Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Opioid oral morphine milligram equivalent mme conversion factors1,2. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Converting fentanyl patch to oxycontin questions answered by dr. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Doctors give trusted answers on uses, effects, sideeffects, and cautions. 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. 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. Buprenorphine conversions practical pain management. Equianalgesic chart changes in italics ui health care. I went from worst pain ever to telling my brother who took me in that it felt like the drug was hugging my insides.
It should not be used to determine doses when converting a patient from one opioid to another. Both drugs work the same way in the body to relieve pain. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Are morphine, dilaudid and fentanyl stronger than oxycontin. I havent yet figured out the best times to take the meds. Can a patient be given dilaudid by iv while on a fentanyl patch 100mcg. I was on fentaynl patch 75 mcg for almost 4 years and just within last 2 mths ive been getting terrible rashes from the patch. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. 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. Oral opioid dosing equivalents and conversions university of. Conversion from other opioids to dilaudid oral solution or dilaudid tablets. 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.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. Titrate liberally and rapidly to analgesic effect during first 24 hours. Transdermal and parenteral fentanyl dosage calculations. Equivalence between oral morphine and transdermal fentanyl. Opioid conversion ratios guide to practice 2010, eastern metropolitan region. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po hydrocodone.
Transdermal patch should be used only in opioid tolerant patients. Equianalgesic dosing of opioids for pain management. Dilaudid tablets contain hydromorphone, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, oxycodone, methadone, morphine, oxymorphone and tapentadol. Isnt morphine and dilaudid and fentynol stronger than oxycontin and isnt there the very same potential for abuse and dependence. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous 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. The total daily morphine milligram equivalents mme will be displayed. 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. The authors make no claims of the accuracy of the information contained herein. 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. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Both dilaudid and fentanyl can be habit forming even at prescribed doses.
After application of the fentanyl patch peak plasma levels are achieved 24 hours significant plasma levels. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Morphine and codeine related drugs make me throw up tons. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Dilaudid liquid and tablets hydromorphone hydrochloride. So the doctor put me on 16 mg tabs take 2 a day together. Compare fentanyl vs hydromorphone comprehensive analysis. Opioid converter morphine equivalent calculator omni. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. A safe and effective method for converting cancer patients.
However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Buprenorphine has a higher binding affinity to mureceptors compared to every fullagonist opioid prescribed for inhome use as well as naloxone narcan. What would the conversion be from 150mcgs of fentanyl patches every 3 days be to dilaudid hydromorhone. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Transdermal and parenteral fentanyl dosage calculations and conversions. 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. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Doses listed are equivalent to 10 mg of parenteral morphine. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain. Morphine milligram equivalent mme calculator nyc health. Conversions with methadone methadone is inexpensive and effective in certain patient populations. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. 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 formulae for converting methadone are in the footnotes of the table.
My pm doc is switching me from mscontin er 60 mg, 2 tabs 3 times day and dilaudid 4 mg. Dr prescribed dilaudid and fentanyl patch, is this safe. 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. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Oral dosage extendedrelease for conversion from transdermal fentanyl patch adults calculate the total daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for each 25 mcghour fentanyl transdermal patch. Due to crosstolerance, when switching from one opioid to another, the starting dose of the new opiod should be. Given the reputation for abuse of this me many drs encourage changing me to dilaudid or morphine pump or patches. Opioid conversion and brand availability in canada. 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. 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.
These bidirectional differences are not captured in a traditional equianalgesic table. Opioid oral morphine milligram equivalent mme conversion. There are many opioids and many formulations available e. Equivalent doses are based on the 24 hour dose of fentanyl or. But all of a sudden shes on 75mcg fentanyl patches, 1mg xanax, and 8mg dilaudids multiple times a day. Converting from oral morphine to fentanyl transdermal patch. Im in a hosp so i feel a little safe if something goes wrong. Conversion algorithm for instructions on converting from one opioid to another. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
What would the conversion be from 150mcgs of fentanyl. People with a fentanyl patch continue to have oral pain medication for breakthrough pain. Dilaudid ive found helpful and ive only had fentanyl once but it was great lol. Narcotic pain relievers also can be addictive and abused. If a patient is on morphine oral, the fentanyl transdermal equivalent is. Dilaudid, exalgo hydromorphone dosing, indications. Both are opioids so side effects would be very similar. They all interact with specific opioid receptors such as.
Opioid conversion calculator for morphine equivalents. Opioid conversion and brand availability in canada michael g. What is the conversion from 150 mcg fentanyl patches every 3 days to dilaudid. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. How strong is dilaudid for pain compared to percocet. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. From a practical perspective, buprenorphine cannot have a linear conversion tofrom morphine or an equivalent because of its complex pharmacology and pharmacokinetics, including. For frail elderly patients, use more conservative conversion or a lower strength patch e. Neither nor any other party involved in the preparation or publication of this site shall be liable for any special. This tool does not contain all of the important safety information needed to prescribe butrans. Morphine dose equivalence not reliably established. Opioid conversions calc single agent equianalgesic.
Meptazinol meptid 200mg 4mg to 8mg oxycodone 10mg 20mg pethidine oral 50mg 5mg to 6. Canadian guideline for safe and effective use of opioids. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. Fentanyl patch converter globalrph conversion from. Hydromorphone dilaudid immediate every 23 hours 2,4, 8mg tabs, 1mgml. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain.
Conversion from morphine or equivalent to fentanyl transdermal. 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 analgesics because. What is the conversion from 150 mcg fentanyl patches every. Begin by tapering your patients current opioid total daily dose down to 30 mgd oral mme or less. Morphine milligram equivalent mme calculator instructions. The amount of residual drug in the patients system must be accounted for. 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. A friend told her about a pain patch that worked well. Sometimes people with stable pain are switched to a fentanyl patch, which lasts even longer.
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