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 total daily morphine milligram equivalents mme will be displayed. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Duragesic patches are intended for transdermal use on intact skin only. Do not use a fentanyl transdermal system if the pouch seal is broken or the patch is cut, damaged or changed in any way. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl.
Advice should be sought from the palliative care team. Ninety adult patients undergoing cardiac surgery were randomized to a fentanyl based, sufentanilbased, or remifentanilbased anesthetic. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief.
Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Titrate liberally and rapidly to analgesic effect during first 24 hours. The eviq opioid conversion calculator is only to be used for patients greater than 12 years old. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. Transdermal and parenteral fentanyl dosage calculations and. Use an individualized, multimodal treatment plan to manage pain. The conversion calculation for a continuous fentanyl drip at 100mcghr is needless to say, much much more than 1020mg of oxycodone q6 hrs.
Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Changing an oral or iv opioid to transdermal fentanyl 1. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. In a recent experience, a similar initial conversion ratio between tts fentanyl and oral methadone was used. Road map for opioid management in the inpatient setting. Describe different types of breakthrough pain and recommend an opioid regimen to treat these pains.
Total dosage expressed as fentanyl base low dose moderate dose high dose 2 mcgkg 0. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. Conduct a full body skin assessment of patients prior to administering a new opioid to rule out the possibility that the patient has an applied fentanyl patch or implanted drug delivery system or infusion pump. It can help identify patients who may be misusing prescription opioids or. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Fentanyl transdermal system fentanyl transdermal system. May 05, 2014 fentanyl is a low molecular weight synthetic opioid, with high potency analgesic effect in intravenous route injection. As if this were not enough, the skill of converting opioids requires more than the use of simple conversion rates. Conversion factors in this table cannot be used to convert from duragesic to another opioid doing so may lead to fatal overdose due to. Morphine milligram equivalent mme calculator nyc health. Only consider prescribing transdermal fentanyl if familiar with. For perspective, strom 2010 was able to treat the pain of intubated patients with a median opioid dose equivalent to 20 mg oxycodone daily. May 09, 2016 fentanyl is typically infused at 50200 mcghr, equivalent to 240960 mg of oxycodone daily. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl.
Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Fentanyl is a low molecular weight synthetic opioid, with high potency analgesic effect in intravenous route injection. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature. Remember to enter all opioids the patient is taking. Mar 28, 2016 the conversion calculation for a continuous fentanyl drip at 100mcghr is needless to say, much much more than 1020mg of oxycodone q6 hrs. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Medically, fentanyl is used by injection, as a patch on the skin.
Do not remove a fentanyl transdermal system from the pouch until you are ready to use it. 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. Recommend an appropriate dose of transdermal fentanyl when. Feb 22, 2016 karen shapiro, pharmd, bcps, instructor. Therefore, we frontloaded sufentanil at approximately one third the dose of the fentanyl to compensate for the shorter halflife. You mention it above but i was curious if you had any additional thoughts on why this might be.
A structured approach to opioid selection and titration. Although sufentanil is typically considered to be 5 to 10 times more potent than fentanyl, it has a shorter halflife than fentanylapproximately half as long. Yet this dose or similar doses seem to have a much greater impact on the patient compared to what id expect. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose. Dosing and titrating opioids emergency preparedness and. Sep 21, 2016 in a recent experience, a similar initial conversion ratio between tts fentanyl and oral methadone was used. For patients under this age consult with a pain or palliative care specialist.
A comparison of fentanyl, sufentanil, and remifentanil for f. Rapid switching between transdermal fentanyl and methadone in. Fentanyl citrate injection, usp rx only description. Fentanyl is a synthetic centrally acting opioid agonist that has a rapid onset of action, short duration of effect, and lack of histamine release. For this reason the date of birth field is mandatory. For delivery rates in excess of 100 mcghour, multiple systems may be used. Duragesic label page 1 full prescribing information for use. The conversion process must take into account such factors as. Asking the right questions to find the best answers cheryl k genord, r. Fentanyl patch converter globalrph conversion from. I use duragesic fentanyl patches 125 mcg one 100 mcg patch and one 25 mcg patch every 72 hours for intense chronic pain caused by generalized internal chronic rsd and i take msir morphine sulfate immediate release capsules 30 mg one capsule once or twice daily as needed for. Narcotic pain relievers also can be addictive and abused. Fentanyl dose equivalent subcut morphine dose subcutaneous prn. Proper conversion is dependent upon a variety of factors drug dosage, crosstolerance or lack thereof among opioids, and physiologic differences in drug metabolism.
Determine an appropriate strategy to change an opioid regimen, including both the regularly scheduled and rescue opioids. A comparison of fentanyl, sufentanil, and remifentanil for. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Transdermal and parenteral fentanyl dosage calculations. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. Duragesic label page 1 full prescribing information for. Opioid conversion table instructions convert all iv medications to iv morphine convert iv morphine to po morphine 1. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Both drugs work the same way in the body to relieve pain.
The joint commission provides hospitals guidance for better. Duragesic fentanyl transdermal dosing, indications. 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. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. In addition to the analgesia during surgery, fentanyl may also provide some pain relief in the immediate postoperative period. According to iv doses, fentanyl is considered to have 50 to 100 times the potency of morphine. Converting from oral morphine to fentanyl transdermal patch. Jan 29, 2018 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. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Option for converting final out put into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. It has a rapid onset and its effects generally last less than two hours.
Transdermal fentanyl patches versus patientcontrolled. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. A safe and effective method for converting cancer patients. 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. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis.
Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. No equianalgesic table is able to take into account patientspecific factors primarily hepatic function, renal function, and age. Opioid oral morphine milligram equivalent mme conversion. Postoperative pain was measured at 30 min after extubation and at 6. Due to the small molecule structure and high lipid solubility, fentanyl could be a good choice for transdermal use. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Fentanyl citrate injection, usp is a potent o p i o i d ag o nis t. The texas prescription monitoring program is an electronic database that tracks controlled substance prescriptions.
Fentanyl and fentanyl analogs are increasingly entering the drug supply as counterfeit tablets or substituted for prevention and treatment of neonatal pain view in chinese ventilated infants treated with fentanyl compared with controls but there were no differences in clinical outcomes between the fentanyl and placebotreated groups. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a generous dose of common sense. Converting to transdermal fentanyl palliative care. Each milliliter of solution contains fentanyl citrate equivalent to 50 mcg of fentanyl base, adjusted to ph 4. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. 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. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. The joint commission provides hospitals guidance for. Gain insight on this pain management option, its indications and usage, associated risk factors, and stepbystep application tips. One explanation may be that fentanyl is functioning as a weak.
Opioid metabolism and excretion do differ among the opioids. Dose conversion guidelines for transdermal fentanyl see tables. The conversion factors in these tables are only to be used for the conversion from current opioid therapy to duragesic us labeling. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Morphine milligram equivalent mme calculator instructions. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Dosing and titrating opioids clinician outreach and communication activity coca call. Opioid conversion calculator morphine equivalents advanced. Rapid switching between transdermal fentanyl and methadone. Fentora fentanyl dose, indications, adverse effects.
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