Switching from 100mcg duragesic patch to ms contin or. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Each of these drugs has a different halflife, side effect and safety profile, and some are better for some people, and some are more. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. It must be made clear however that the methadone is being used to treat pain, and that the taper is being done for medical. Opioid converter morphine equivalent calculator omni. It should not be used to determine doses when converting a patient from one opioid to another. Conversion from morphine or equivalent to fentanyl transdermal.
They all interact with specific opioid receptors such as. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Calculate the total 24hour morphine dose or morphineequivalent. When the opioid regimen includes modified and immediaterelease preparations. 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 morphine sulfate ir. Oxycontin, xtampza er oxycodone dosing, indications. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. 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. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion. Transdermal fentanyl mcg hour patch size reference 30 10 to 15 300 12 3,12. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
Conversion from transdermal fentanyl to hysingla er. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Patches conversion doses drug name drug dose equivalent oral morphine dose fentanyl 25 patch 25microgramshour 30mg to 4mg24hours 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. Oral opioid dosing equivalents and conversions university of. Do i need a stronger dosage to not go into withdrawal. Potency, defined as the dose required to produce a given effect, is typically compared relative to morphine and differs.
Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg morphine per day, 25 mcg. Opioids may be all that a person needs for acute pain broken bone, sprained ankle but is never the primary treatment of any chronic pain. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral. Equianalgesic chart changes in italics ui health care. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Msir morphine sulfate instant release will release rapidly usually on the order of 1030 minutes whereas mscontin is a controlled release formulation that, unless crushed or chewed or. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Switched from fentanyl patch 15mcg to mscontin 15mg.
Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice on removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting. Canadian guideline for safe and effective use of opioids. Ms contin 100 mg and 200 mg tablets, a single dose greater than 60 mg, or a total daily dose greater than 120 mg, are only for use in patients in whom tolerance to an opioid of comparable potency has been established. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. This is my 1st post so ill give a little background. Available at uihc as an immediaterelease tablet and oral. In one study, patients treated with ir morphine were randomly assigned to either switch to an er morphine ms contin or continue on their existing ir morphine formulation. A number of oral and transdermal er opioid formulations are currently available table 1. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Demystifying opioid conversion calculations stephanie cheng, pharmd, mph, bcgp.
Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as there is. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. Currently, there are no empirical studies converting fentanyl to morphine. Doctors give trusted answers on uses, effects, sideeffects, and cautions. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day.
Opioid dose equivalence faculty of pain medicine anzca. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Update on prescription extendedrelease opioids and. Equivalence between oral morphine and 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 treatment. Ms contin, astramorph morphine dosing, indications. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Some experts use this conversion in cancer patients. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Calculate dose needed for prn immediate release rescue opioid. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine.
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. I did that because it says it takes the patch 8 hours to work. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. A practical guide to tapering opioids mental health. This is based on studies converting from morphine to fentanyl. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. For frail elderly patients, use more conservative conversion or a lower strength patch e.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. Opioid switching using equivalence tables home saskatchewan. Calculation of oral morphine equivalent daily dose omedd. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Im having to switch to 25 milligram fentanyl patch. The tablet strength closest to the calculated dose is 30 mg.
Fentanyl patch converter globalrph conversion from. Butrans contains buprenorphine, a schedule iii controlled substance. Morphine dose equivalence not reliably established. He is not certain this has been helping his pain very much, and it is quite expensive. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Opioid conversion ratios guide to palliative care practice. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Calculates total daily morphine milligram equivalents. Pain management in hospice care todays geriatric medicine. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Opioid conversion calculator for morphine equivalents. Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present.
Equianalgesic dosing of opioids for pain management. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. In these last 20 years ive used these longacting opioids. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Recommend an appropriate dose of transdermal fentanyl when. Select microgram per hour dose of transdermal fentanyl based on table 2. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Degroote national pain centre opioid manager switching opioids download. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioid dose equivalence home faculty of pain medicine. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Morphine milligram equivalents mme calculator mdcalc. What are the differences between ms contin 15mg cr and. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Opioid switching using equivalence tables page 1 of 5. From to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch. 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. See fentanyl information below for initiating patch and patch to po dosing. Opioid oral morphine milligram equivalent mme conversion. Round up or down based on patient factors and available patch sizes. Many programs use methadone, as it is less likely to produce euphoria and is inexpensive compared with the other longacting agents. Patients switched to ms contin reported lower pain intensity, improved strength, improved quality of life, and better adjustment to disease and treatment.