How should conversion from oral morphine to fentanyl. Avinza, kadian, ms contin, oxycontin, opana er, duragesic, and embeda are not indicated as an asneeded prn analgesic. She would like to try an immediaterelease opioid agent, hydromorphone. Ms contin morphine sulfate provides good longterm pain control without the need to take medicine frequently, but watch out for constipation. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. I thought the weird flu like symptoms might be a result of the new drug, but apparently it has to be withdrawal from the morphine. Longacting and extendedrelease opioid products required to have an opioid rems. For instance, yesterday i took 60 milligram ms contin and at.
How should conversion from oral morphine to fentanyl patches be carried out. When initiating transdermal fentanyl, patients should use shortacting opioids as needed until. Fentanyl patch converter globalrph conversion from. Convert each number in your list to iv morphine equivalents, by using column 2. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Opioid oral morphine milligram equivalent mme conversion factors1,2. Morphine immediaterelease tablets, oral solutionk,l. What are the steps for converting from morphine or equivalent to. 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. Transdermal and parenteral fentanyl dosage calculations.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Blood concentrations can be improved by dosing every 8 hours, but more frequent dosing obviates one of the benefits of using extendedrelease medications dohoo, 1997. Opioid conversion and brand availability in canada michael g.
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. Oral transmucosal fentanyl citrate 200 mcg 30 unitscarton actiq. Conversions with methadone methadone is inexpensive and effective in certain patient populations. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. Converting from oral morphine to fentanyl transdermal patch. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. For frail elderly patients, use more conservative conversion or a lower strength patch e. Patches in the last days of life leave the buprenorphine or fentanyl patch in situ and change regularly as prescribed. There is also a msir which is a morphine sulfate immediate release as well. Morphine milligram equivalent mme calculator instructions. There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials.
Do not initiate fentanyl patches at the end of life when the oral route is no longer available. The methadone conversion table indicates that a conversion factor for a domed. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Fentanyl patches are another option, but are expensive and difficult to titrate. Opioid oral morphine milligram equivalent mme conversion. Currently, there are no empirical studies converting fentanyl to morphine. List of extendedrelease and longacting opioid products. Conversions from one opiate to another are typically done reducing the new opiate dose by 20 30 % for cross tolerance. Pain management,pharmacists, nursing, physicians,health care providers,morphine, tylox, lortab, vicodin, fentanyl, dilaudid, meperidine, percodan, oxycodone. For chronic dosing, 10 mg iv morphine 30 mg oral morphine. The difference is in the time factor oxycontin has an advertised dosage time of 12 hours effective dosage, while fentanyl patches are good for either 48 to 72 hours depending on the individual. Select microgram per hour dose of transdermal fentanyl based on table 2. Meperidine is nota recommended drug in a palliative care setting and is to be avoided.
Didnt know where else to put this, but i was recently switched from morphine 60mg er to the fentanyl duragesic patch. Canadian guideline for safe and effective use of opioids. Are oxycontin and fentanyl patches safe to take at the. Opioid converter morphine equivalent calculator omni. Decrease new dose 3050% to allow for incomplete crosstolerance. Unfortunately my late wife had to take both the ms contin and occasionally the msir during a period of 6 12 years as she battled heart disease and diabetes up until. The total daily morphine milligram equivalents mme will be displayed. Opiate conversion with an incomplete crosstolerance adjustment crosstolerance is a phenomenon that occurs in many drug groups and has consequences in the usage of opiates. It should not be used to determine doses when converting a patient from one opioid to another. Morphine milligram equivalent mme calculator nyc health. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Fentanyl transdermal system 25 mcghr 5 patches carton duragesic. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. For transdermal preparations patches the equianalgesic oral morphine dose is listed for the lowest strength of each patch opioid patch strength.
Equivalence between oral morphine and transdermal fentanyl. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid.
Opioid conversion tips changing to another oral opioid question. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. Converting from fentanyl back to oral pain meds is a difficult. Equianalgesic dosing of opioids for pain management. Do not use this table to convert from fentanyl transdermal system to other opioid. If needed, give additional analgesia using a different opioid. Do i need a stronger dosage to not go into withdrawal. 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. 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. Calculate the total 24hour morphine dose or morphineequivalent.
Reserve fentanyl patches for use in opioidtolerant patients with chronic pain and established opioid needs who cannot take oral morphine, for example, in severe renal impairment. Morphine sulfate extendedrelease tablets 30 mg 100 u. Because it may be difficult to determine analgesic need using a controlledrelease product, it is recommended to initiate therapy with immediaterelease products. The equianalgesic chart indicates that 20 mg of oral oxycodone is equal to 30 mg of oral morphine. 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. As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount.
S when converting from 30 to 80 mg of morphine equivalents daily dose, first taper to 30 mg oral morphine equivalents, then start with the 10 mcghr patch. Oxycontin, xtampza er oxycodone dosing, indications. Oral opioid dosing equivalents and conversions university of. 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. Fentanyl to ms contin conversion pain management medhelp. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. There is no direct conversion for fentanyl lozenge to. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Switching from 100mcg duragesic patch to ms contin or. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Parenteral oral parenteral oral parenteral oral oral.
Pain management in hospice care todays geriatric medicine. Coggins, pharmd, cgp, fascp todays geriatric medicine vol. 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. This is my 1st post so ill give a little background. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. Do not convert mcg for mcg among fentanyl products i. Equianalgesic chart changes in italics ui health care. Im having to switch to 25 milligram fentanyl patch. Only persons with experience should be using methadone. The patients current dose of 240 mg per day of oral oxycodone is equal to 360 mg per day of oral morphine.
Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f. Remember to enter all opioids the patient is taking. Scottish palliative care guidelines fentanyl patches. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Pain control, one of the central goals of hospice care, is a top priority in endoflife care. Teens arrested for fentanyl stash at school worth more. Switched from fentanyl patch 15mcg to mscontin 15mg. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. These pills shown are not fentanyl but are ms contin 30 mg continuous release pills just like stated. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1. To convert to oral morphine equivalent, multiply by. Conversion from morphine or equivalent to fentanyl transdermal. Mscontin does not achieve therapeutic blood levels in dogs when it is administered every 12 hours.
Opioid conversion ratios guide to palliative care practice. It is safer to underestimate a patients 24hour oral morphine dosage and provide rescue medication e. Consider increasing scheduled opioid dose by 3050%. Fentanyl patches might also be useful when oral opioids cannot be used because of vomiting or difficulty swallowing. Opioid conversion calculator for morphine equivalents.