Oct 15, 2019 it is available as fentanyl transdermal system. Cachexia and absorption of transdermal fentanyl pallimed. The cii rate was decreased by 50% 6 hours after application of the fentanyl. 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. Advanced opioid conversion calculator morphine equivalents. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Select microgram per hour dose of transdermal fentanyl. Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral.
Subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Conversion of opioid analgesics to fentanyl transdermal. The conversion ratios are approximate and are intended as a guide only. Duragesic fentanyl transdermal dosing, indications. 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. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. In patients receiving longacting opioid formulations sr, transdermal, a rescue dose for breakthrough pain is recommended. Transdermal td fentanyl is a self adhesive skin patch which provides continuous systemic delivery during the 72 hour application period. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death.
Subcutaneous morphine mgday subcutaneous oxycodone mgday. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl. The chemical name is nphenyln12phenylethyl4piperidinyl propanamide. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Converting from oral morphine to fentanyl transdermal patch. Threedaytype transdermal fentanyl patch conversion by rapid.
Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Transdermal and parenteral fentanyl dosage calculations. When using this chart, calculate the total daily dose of morphine. Opioid conversion ratios guide to palliative care practice 2016. Dose conversion tool butrans buprenorphine transdermal. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Transdermal fentanyl is formulated as both a gelcontaining reservoir and a drug inadhesive matrix patch see sidebar. Converting from oral morphine to fentanyl transdermal patch mr. Efficacy and safety of a sixhour continuous overlap method. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Check with your doctor if you have questions about this.
Fentanyl patches durogesic for chronic pain nps medicinewise. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine. How should conversion from oral morphine to fentanyl patches be. Butrans is for transdermal use on intact skin only each butrans patch is intended to be worn for 7 days butrans doses of 7. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Converting from oral morphine to fentanyl transdermal patch teaching exercise 2. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Aug 19, 2014 cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75100.
Fentanyl accumulates to form a depot in the skin below the. This is because the majority of opioid is entering the cns. What every pharmacist should know about transdermal fentanyl. How should conversion from oral morphine to fentanyl patches.
Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Always ensure that an old patch has been removed before a new patch is applied. Feb 17, 2020 fentanyl transdermal system contains fentanyl, an opioid agonist, and is 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. Duragesic fentanyl transdermal system is a transdermal system providing continuous systemic delivery of fentanyl, a potent opioid analgesic, for 72 hours. If you are converting a patient to or from fentanyl i. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. When initiating transdermal fentanyl in a patient currently treated with. Nov 14, 2017 fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl share this.
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. A safe and effective method for converting cancer patients. Duragesic label page 1 full prescribing information for. Transdermal fentanyl mcg hour patch size reference 30 10 to 15 300 12 3,12 60 20 to 30 600 25 3,12 120 40 to 60 1200 50 3,12 180 60 to 90 1800 75 3,12 240 80 to 120 2400 100 3,12 seek specialist palliative care advice when converting at high doses. In the iv form fentanyl is often used in icus for pain control due to its rapid onset of action and due to the minimal histamine release associated with fentanyl in comparison to morphine. Select microgram per hour dose of transdermal fentanyl based. Eastern metropolitan region palliative care consortium victoria opioid conversion ratios guide to palliative care practice 2016. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied.
The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. For patients that require more than 100 mcghour, several transdermal systems may be used. Fencino 12 microgramshour transdermal patch summary of. An alternative algorithm for dosing transdermal fentanyl for. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Considering patient has not been compliant recently, in addition to recent weight loss indicating cachexia, reducing the dose to a 100mcg patch applied topically. The fentanyl skin patch is only used for opioidtolerant patients. Data from two small studies has shown that conversion of oral morphine to transdermal fentanyl with a ratio of 100. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. C the conversion table is unidirectional only and should only be used to convert adult patients from their current oral or parenteral opioid analgesic to the approximate fentanyl transdermal patch for use in chronic pain. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Remove transdermal and titrate dose of new analgesic based upon patients report of pain until adequate analgesia has been attained. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. What are the steps for converting from morphine or. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Compare butrans vs fentanyl headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Transdermal fentanyl comes as a patch to apply to the skin. Initial dose based on previous 24hour opioid requirement consult product literature, for evaluating analgesic efficacy and dose increments, see under chronic intractable pain not currently treated with a strong opioid analgesic, for conversion from long term oral morphine to transdermal fentanyl, see pain management with opioids under. Significant amounts of fentanyl continue to be absorbed from the skin for. Threedaytype transdermal fentanyl patch conversion by rapid titration method with shortacting oral oxycodone. Standards and guidelines for the use of transdermal opioids in palliative care july 2014 3 patients may experience opioid withdrawal symptoms e.
Scottish palliative care guidelines fentanyl patches. Change your patch at about the same time of day every time you change it. Converting to transdermal fentanyl palliative care network of. Because fentanyl has a low molecular weight and high solubility in both fat and water, the drug is a good candidate for transdermal administration. Dailymed fentanyl transdermal patch, extended release. Converting to transdermal fentanyl palliative care network. Converting to transdermal fentanyl palliative care. Transdermal and parenteral fentanyl dosage calculations and. Two parallel dosage conversion ratios are currently recommended by most manufacturers of fentanyl patches. Opioid conversion ratios guide to palliative care practice. Duragesic label page 1 full prescribing information for use. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. The patch is usually applied to the skin once every 72 hours.
Recommend an appropriate dose of transdermal fentanyl when. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. The patient should avoid exposure to excessive heat e. Breitbart method morphine oral 50mg transdermal fentanyl 25 mcghour. Duragesic patches are intended for transdermal use on intact skin only. Fentanyl may also cause severe, possibly fatal, breathing problems. What every pharmacist should know about transdermal. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Do not use table 2 to convert from duragesic to other therapies because this conversion to duragesic is conservative and will overestimate the dose of the new agent. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.