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. Oxycontin, xtampza er oxycodone dosing, indications. Taken orally, oxycodone is twice as potent as morphine, but intravenously, morphine is twice as strong as oxycodone. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. It must be made clear however that the methadone is being used to treat pain, and that the taper is being done for medical. Converting from oral morphine to fentanyl transdermal patch. John smith, a terminally ill lung cancer patient has pain that is well. Oct 25, 2019 there are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 9 mg equivalent to 10 mg oxycodone hcl every 12 hours of xtampza er, should be initially substituted for each 25 mcghr. Fentanyl patches are designed to release fentanyl citrate over 72 hours.
It should not be used to determine doses when converting a patient from one opioid to another. 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. 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. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. Remember to enter all opioids the patient is taking. 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. Fentanyl and morphine are two highly potent opioid painrelievers. Fentanyl first rotate to another opioid, such as morphine cr or methadone. Proper storage of patches and disposal of used fentanyl patches is necessary to prevent accidental exposurerisk of death by others. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. I had the cheap mylan patches flat and not jell filled so i ended up cutting them.
Opioid conversion ratios guide to palliative care practice. Recommend an appropriate dose of transdermal fentanyl when. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. Ms contin morphine sulfate provides good longterm pain control without the need to take medicine frequently, but watch out for constipation.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Scottish palliative care guidelines fentanyl patches. Dosage use only when converting another opioid to fentanyl patch. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. Nov 22, 2004 ms contin morphine sulfatecontrolledrelease package insert. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Side effects of duragesic fentanyl transdermal, warnings, uses.
What to do with oxycodone, ms contin, and fentanyl. It is safer to underestimate a patients 24hour oral morphine dosage and provide rescue medication e. A few questions first off, i feel like the starting doses of each of these medications one pill patch is less than the common dose. Ms contin morphine sulfate provides good longterm pain control without the need to take. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. My question is, if im going to the right dosage of fentanyl patch which is 25 milligrams every 72 hours from, 60 milligrams of ms contin. Thats some bad stuff to get off of and there is no easy way that i have found. Ms contin 60 mg by mouth every 12 hours, with morphine oral solution 20 mg every 2. Opioid oral morphine milligram equivalent mme conversion. Pain management in hospice care todays geriatric medicine.
Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. Fentanyl is a horrible drug and is 80 times stonger that morphine. Canadian guideline for safe and effective use of opioids. Oral morphine milligram equivalent conversion tablei. 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. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Morphine is most often used in hospitals and clinical settings to relieve postsurgical pain, while fentanyl may be prescribed to treat chronic pain including that of terminal cancer. In conversion from transdermal fentanyl to oxycodone er, for each 25 mcghour transdermal dose, substitute 10 mg oxycodone er every 12 hours. Converting to transdermal fentanyl palliative care. Round up or down based on patient factors and available patch sizes.
I felt a lot more like myself but i persoanlly don. Equianalgesic chart changes in italics ui health care. If patient is currently receiving opiates, convert to fentanyl patch equiv. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. The total daily morphine milligram equivalents mme will be displayed.
Canadian guideline for safe and effective use of opioids for. Duragesic fentanyl transdermal system is available in generic form. Simple conversion, fentanyl patch, methadone and iv infusion doses. 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 4 tablets x 15mg 60mg 60mg. Patients switched to ms contin reported lower pain intensity, improved. 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. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Im not sure why your doctor didnt prescribe an equipotent dose of morphine, but by my calculations you. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Equianalgesic dosing of opioids for pain management. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg. Side effects of mscontin morphine sulfate controlled. 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 chemical name is nphenyln12phenylethyl4piperidinyl propanamide.
After 72 hours, approximately 40% of fentanyl remains in the patch. Ms contin morphine sulfatecontrolledrelease package insert. Conversion of opioid analgesics to fentanyl transdermal. Some experts use this conversion in cancer patients. Conversion algorithm for instructions on converting from one opioid to another. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. In the case of converting morphine to methadone, methadone has a relative potency of 4. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Transdermal and parenteral fentanyl dosage calculations. What are the steps for converting from morphine or.
Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. May 01, 2020 conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Transdermal patch should be used only in opioid tolerant patients. Google scholar lichtor jl, sevarino fb, and joshi gp. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Dose conversion tool butrans buprenorphine transdermal.
In other words, the conversion factor not accounting for days of use would be 6025 or 2. This is my 1st post so ill give a little background. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Fentanyl patch converter globalrph conversion from. Opioid conversion ratios guide to palliative care practice 2016.
Many programs use methadone, as it is less likely to produce euphoria and is inexpensive compared with the other longacting agents. Oral morphine milligram equivalent conversion table updated 8. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Morphine milligram equivalent mme calculator instructions. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its constant for the most part. The tablet strength closest to the calculated dose is 30 mg. Butrans contains buprenorphine, a schedule iii controlled substance. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Fentanyl patch 25mcghr patch roughly 50mg oral morphineday buprenorphine patch 10mcghr patch 25mg oral morphineday weaker stronger how to use the ome table drug multiply current dose by this factor to equal oral morphine dose tramadol 0.
Advice should be sought from the palliative care team. Switching from 100mcg duragesic patch to ms contin or. Duragesic label page 1 full prescribing information for. In conversion from transdermal fentanyl to oxycodone er, for each 25. Fentanyl to ms contin conversion pain management medhelp. So, can someyou please tell swim what the common dose of each of these is.
Fentanyl patch converter globalrph conversion from other. Oct 01, 2018 ms contin morphine sulfate is a narcotic pain reliever prescribed to treat moderate to severe pain. Morphine milligram equivalent mme calculator nyc health. The patch dosage form of duragesic12 actually delivers 12. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. Opioid conversion calculator for morphine equivalents. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Ms contin morphine sulfate is a narcotic pain reliever prescribed to treat moderate to severe pain. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Switched from fentanyl patch 15mcg to mscontin 15mg. See fentanyl information below for initiating patch and patch to po dosing. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Morphine ms contin slow release every 12 hours 5, 10, 15, 30, 60, 100.
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. The table is based on oral dosing for chronic noncancer pain. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. I am currently trying to come down on the daily narcotic meds i take and am taking oxycodone 34 xs daily, lyrica 200 mg 34 xs daily and ambien cr 12. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs.
Doses of oxycodone er should be initiated 18 hours after the removal of the fentanyl patch. Side effects of duragesic fentanyl transdermal, warnings. I did a conversion once when i found a table online and was shocked to find out that the 100mcg patches i was on are equivalent to over 200 mgs of oxycodone. There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci. Transdermal and parenteral fentanyl dosage calculations and. Both drugs effectively reduce pain but carry high abuse potentials. Only in exceptional circumstances should the buprenorphine or fentanyl patch be removed and the equivalent opioid dose given in a syringe driver, and only after discussion with the palliative care team. Transdermal fentanyl mcg hour patch size reference 30 10 to 15 300 12 3,12 60 20 to 30 600 25 3,12.