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. There is also a msir which is a morphine sulfate immediate release as well. Didnt know where else to put this, but i was recently switched from morphine 60mg er to the fentanyl duragesic patch. Conversions with methadone methadone is inexpensive and effective in certain patient populations. Avinza, kadian, ms contin, oxycontin, opana er, duragesic, and embeda are not indicated as an asneeded prn analgesic. How should conversion from oral morphine to fentanyl. Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. 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. Patches in the last days of life leave the buprenorphine or fentanyl patch in situ and change regularly as prescribed. These pills shown are not fentanyl but are ms contin 30 mg continuous release pills just like stated. 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. The equianalgesic chart indicates that 20 mg of oral oxycodone is equal to 30 mg of oral morphine.
Equivalence between oral morphine and transdermal fentanyl. 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. Fentanyl patch converter globalrph conversion from. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. How should conversion from oral morphine to fentanyl patches be carried out. Do i need a stronger dosage to not go into withdrawal. Oral opioid dosing equivalents and conversions university of. 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. 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. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sciv mg po mg comments morphine 10 30a codeine 120 sc only 200 metabolized to morphine fentanyl patch see table below useful when po pr routes not an option fentanyl 0. Pain management,pharmacists, nursing, physicians,health care providers,morphine, tylox, lortab, vicodin, fentanyl, dilaudid, meperidine, percodan, oxycodone.
Do not initiate fentanyl patches at the end of life when the oral route is no longer available. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Scottish palliative care guidelines fentanyl patches. As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount.
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. Fentanyl to ms contin conversion pain management medhelp. Opioid conversion tips changing to another oral opioid question. She would like to try an immediaterelease opioid agent, hydromorphone. The methadone conversion table indicates that a conversion factor for a domed. Pain management in hospice care todays geriatric medicine. The total daily morphine milligram equivalents mme will be displayed. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts. For frail elderly patients, use more conservative conversion or a lower strength patch e. Parenteral oral parenteral oral parenteral oral oral. Calculate the total 24hour morphine dose or morphineequivalent.
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. 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. Consider increasing scheduled opioid dose by 3050%. If needed, give additional analgesia using a different opioid. Canadian guideline for safe and effective use of opioids. What are the steps for converting from morphine or. Morphine immediaterelease tablets, oral solutionk,l. Because it may be difficult to determine analgesic need using a controlledrelease product, it is recommended to initiate therapy with immediaterelease products. For instance, yesterday i took 60 milligram ms contin and at.
Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. For chronic dosing, 10 mg iv morphine 30 mg oral morphine. Mscontin does not achieve therapeutic blood levels in dogs when it is administered every 12 hours. Currently, there are no empirical studies converting fentanyl to morphine. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. To convert to oral morphine equivalent, multiply by. List of extendedrelease and longacting opioid products. Conversion from morphine or equivalent to fentanyl transdermal. Convert each number in your list to iv morphine equivalents, by using column 2.
Equianalgesic chart changes in italics ui health care. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. 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. 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. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Do not convert mcg for mcg among fentanyl products i. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Converting from fentanyl back to oral pain meds is a difficult. 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.
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. Decrease new dose 3050% to allow for incomplete crosstolerance. Switching from 100mcg duragesic patch to ms contin or. Converting from oral morphine to fentanyl transdermal patch. Morphine sulfate extendedrelease tablets 30 mg 100 u. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3.
In an inpatient setting, rescue doses can be provided iv every 1530 minutes. Opioid oral morphine milligram equivalent mme conversion. This is my 1st post so ill give a little background. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. Oral transmucosal fentanyl citrate 200 mcg 30 unitscarton actiq. 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. It is safer to underestimate a patients 24hour oral morphine dosage and provide rescue medication e. Pain control, one of the central goals of hospice care, is a top priority in endoflife care. Fentanyl transdermal system 25 mcghr 5 patches carton duragesic.
Meperidine is nota recommended drug in a palliative care setting and is to be avoided. Morphine milligram equivalent mme calculator nyc health. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Opioid oral morphine milligram equivalent mme conversion factors1,2. Oxycontin, xtampza er oxycodone dosing, indications. Equianalgesic dosing of opioids for pain management. Only persons with experience should be using methadone.
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. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a risk. It should not be used to determine doses when converting a patient from one opioid to another. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Coggins, pharmd, cgp, fascp todays geriatric medicine vol. Conversions from one opiate to another are typically done reducing the new opiate dose by 20 30 % for cross tolerance. Switched from fentanyl patch 15mcg to mscontin 15mg. Opioid conversion calculator for morphine equivalents. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Opioid conversion and brand availability in canada michael g. Morphine milligram equivalent mme calculator instructions. There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials.
Opioid converter morphine equivalent calculator omni. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. Fentanyl patches are another option, but are expensive and difficult to titrate. 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.
What are the steps for converting from morphine or equivalent to. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. 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. Fentanyl patches might also be useful when oral opioids cannot be used because of vomiting or difficulty swallowing. 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. Im having to switch to 25 milligram fentanyl patch. Ms contin morphine sulfate provides good longterm pain control without the need to take medicine frequently, but watch out for constipation. Longacting and extendedrelease opioid products required to have an opioid rems.
The patients current dose of 240 mg per day of oral oxycodone is equal to 360 mg per day of oral morphine. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Select microgram per hour dose of transdermal fentanyl based on table 2. When initiating transdermal fentanyl, patients should use shortacting opioids as needed until. Teens arrested for fentanyl stash at school worth more. 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 conversion ratios guide to palliative care practice. 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. There is no direct conversion for fentanyl lozenge to. Do not use this table to convert from fentanyl transdermal system to other opioid.
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