The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Opioid oral morphine milligram equivalent mme conversion. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive. Hydromorphone oral tablet is a prescription drug thats available as the brandname drugs dilaudid immediate release and exalgo extended release. Opioid switching using equivalence tables home saskatchewan. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. Calculate the total 24hour morphine dose or morphine equivalent. What are the steps for converting from morphine or equivalent to.
The recommended dose is 25 to 100 mcghour patch applied every 72 hours. Calculate the equivalent 24 hour dose of morphine milligram equivalent do not use table 1. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Opioid conversion guidelines gippsland region palliative care. 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. Generic fentanyl is covered by some medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. The total daily morphine milligram equivalents mme will be displayed. Mar 12, 2010 then come dilaudid, one really needs to limit themselves to exactly what and how it it is prescribed. Transdermal and parenteral fentanyl dosage calculations and. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Morphine milligram equivalent mme calculator instructions. Primary doctor will be in best position to answer the question. The table has been derived from the data sheet, and simplified to match available preparations. Select microgram per hour dose of transdermal fentanyl based on table 2.
Compare fentanyl vs hydromorphone comprehensive analysis by. Canadian guideline for safe and effective use of opioids for. 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 the patches should never be used as the main source of pain control for post op patients.
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. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a generous dose of common sense. Oct 09, 2018 bioequivalence between the dilaudid 8 mg tablet and an equivalent dose of dilaudid oral solution has been demonstrated. They all interact with specific opioid receptors such as.
Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. 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. Why would my primary care doc want to go straight from 60 mg day of morphine er to a fentanyl patch instead of dilaudid. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Equianalgesic conversions used in this calculator are based on the american pain society guidelines.
Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg day morphine, 25 mcgday transdermal fentanyl, 30 mg day po oxycodone, 8 mg day po hydromorphone, 25 mg day po oxymorphone, 60 mg day po hydrocodone, or an equianalgesic dose of another opioid. Side effects of dilaudid and fentanyl that are similar include. Equianalgesic chart changes in italics ui health care. Both are opioids so side effects would be very similar. The manufacturer considers a fentanyl transdermal dose of 100 ghour approximately equivalent to 360 mgday of oral morphine. Opioids opiates are a group of analgesic drugs, used primarily for pain management. What is stronger, percocet, fentanyl patch, dilaudid, or. 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. Fentanyl patches durogesic for chronic pain nps medicinewise. Equivalent opioid calculator equianalgesic dosage conversion calculator. The patches should be applied and removed as ordered by the doctor and only on the person for whom they were prescribed. Effects of patch last for 18 24 hours after the patch is removed. Dilaudid is roughly 57x more potent than morphine where as hydrocodone is. Compare fentanyl vs hydromorphone head to head with other drugs for uses, ratings, cost, side effects, interactions and more.
Manage breakthrough pain with morphineshortacting opioid prn. Fentanyl patch converter globalrph conversion from other. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. In the uk fentanyl is a controlled drug and can only be prescribed by a doctor, fentanyl is approximately 100 times more potent than morphine, with 100 micrograms of fentanyl approximately equivalent to 10 mg of morphine and 75 mg of pethidine meperidine in analgesic activity. Morphine milligram equivalent mme calculator nyc health. Fentanyl patch converter globalrph conversion from. What is the equivalent of dilaudid 1mg to morphine answers. Conversion from morphine or equivalent to fentanyl transdermal.
It will differ from doctor to doctor but this is the most up to date dose i have found. Converting to transdermal fentanyl palliative care network. Dilaudid hydromorphone hydrochloride and fentanyl are opioid narcotic pain relievers used to manage pain in individuals whose pain its severe enough that it requires 247, longterm opioid treatment. So the hydrocodone would be much less potent as hydromorphone dilaudid or morphine. Oral opioid dosing equivalents and conversions university of. In the case of converting morphine to methadone, methadone has a relative potency of 4. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Fentanyl duragesic is a moderately priced drug used to treat chronic pain. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. But all of a sudden shes on 75mcg fentanyl patches, 1mg xanax, and 8mg dilaudids multiple times a day. I stopped using dilaudid 2mg orally, fentanyl patches 50 mch. 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. Doctors give trusted answers on uses, effects, sideeffects, and cautions. For oral dilaudid hydromorphone the equivalent dose would be between 7580mgs.
Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. A patient currently using fentanyl 50 mcg patches is switched to oral hydromorphone. Estimates on equivalence vary but a conversion factor of 1mcg fentanyl hr 2 mg morphineday is suggested as a conservative starting pint. 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. Particular care is required when dealing with high doses of opiates. Opioidtolerant patients are those who have been taking daily, for a week or longer, at least 60 mg of oral morphine, 30 mg of oral oxycodone, or at least 8 mg of oral. When converting, because the patches cover a range of equivalent oral morphine doses, it is usually safer to choose an initial dose at the lower end of the equivalent dose range plus breakthrough analgesia. Fentanyl and morphine are two highly potent opioid painrelievers. But unfortunately, its the cocktail of drugs that my mom is currently prescribed. Both drugs effectively reduce pain but carry high abuse potentials. After oral administration of dilaudid, peak plasma hydromorphone concentrations are generally attained within. My doctor prescribed these pain and sleep meds continuously for the past 3 years due to pain from an abdominal surgery gone wrong, and chronic kidney stones.
Transdermal fentanyl patches were designed to provide longlasting opioid therapy. Decrease new dose 3050% to allow for incomplete crosstolerance. Advanced opioid conversion calculator morphine equivalents. Doses required to control pain vary widely among patients. She has basically no tolerance to either of these classes of drugs. Opioid converter morphine equivalent calculator omni. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Transdermal patch should be used only in opioid tolerant patients. There is still medication left in used patches when they are taken off the skin. Opioid conversion calculator for morphine equivalents. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. Duragesic fentanyl transdermal dosing, indications. Dilaudid headtohead comparisons of medication uses, side effects, ratings. Remember to enter all opioids the patient is taking. Opioid oral morphine milligram equivalent mme conversion factors1,2. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Converting from oral morphine to fentanyl transdermal patch. In patients receiving longacting opioid formulations sr, transdermal, a rescue dose for breakthrough pain is recommended. 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 treatment. There are differences in the literature regarding opioid conversion ratios. Opioid equivalence chart gloucestershire hospitals nhs. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch.
1295 985 900 71 199 26 1399 505 912 1023 1199 899 1293 567 839 657 498 338 1465 298 670 696 77 208 1490 704 1240 897