Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Ideally, you should be on some combination of long and short acting. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Transdermal patch should be used only in opioid tolerant. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse.
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. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. Converting shortacting ir longacting er for wellcontrolled, chronic pain. Side effects of opana er oxymorphone hydrochloride. Side effects of duragesic fentanyl transdermal, warnings. The amount of residual drug in the patients system must be accounted for. Transdermal and parenteral fentanyl dosage calculations. Opioid conversion other opioids compared to morphine. Duragesic label page 1 full prescribing information for. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Equianalgesic dosing of opioids for pain management. Another strategy could be to add a long acting opoid agent like a fentanyl patch and decrease your need for short acting.
Conversion back from prior opioid divides by the conversion factor shown in the table. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Remember to enter all opioids the patient is taking. Round up or down based on patient factors and available patch sizes. Compare fentanyl vs oxymorphone comprehensive analysis. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Pain medicationslong acting opioids flashcards quizlet. 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. Oxymorphone to fentanyl equivalent doctor answers on. The extendedrelease form of opana is for aroundtheclock treatment of pain. Fentanyl can be easily extracted from the patch and used as an injection, smoked or snorted some patches are easier to crack than others, but the truth remains that you can concentrate the dose from a patch and get it to you blood stream faster. Converting from oral morphine to fentanyl transdermal patch. I am going to try replacing that for a short time with a fentanyl patch to see if i have any improvement in pain mgmt. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
Advice should be sought from the palliative care team. I am having trouble with an allergy to the fentanyl patch. Choose either one but not both unless you require a rescue drug. I am currently taking opana er 30mg 2 tid for long term spinal pain due to breaks and fusions. For drug coverage and provider type information, see the. Morphine milligram equivalent mme calculator instructions. The pain relief is inconsistent for some reason, as well. 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. Oxymorphone opana erfentanyl patch duragesic every 72 hours. Binds to various opioid receptors, producing analgesia and sedation opioid agonistavailable in following formats 12mcghr or 25mcghr or 37. Asked in fentanyl can you take the fentanyl patch off.
Dosage use only when converting from another opioid to fentanyl patch. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. I have been battling severe constipation regardless of numerous methods to remedy it. The patch will take a little while to get in to your system. Fentanyl patch converter globalrph conversion from. 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. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Morphine sulfate and naltrexone extendedrelease capsules. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Methadone american society for pain management nursing.
Opana ir can be used every four hours to every 6 hours as needed. List of extendedrelease and longacting opioid products. Oxycontin, xtampza er oxycodone dosing, indications. The patch is fentanyl the strongest family of opiates we have. 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. Conversion algorithm for instructions on converting from one opioid to another.
This calculator should not be used to determine doses when converting a patient from one opioid to another. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Hi everyone, i am new to this board, but not to taking pain meds. Hello i am a fulltime student and mom to a beautiful 16 month old. The conversion factors in this table are only for the conversion from one of the listed oral opioid analgesics to opana er. Its often administered via injection or transdermal patch, or. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Both drugs work the same way in the body to relieve pain. If that is case, might select a fentanyl patch as the best approach. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Duragesic fentanyl transdermal system is available in generic form. This is especially important for fentanyl and methadone conversions.
Calculate the total 24hour morphine dose or morphineequivalent. A safe and effective method for converting cancer patients. The total daily morphine milligram equivalents mme will be displayed. Conversion charts are only guidelines equianalgesic data is a good approximate. Street value fentanyl patch 25 mg fentanyl pflaster. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Doses 25 mcghr patch are reserved for opioidtolerant individuals. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. In the case of converting morphine to methadone, methadone has a relative potency of 4. So divide 270mg of opana to every 46 hours as you and your pain doctor decide. It should not be used to determine doses when converting a patient from one opioid to another.
Morphine milligram equivalent mme calculator nyc health. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Opioid conversions calc single agent equianalgesic. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Oral morphine milligram equivalent conversion tablei.
Fentanyl fentanyl citrate, pictured here, is a class ii controlled substance and one of the most powerful opioids on the market. All noninjectable fentanyl products are for opioidtolerant patients. Though molecularly similar to fentanyl, this synthetic opioid is 100 times stronger than its chemical cousin and 10,000. I am currently on 50mcg fentanyl patches and have been since sept. In 2017, opana manufacturer endo pharmaceuticals agreed to pull the extendedrelease formulation of drug, opana er, from the market at the request of the food and drug administration because of its high abuse potential. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Recommend an appropriate dose of transdermal fentanyl when. This table cannot be used to convert from opana er to another opioid. What is the proper dose of opana er if using 50 mcg patch. Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose. All this leads to potential od and death, let alone the reality of spiking your tolerance. Buprenorphine is a dehydroxylated phenanthrene and is chemically similar to other opioids such as hydrocodone, oxycodone, levorphanol, hydromorphone, oxymorphone, and others.
Opioid oral morphine milligram equivalent mme conversion. Select microgram per hour dose of transdermal fentanyl based on table 2. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. I am just wondering what regimen i should use to safely do this. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Conversion from morphine or equivalent to fentanyl transdermal. 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. Some experts use this conversion in cancer patients.
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