Opioid dose equivalence home faculty of pain medicine. See fentanyl information below for initiating patch and patch to po dosing. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. Msir morphine sulfate instant release will release rapidly usually on the order of 1030 minutes whereas mscontin is a controlled release formulation that, unless crushed or chewed or. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Update on prescription extendedrelease opioids and. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Pain management in hospice care todays geriatric medicine. Hi, what would be the approx correct equivalency for switching from using 100mcg duragesic patch to ms contin pills what mg dosage should the pills be at to equal the patch. Equianalgesic chart changes in italics ui health care.
Degroote national pain centre opioid manager switching opioids download. Opioid conversion calculator for morphine equivalents. Ms contin, astramorph morphine dosing, indications. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
Doctors give trusted answers on uses, effects, sideeffects, and cautions. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Potency, defined as the dose required to produce a given effect, is typically compared relative to morphine and differs. It should not be used to determine doses when converting a patient from one opioid to another. He is not certain this has been helping his pain very much, and it is quite expensive. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Ms contin 100 mg and 200 mg tablets, a single dose greater than 60 mg, or a total daily dose greater than 120 mg, are only for use in patients in whom tolerance to an opioid of comparable potency has been established. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Calculation of oral morphine equivalent daily dose omedd. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Calculate dose needed for prn immediate release rescue opioid.
Transdermal fentanyl mcg hour patch size reference 30 10 to 15 300 12 3,12. In one study, patients treated with ir morphine were randomly assigned to either switch to an er morphine ms contin or continue on their existing ir morphine formulation. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. A practical guide to tapering opioids mental health. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. The tablet strength closest to the calculated dose is 30 mg. Demystifying opioid conversion calculations stephanie cheng, pharmd, mph, bcgp.
Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Do not convert mcg for mcg among fentanyl products i. Opioid conversion ratios guide to palliative care practice. 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 treatment. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Canadian guideline for safe and effective use of opioids. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to. In other words, the conversion factor not accounting for days of use would be 6025 or 2. A number of oral and transdermal er opioid formulations are currently available table 1. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extendedrelease opioid formulations, reserve oxycontin for use in patients for whom alternative treatment options e.
It must be made clear however that the methadone is being used to treat pain, and that the taper is being done for medical. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. Select microgram per hour dose of transdermal fentanyl based on table 2. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. What are the differences between ms contin 15mg cr and. 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.
Equivalence between oral morphine and transdermal fentanyl. This is based on studies converting from morphine to fentanyl. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg morphine sulfate ir. When the opioid regimen includes modified and immediaterelease preparations. Recommend an appropriate dose of transdermal fentanyl when. Each of these drugs has a different halflife, side effect and safety profile, and some are better for some people, and some are more. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Morphine milligram equivalents mme calculator mdcalc. Converting from oral morphine to fentanyl transdermal patch. I did that because it says it takes the patch 8 hours to work.
Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. This is my 1st post so ill give a little background. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Currently, there are no empirical studies converting fentanyl to morphine.
Opioids may be all that a person needs for acute pain broken bone, sprained ankle but is never the primary treatment of any chronic pain. Do i need a stronger dosage to not go into withdrawal. Patients switched to ms contin reported lower pain intensity, improved strength, improved quality of life, and better adjustment to disease and treatment. Oral opioid dosing equivalents and conversions university of. Many programs use methadone, as it is less likely to produce euphoria and is inexpensive compared with the other longacting agents.
Butrans contains buprenorphine, a schedule iii controlled substance. Opioid switching using equivalence tables page 1 of 5. Oxycontin, xtampza er oxycodone dosing, indications. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Opioid oral morphine milligram equivalent mme conversion. Calculate the total 24hour morphine dose or morphineequivalent. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Switched from fentanyl patch 15mcg to mscontin 15mg. Some experts use this conversion in cancer patients.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. Transdermal and parenteral fentanyl dosage calculations. 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. Meperidine is not a recommended drug in a palliative care setting and is to be avoided.
For frail elderly patients, use more conservative conversion or a lower strength patch e. Round up or down based on patient factors and available patch sizes. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. From to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch. If a patient has not been on an equivalent of 6090mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch. Im having to switch to 25 milligram fentanyl patch. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as there is. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Opioid dose equivalence faculty of pain medicine anzca.
Equianalgesic dosing of opioids for pain management. Conversion from morphine or equivalent to fentanyl transdermal. Morphine dose equivalence not reliably established. 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. Switching from 100mcg duragesic patch to ms contin or. Available at uihc as an immediaterelease tablet and oral. In these last 20 years ive used these longacting opioids. Transdermal fentanyl is approximately 80 times as potent as morphine. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg morphine per day, 25 mcg. Calculates total daily morphine milligram equivalents. They all interact with specific opioid receptors such as. Fentanyl patch converter globalrph conversion from. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioid converter morphine equivalent calculator omni.
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