Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. The following source was used for morphine equivalent conversion factors per mg of opioid. Hydromorphone 2mg, 4mg tablets 3mg suppositories fentanyl transdermal patches. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. The calculation of opioid conversion is a crucial step in intensive care and is. Aug 10, 2011 fin they gave me dilaudid it helped a little. My mothers pill bottle say a 4mg dilaudid can be taken every 4. Duragesic fentanyl transdermal dosing, indications. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Formulations include 12, 25, 50, 75 and 100 ucghour patches, but the 12 ucghour patch is generally used for dose adjustment rather than initiation of fentanyl.
Transdermal and parenteral fentanyl dosage calculations. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Do not use this tool to convert from one opioid to a different opioid. The patients calculated dose of 25 mg of oral hydromorphone is equal to 100 mg of oral morphine. 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. These bidirectional differences are not captured in a traditional equianalgesic table.
Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Jan 29, 2018 if pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Opioid conversion calculator for morphine equivalents. It should not be used to determine doses when converting a patient from one opioid to another. Remember to enter all opioids the patient is taking.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid oral morphine milligram equivalent mme conversion. This is based on studies converting from morphine to fentanyl. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Morphine immediaterelease tablets, oral solutionk,l. Hydromorphone 4 mg po q2h prn breakthrough pain, using on average 6 doses. A safe and effective method for converting cancer patients. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Neither nor any other party involved in the preparation or publication of this site shall be liable for any special. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Opioid conversions calc single agent equianalgesic globalrph.
Opioid converter morphine equivalent calculator omni. For frail elderly patients, use more conservative conversion or a lower strength patch e. Anne, who disliked taking pills and was interested in the convenience of changing a patch only every 3 days, made an appointment to see her family physician to discuss the transdermal fentanyl patch. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Transdermal and parenteral fentanyl dosage calculations and. Canadian guideline for safe and effective use of opioids. Oral morphine milligram equivalent conversion table updated 8. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. How strong is dilaudid for pain compared to percocet. Converting from oral morphine to fentanyl transdermal patch. I havent yet figured out the best times to take the meds. Opioid oral morphine milligram equivalent mme conversion factors1,2. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%.
Opioid conversions calc single agent equianalgesic. I would think 12 mcg of fentanyl would cover 5 10325 mg of oxycodone. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. 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. Dec 15, 2001 the cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. In the case of converting morphine to methadone, methadone has a relative potency of 4. There are many opioids and many formulations available e. This medicine is in a class of drugs called opiate analgesics. Unanswered questions what is gujarati name of halim seeds. 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. 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.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Morphine milligram equivalent mme calculator instructions. Opioid conversion and brand availability in canada. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. 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. Equivalence between oral morphine and transdermal fentanyl. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. The amount of residual drug in the patients system must be accounted for.
Based on level of pain control at the time of conversion poor pain control 100% moderate pain control 75% excellent pain control 50% 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 tramadol 50mg tablets. Narcotic pain relievers also can be addictive and abused. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed. My pm doc is switching me from mscontin er 60 mg, 2 tabs 3 times day and dilaudid 4 mg. Equianalgesic chart changes in italics ui health care. Transdermal patch should be used only in opioid tolerant patients. Im in a hosp so i feel a little safe if something goes wrong.
The authors make no claims of the accuracy of the information contained herein. What is the conversion from 150 mcg fentanyl patches every. The total daily morphine milligram equivalents mme will be displayed. Transdermal fentanyl is approximately 80 times as potent as morphine. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Even though you are on the lower dose, fentanyl is something like 80 times stronger than morphine. Doses listed are equivalent to 10 mg of parenteral morphine.
Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Titrate liberally and rapidly to analgesic effect during first 24 hours. Equianalgesic dosing of opioids for pain management. A friend told her about a pain patch that worked well. Dr prescribed dilaudid and fentanyl patch, is this safe, don. Currently, there are no empirical studies converting fentanyl to morphine. Canadian guideline for safe and effective use of opioids for. Dilaudid is the brand name of the drug hydromorphone, which is used to relieve pain. Comparison of 4mg dilaudid to 30 mg morphine answered by a verified doctor. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Fentanyl patch converter globalrph conversion from. Start with equivalent total daily dose of immediate release formulation and administer once daily. Dilaudid and fentanyl together is fentanyl an opiate is fentanyl stronger than dilaudid. Paralytic ileus, opioid nontolerant patients, known ro suspected preexisting gi surgery.
Do not convert mcg for mcg among fentanyl products i. What would the conversion be from 150mcgs of fentanyl patches every 3 days be to dilaudid hydromorhone. How to calculate equivalent morphine dosage when changing the method of administration. Conversion from other oral hydromorphone formulations. I can only tell you from the prospective of me using the medication, dilaudid works on a diffeent part of the brain than what percocet is i found dilaudid to be stronger but what works with one pain patient does not do the job for another it does really take a lot of work to find the medication that woroks best for each individual patient, at some point in time a drug such as dilaudid that has. Conversions with methadone methadone is inexpensive and effective in certain patient populations. What would the conversion be from 150mcgs of fentanyl patches. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain.
Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Dr prescribed dilaudid and fentanyl patch, is this safe. Morphine dose equivalence not reliably established. Opioid conversion and brand availability in canada michael g. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. They all interact with specific opioid receptors such as. 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. 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. However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Fentanyl patch converter globalrph conversion from other. What would the conversion be from 150mcgs of fentanyl patches every 3 days be to. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. 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 52.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Meptazinol meptid 200mg 4mg to 8mg oxycodone 10mg 20mg pethidine oral 50mg 5mg to 6. Equivalent doses are based on the 24 hour dose of fentanyl or. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Both dilaudid and fentanyl can be habit forming even at prescribed doses.
Monitor the patient carefully for respiratory depression. Both drugs work the same way in the body to relieve pain. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. My pharmacist actually checks the conversion on their own. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Dilaudid, exalgo hydromorphone dosing, indications. Oral opioid dosing equivalents and conversions university of.
Can a patient be given dilaudid by iv while on a fentanyl patch. 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. This is based on performing a morphine to fentanyl conversion. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Do not use this table to convert from fentanyl transdermal system to other opioid. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Morphine milligram equivalent mme calculator nyc health. 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. Oct 19, 2004 1 fentanyl has a long halflife, but has a short duration of action due to its lipophilic structure and rapid redistribution hence the advantage of using it in conscious sedation, but if you run it as a drip you fill your reservoir and then the long halflife comes into play thus making a fentanyl drip in the icu setting equivalent to a dilaudid drip from a pharmacokinetic point of view. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches.
Information in questions, answers, and other posts on this site posts comes from individual users, not justanswer. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. 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. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Start exalgo dose at 50% of calculated daily dose every 24 hours. What is the conversion from 150 mcg fentanyl patches every 3. What would the conversion be from 150mcgs of fentanyl. The patch does take a while to kick in when you first put it on. Opioid switching using equivalence tables saskatchewan.
Use of this table for conversion from fentanyl to other opioids can overestimate the dose of the new agent and may result in an overdosage. The table is based on oral dosing for chronic noncancer pain. The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much opiate during the conversion period. Hydromorphone oral tablet is a prescription drug thats available as the brandname drugs dilaudid immediate release and exalgo extended release. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. If pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3. I have been on the fentanyl patch and dilaudid for years.
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