Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Fencino 12 microgramshour transdermal patch summary of. 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. Transdermal and parenteral fentanyl dosage calculations and. 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.
Opioid conversion ratios guide to palliative care practice. Dailymed fentanyl transdermal patch, extended release. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Check with your doctor if you have questions about this. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Administer onehalf of the patients total daily taken. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Cachexia and absorption of transdermal fentanyl pallimed. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. 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. Opioid conversion ratios guide to palliative care practice 2016.
Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. An alternative algorithm for dosing transdermal fentanyl for. Each butrans patch is intended to be worn for 7 days. Do not use this tool to convert from one opioid to a different opioid. Significant amounts of fentanyl continue to be absorbed from the skin for. Facts about the fentanyl transdermal patch fentanyl is a lipophilic opioid that is hundred times as strong as morphine. The conversion doses in these tables are only for the conversion from one of the. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. A safe and effective method for converting cancer patients from.
Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2. 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. Oct 15, 2019 it is available as fentanyl transdermal system. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. May 01, 2020 conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent.
Fentanyl patch converter globalrph conversion from other opiates. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Fentanyl may also cause severe, possibly fatal, breathing problems. Transdermal td fentanyl is a self adhesive skin patch which provides continuous systemic delivery during the 72 hour application period. Fentanyl moves in the direction of the lower concentration at a rate. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. Duragesic fentanyl transdermal system is a transdermal system providing continuous systemic delivery of fentanyl, a potent opioid analgesic, for 72 hours. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. 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.
Because this delay may result in a transient decrease in blood concentrations, the transition from intravenous to transdermal fentanyl may be associated with an increase in pain. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Considering patient has not been compliant recently, in addition to recent weight loss indicating cachexia, reducing the dose to a 100mcg patch applied topically. Bernardine newhouse november 14, 2017 uncategorized leave a. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Duragesic fentanyl transdermal system releases fentanyl from the reservoir at a nearly constant amount per unit time. Scottish palliative care guidelines fentanyl patches. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. Durogesic dtrans 50 mcghr transdermal patch summary of. 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. Fentanyl patch dose than that which the conversion tables recommend, including the use of the 12 mcgh dose by itself or in combination with another dose, provided the patient is not opioidnaive see contraindications.
Converting to transdermal fentanyl palliative care network of. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Converting from oral morphine to fentanyl transdermal patch mr. Oct 15, 2019 a study conducted with the duragesic fentanyl transdermal patch in elderly patients demonstrated that fentanyl pharmacokinetics did not differ significantly from young adult subjects, although peak serum concentrations tended to be lower and mean halflife values were prolonged to approximately 34 hours. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. A study conducted with the duragesic fentanyl transdermal patch in elderly patients demonstrated that fentanyl pharmacokinetics did not differ significantly from young adult subjects, although peak serum concentrations tended to be lower and mean halflife. What are the steps for converting from morphine or. Duragesic label page 1 full prescribing information for. A study to assess the safety, dose conversion, and dose.
The cii rate was decreased by 50% 6 hours after application of the fentanyl. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Buprenorphine is a less potent opioid than fentanyl. Twostep titration weans patients from iv to patch fentanyl. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release.
Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Threedaytype transdermal fentanyl patch conversion by rapid. A safe and effective method for converting cancer patients. Fentanyl patch converter globalrph conversion from. Transdermal and parenteral fentanyl dosage calculations. For patients that require more than 100 mcghour, several transdermal systems may be used. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of.
There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Recommendations based on data contained in the package insert. Conversion of opioid analgesics to fentanyl transdermal.
Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The fentanyl skin patch is only used for opioidtolerant patients. Transdermal fentanyl comes as a patch to apply to the skin. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Durogesic dtrans is a translucent, rectangular transdermal patch with rounded corners. The manufacturer of duragesic brand transdermal fentanyl recommends that unused patches should be folded in half so the adhesive side adheres to itself, and. The chemical name is nphenyln12phenylethyl4piperidinyl propanamide. Each patch is marked in coloured printing ink as follows.
Wait 18 hours after patch removed, then initiate conservative dose of approximately 10 mg once every 12 hours oxycodone controlledrelease for each 25 mcghour fentanyl transdermal patch. 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. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Threedaytype transdermal fentanyl patch conversion by rapid titration method with shortacting oral oxycodone.
The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Sandoz fentanyl patch fentanyl transdermal system is indicated for the management of pain severe enough to require daily, continuous, longterm opioid treatment, and. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Dosing considerations with transdermal formulations of. Conversions to and from duragesic 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 table updated 8. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Converting from oral morphine to fentanyl transdermal patch. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75100. The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Butrans is for transdermal use on intact skin only. Remove transdermal and titrate dose of new analgesic based upon patients report of pain until adequate analgesia has been attained.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. When using this chart, calculate the total daily dose of morphine. Duragesic label page 1 full prescribing information for use. The following source was used for morphine equivalent conversion factors per mg of opioid. Recommend an appropriate dose of transdermal fentanyl when. Transdermal fentanyl patches are unsuitable for opioid naive patients 1. In patients receiving longacting opioid formulations sr, transdermal, a rescue dose for breakthrough pain is recommended. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours.
Pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. The conversion ratios are approximate and are intended as a guide only. Change your patch at about the same time of day every time you change it. The objective of this study is to assess the safety of treatment with duragesic a transdermal patch delivering the narcotic painreliever fentanyl in doses of 12. The patch is usually applied to the skin once every 72 hours. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl. Duragesic fentanyl transdermal dosing, indications. Converting to transdermal fentanyl palliative care. Select microgram per hour dose of transdermal fentanyl based.
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