equivalence tables saskatchewan. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Transdermal fentanyl is approximately 80 times as potent as morphine.
Fentanyl buccal or sl tablets, or lozengetroche5 mcg. The conversion ratios listed below are the conversion ratios commonly used in practice at our ladys hospice and. 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 opiate during the conversion period. Conversion from other oral hydromorphone formulations. Morphine milligram equivalent mme calculator nyc health. 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. 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. Fentanyl patch converter globalrph conversion from. Above 300mg morphine, oxycodone and morphine are 1.
Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. In other words, the conversion factor not accounting for days of use would be 6025 or 2. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Compare fentanyl vs hydromorphone comprehensive analysis. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. It should not be used to determine doses when converting a patient from one opioid to another. Opioid conversion calculator for morphine equivalents. 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. This is based on studies converting from morphine to fentanyl. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl.
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