Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral. Converting to transdermal fentanyl palliative care. Transdermal and parenteral fentanyl dosage calculations. Fentanyl, on the other hand, was first synthesized in 1959 and was not introduced to wider medicinal use until the 1990s. Hydromorphone is more potent than morphine, which simply means that a smaller quantity of hydromorphone has the same pain relieving effect as a larger quantity of morphine. Fentanyl dosage increase guideline is based on the daily dose of supplementary oral morphine. The fentanyl patch comes in multiples of 25 micrograms. Jul 01, 2016 subsequently, a transdermal fentanyl patch 50 mcghr was added to the iv hydromorphone regimen and the pain score improved from 81010 to 6810 within three days of therapy. Morphine milligram equivalent mme calculator nyc health. In contrast, the newer generic patch by mylan lacks a reservoir, with the fentanyl instead being suspended in a gel matrix within the. Compare fentanyl vs hydromorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Converting from oral morphine to fentanyl transdermal patch.
Equianalgesic chart changes in italics ui health care. To discontinue fentanyl, remove patch and titrate dose of a new analgesic based on the patients report of pain. Recommend an appropriate dose of transdermal fentanyl when. Fentanyl patch protocol ventura county, california. What are the steps for converting from morphine or. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. For some patients, however, hydromorphone may be a better first choice. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows.
Dr prescribed dilaudid and fentanyl patch, is this safe, don. It has a rapid onset and its effects generally last less than two hours. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. Advanced opioid conversion calculator morphine equivalents.
For patients on opioids other than oral morphine, please use the following chart to calculate. Duragesic fentanyl transdermal dosing, indications. Dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia.
After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. Converting to transdermal fentanyl palliative care network. If converting from oral to iv hydromorphone, use a conversion ratio of 7. Assessment algorithm for sedated adult icu patients icu. Medically, fentanyl is used by injection, as a patch on the skin, as a nasal spray, or in the mouth. For example, someone taking 10 mg of morphine may be switched to 1 or 2 mg of hydromorphone. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Select microgram per hour dose of transdermal fentanyl based. Dr prescribed dilaudid and fentanyl patch, is this safe, dont want to overdose. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Previous case reports describe intravenous iv injection after the extraction of liquid fentanyl from this reservoir 27. Oct 01, 2018 dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Opioid switching using equivalence tables saskatchewan. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours.
For frail elderly patients, use more conservative conversion or a lower strength patch e. Remember to enter all opioids the patient is taking. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl.
Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Subsequently, a transdermal fentanyl patch 50 mcghr was added to the iv hydromorphone regimen and the pain score improved from 81010 to 6810 within three days of therapy. Fentanyl topical may also be used for purposes other than those listed in this medication guide. Opioid converter morphine equivalent calculator omni. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. So round up the calculated 5 micrograms dosage of fentanyl to 125 micrograms or a 150 microgram patch depending on whether patients pain is under good control or not. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Aug 10, 2011 dr prescribed dilaudid and fentanyl patch, is this safe, dont want to overdose. Compare fentanyl vs hydromorphone comprehensive analysis. They all interact with specific opioid receptors such as. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. I highly recommend iv pca patient controlled analgesia infusion pump commonly seen in post surgery recovery rooms. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Conversion of opioid analgesics to fentanyl transdermal.
Transdermal patch should be used only in opioid tolerant patients. 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. The mean calculated delivery rate of fentanyl was 8. The fentanyl patch is on the skin, the dilaudid is iv so it is uncomfortable, requires venopuncture, or for chronic use a devise like a pouch under the skin on the chest which adds more side effects and complications. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent.
Surprisingly, crosstolerance between opioids is often incomplete. Fentanyl patch converter globalrph conversion from. Compare fentanyl vs hydromorphone comprehensive analysis by. Transdermal and parenteral fentanyl dosage calculations and.
Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Dailymed dilaudid hydromorphone hydrochloride injection. 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. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. An alternative algorithm for dosing transdermal fentanyl for. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Please use the following guideline to calculate a fentanyl patch dose increase. Dr prescribed dilaudid and fentanyl patch, is this safe. In patients receiving longacting opioid formulations sr, transdermal, a rescue dose for breakthrough pain is recommended. 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. While they are both opioids, the primary difference between the two is that morphine is a naturally occurring, plantbased substance, whereas fentanyl is entirely synthetic. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator.
Effects of patch last for 18 24 hours after the patch is removed. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Approximately 37% of hydromorphone undergoes glucuronidation to produce hydromorphone 3glucuronide h3g. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. 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. Apr 18, 2015 the original system, duragesic, has a reservoir which contains fentanyl in a fluid state. So by applying the patch with the last dose of the oral morphine the chances of increasing pain during the drug transition can be avoided. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Stop long acting oral morphine after applying patch. 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 patients to another opioid, remove the transdermal fentanyl patch. Overestimating the dose when converting patients from another opioid analgesic.
The dose of fentanyl should not be adjusted for at least 72 hours after application of the. I highly recommend ivpca patient controlled analgesia infusion pump commonly seen in post surgery recovery rooms. The oxygen saturation remained above 96% on room air and the patient was awake and alert with a sedation score. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain. Morphine milligram equivalent mme calculator instructions. Both morphine and hydromorphone are used to treat moderate to severe pain.
As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount. Fentanyl patch protocol never cut or trim the patch. 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. Both are opioids so side effects would be very similar. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Can a patient be given dilaudid by iv while on a fentanyl patch 100mcg. Total daily morphine 200 mg po in 24 hours divided by 3 67 mg iv conversion factor.
Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Safety of chronic transdermal fentanyl use in patients on. The total daily morphine milligram equivalents mme will be displayed. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Fentanyl patch converter globalrph conversion from other. Icu sedation guidelines of care icu sedation 2009 adult icu pain orders 1. Asked 10 aug 2011 by sober123 updated 5 december 2017 topics dilaudid, pain, fentanyl, oxycodone, breakthrough pain, postoperative pain, knee joint replacement, surgery, doctor, knee. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone po diamorphine po diamorphine sc iv. Opioids opiates are a group of analgesic drugs, used primarily for pain management. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Seventeen hours or more are required for a 50% decrease in.