Dilaudid morphine conversion doctors answer your questions. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. 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. Opioid conversion ratios guide to palliative care practice. If converting from oral to iv hydromorphone, use a conversion ratio of 7. Why would my primary care doc want to go straight from 60 mgday of morphine er to a fentanyl patch instead of dilaudid. Butrans contains buprenorphine, a schedule iii controlled substance. The following source was used for morphine equivalent conversion factors per mg of opioid. 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.
Converting from oral morphine to fentanyl transdermal patch. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. This is based on studies converting from morphine to fentanyl. What is the conversion from 150 mcg fentanyl patches every 3. Opiate conversion is conducted basing on relative drug potency in equianalgesic charts. Dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Morphine milligram equivalent mme calculator instructions. Opioid conversions calc single agent equianalgesic globalrph. The fentanyl patch duragesic is used for people who have stable, chronic pain and require strong pain medication. Canadian guideline for safe and effective use of opioids. Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
Converting to transdermal fentanyl palliative care network of. Primary doctor will be in best position to answer the question. Hydromorphone 2mg, 4mg tablets 3mg suppositories fentanyl transdermal patches. People with a fentanyl patch continue to have oral pain medication for breakthrough pain. The fentanyl patch equivalent dose duragesic for comparison purposes is. 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. Do not use this table to convert from fentanyl transdermal system to other opioid.
Oral morphine milligram equivalent conversion table updated 8. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Equivalent doses are based on the 24 hour dose of fentanyl or. 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 tramadol po tapentadol po dihydrocodeine po pethidine po. Start with equivalent total daily dose of immediate release formulation and administer once daily.
Opioid conversion calculator for morphine equivalents. For frail elderly patients, use more conservative conversion or a lower strength patch e. Advanced opioid conversion calculator morphine equivalents. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Decrease new dose 3050% to allow for incomplete crosstolerance. 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. Select microgram per hour dose of transdermal fentanyl based on table 2. What is the conversion from 150 mcg fentanyl patches every 3 days to dilaudid.
In other words, the conversion factor not accounting for days of use would be 6025 or 2. Remember to enter all opioids the patient is taking. Doses listed are equivalent to 10 mg of parenteral morphine. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain brand names of. Start exalgo dose at 50% of calculated daily dose every 24 hours. How strong is dilaudid for pain compared to percocet.
Morphine milligram equivalent mme calculator nyc health. 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. When the patent expired the manufacturer making the gereric version calls the patch fentanyl transdermal system. Equianalgesic chart changes in italics ui health care. What is the conversion from 150 mcg fentanyl patches every. Fentanyl 50 mcg ml 1500 mcg in 30 ml 10 25 mcg 8 15 minutes 400 800 mcg hydromorphone 0. Morphine dose equivalence not reliably established. Dec 15, 2001 demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Transdermal and parenteral fentanyl dosage calculations and. It should not be used to determine doses when converting a patient from one opioid to another. 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. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Duragesic fentanyl transdermal dosing, indications. They all interact with specific opioid receptors such as.
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. Do not use this tool to convert from one opioid to a different opioid. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service.
The total daily morphine milligram equivalents mme will be displayed. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. Dilaudid liquid and tablets hydromorphone hydrochloride. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. The major discovery is that the classic opioids like morphine, oxycodone, fentanyl, and dilaudid hydromorphone break down into metabolites that are hyperalgesic, that is, molecules that can actually cause pain when they accumulate under conditions of chronic administration. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Transdermal fentanyl is approximately 80 times as potent as morphine. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Fentanyl patch conversions package insert recommendations.
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 tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sciv. The amount of residual drug in the patients system must be accounted for. These bidirectional differences are not captured in a traditional equianalgesic table. Downsides constipation is a common side effect of dilaudid hydromorphone and may require the use of laxatives or stool softeners. Conversion from other oral hydromorphone formulations. Currently, there are no empirical studies converting fentanyl to morphine. Dilaudid, exalgo hydromorphone dosing, indications. Opioid conversions calc single agent equianalgesic. 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 pain. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours.
A safe and effective method for converting cancer patients. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain. Conversion from morphine or equivalent to fentanyl transdermal. Dose conversion tool butrans buprenorphine transdermal. The patch i am looking at this moment is made by watson laboratories, corona, ca. The duragesic fentanyl patch provides longterm pain relief and lowers the number of times you need to take pain medications each day. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
Transdermal patch should be used only in opioid tolerant patients. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Sometimes people with stable pain are switched to a fentanyl patch, which lasts even longer. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
For oral dilaudid hydromorphone the equivalent dose would be between 7580mgs. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. Calculate the total 24hour morphine dose or morphineequivalent. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Oral dosage extendedrelease for conversion from transdermal fentanyl patch adults calculate the total daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr.
Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. It should only be used once a person has been on another opioid for several days and the pain is well managed. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. 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. Oct 19, 2004 dilaudid hydromorphone and fentanyl sublimaze each potentially produces the same degree of pain relief. Guidelines for adult patients intravenous pca orders.
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. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. There are many opioids and many formulations available e. If youre a patient, consult a physician instead of modifying your therapy by yourself. If you are converting a patient to or from fentanyl i. This might explain the experience of switching to more and more.
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. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Canadian guideline for safe and effective use of opioids for. Hydromorphone oral tablet is a prescription drug thats available as the brandname drugs dilaudid immediate release and exalgo extended release.
Transdermal and parenteral fentanyl dosage calculations. Mar 21, 20 the medication fentanyl in the original patch is the same medication as the generic patch made by watson. In the case of converting morphine to methadone, methadone has a relative potency of 4. Recommend an appropriate dose of transdermal fentanyl when.
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. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Fentanyl patch converter globalrph conversion from. The medication fentanyl in the original patch is the same medication as the generic patch made by watson. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. And just fyi hydromorphone is also known as dilaudid. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. Equivalence between oral morphine and transdermal fentanyl. Opioid converter morphine equivalent calculator omni. Effects of patch last for 18 24 hours after the patch is removed.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. You might also be interested in our dosage, paracetamol, and ibuprofen calculators, or steroid converter. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. In the case example above, 216 mg of oral morphine per day is. Remember to double check the results before administering any drugs to your patients. For example the conversion ratios of oral to parenteral morphine ranged from 3.
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