Hydromorphone oral 4 hydromorphone im, iv, sc 20 methadone see methadone guidelines fentanyl patch 25mcghr patch roughly 50mg oral morphineday buprenorphine patch 10mcghr patch 25mg oral morphineday weaker stronger how to use the ome table drug multiply current dose by this factor to equal oral morphine dose tramadol 0. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Opioid converter morphine equivalent calculator omni. Oral hydromorphone is about 47 times as potent as oral morphine. In addition to this i take 2 ibuprophen every 4 hours and several supplemental nerve formula and imflamatory formula supplements to help in this process. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Recommend an appropriate dose of transdermal fentanyl when. Morphine milligram equivalent mme calculator nyc health. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Conversion from other oral hydromorphone formulations.
Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Mar 09, 2012 since you didnt say what your dose of fentanyl is, all i can do is suggest you do a search for an online narcotic converter.
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. I am taking 12 pill of the hydromorphone and 12 pill of the hydrocodone every 4 hours and the full lorazapam 1mg every 6 hours for the extra anxiety that im already feeling. Fentanyl topical may also be used for purposes other than those listed in this medication guide. Hydromorphone is chemically related to morphine, and very commonly used for moderate to severe pain. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. Start with equivalent total daily dose of immediate release formulation and administer once daily. 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.
Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Round up or down based on patient factors and available patch sizes. To convert to oral morphine equivalent, multiply by. Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. There are many opioids and many formulations available e. Oral morphine milligram equivalent conversion table updated 8.
Oxycodone is available as immediate release capsules 5mg, 10mg and 20mg, liquid 1mgml or 10mgml and sustained release tablets 5mg, 10mg, 20mg, 40mg and 80mg. The dilemma of opioid conversion in intrathecal therapy. The major discovery is that the classic opioids like morphine, oxycodone, fentanyl, and dilaudid hydromorphone break down into metabolites that are hyperalgesic, that is, molecules that can actually cause pain when they accumulate under conditions of chronic administration. The ionsys fentanyl transdermal device is used only in a hospital to treat acute pain after surgery. Converting from oral morphine to fentanyl transdermal patch. Duragesic fentanyl transdermal dosing, indications. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. Opioid conversion guidelines gippsland region palliative care. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
What every pharmacist should know about transdermal. Compare fentanyl vs hydromorphone headtohead with other drugs for uses, ratings, cost, side effects, interactions and more. Fentanyl patch use in nonopioid tolerant patients has resulted in fatal respiratory depression. Surprisingly, crosstolerance between opioids is often incomplete. Equianalgesic dose conversions are necessary when changing opioid drug therapy in the clinical.
Fentanyl patch converter globalrph conversion from. Start exalgo dose at 50% of calculated daily dose every 24 hours. The patients calculated dose of 25 mg of oral hydromorphone is equal to 100 mg of oral morphine. Well, according to the fda, opiatetolerance is defined as a patient who has been taking daily, for one week or longer, at least 60mg of oral morphine, 30mg of oral oxycodone, 8mg of oral hydromorphone, 25mg of oral oxymorphone, or an equianalgesic dose of another opioid. What is the conversion from 150 mcg fentanyl patches every. Exalgo hydromorphone hydrochloride extended release. The following source was used for morphine equivalent conversion factors per mg of opioid. Why would my primary care doc want to go straight from 60 mgday of morphine er to a fentanyl patch instead of dilaudid. Fentanyl can be abused and is subject to criminal diversion. Opioid switching using equivalence tables home saskatchewan.
Equianalgesic dosing of opioids for pain management. Ivs fentantyl is included in this table to assist with opioid rotation from fentanyl where patients are admitted to olh s on ivs fentanyl. Opioid manager switching opioids morphine equivalence table. Meptazinol meptid 200mg 4mg to 8mg oxycodone 10mg 20mg pethidine oral 50mg 5mg to 6. National and international guidelines also support the use of a 2. Some experts use this conversion in cancer patients. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. They were on a variety of full agonist opioids, including predominantly oxycodone n 12, hydromorphone n 4, oxymorphone n 2, fentanyl n 6, methadone n 5, and morphine n 6. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Transdermal and parenteral fentanyl dosage calculations and. This might explain the experience of switching to more and more. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr.
What is the conversion from 150 mcg fentanyl patches every 3. Opioid conversions calc single agent equianalgesic globalrph. Parenteral hydromorphone is 20 times as potent as oral morphine. 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. The fentanyl patch equivalent dose duragesic for comparison purposes is a single 100mcg fentanyl patch. Transdermal and parenteral fentanyl dosage calculations. Canadian guideline for safe and effective use of opioids for. Hydromorphone may also cause severe, possibly fatal, breathing problems. Compare fentanyl vs hydromorphone comprehensive analysis. Jan 23, 2020 to calculate the 24hour hydromorphone hydrochloride extendedrelease tablets dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of hydromorphone hydrochloride extendedrelease tablets. The total daily morphine milligram equivalents mme will be displayed. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Equianalgesic chart changes in italics ui health care.
Exalgo hydromorphone hydrochloride extended release tablets. Hydromorphone has a risk for abuse and addiction, which can lead to overdose and death. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Fentanyl buccal or sl tablets, or lozengetroche5 mcg. May 25, 2011 i have been prescribed every strength of vicodin, percocet, hydromorphone both er and ir and it doesnt come in er form in 10mg, only 8mg,12, and 16mg and ir in 2, 4 and 8.
Do not use this tool to convert from one opioid to a different opioid. Often people are switched from morphine to hydromorphone to treat possible side effects from ongoing use of morphine, such as confusion or uncontrolled jerking. Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mg day po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Opioid oral morphine milligram equivalent mme conversion. Fentanyl patch conversions package insert recommendations. The amount of residual drug in the patients system must be accounted for. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Opioids opiates are a group of analgesic drugs, used primarily for pain management. In this situation, we would allow for breakthrough medication to be available during the transition. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Metropolitan region palliative care consortium opioid conversion ratios emrpcc. Advanced opioid conversion calculator morphine equivalents. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose.
The patients calculated dose of 25 mg of oral hydromorphone is. Many patients were on combinations of different immediate release and sustained release combinations of opioid medication. Canadian guideline for safe and effective use of opioids. Then reduce the hydromorphone hydrochloride extendedrelease tablets dose by 50%. Using this conversion guideline, 100mg of morphine will convert to a 50mcghr dose, however the fda guidance suggests 100mg should convert to a 25mcg dose. Remove fentanyl patch 18 hours prior to starting extendedrelease therapy using the conversion of a single 25 mcghr fentanyl transdermal patch to a 12 mg extendedrelease hydromorphone tablet, calculate conversion dose and reduce by 50% to obtain the starting dose of the extendedrelease hydromorphone. 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. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs.
Opioid strength in mg except where noted mme conversion factor. Adverse effect intervention constipation stepwise escalation of regular oral stimulant or osmotic laxative on opioid initiation. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Dailymed hydromorphone hydrochloride extendedrelease. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed.
Remember to enter all opioids the patient is taking. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. The duragesic fentanyl skin patch is used to treat moderate to severe chronic pain. Then the part where hydromorphone or dilaudid is 5x the strength of morphine which is all kadian er is. Primary doctor will be in best position to answer the question. Addressing adverse effects from opioids if the ae is not managed symptomatically and persists for more than one week, switch to another opioid. For a patient on 12 mgday intrathecal morphine, our conversion puts hydromorphone at 3 mgday and, with a reduction for safety, we would be starting at 1. They all interact with specific opioid receptors such as. Morphine milligram equivalent mme calculator instructions. Opioid conversions calc single agent equianalgesic. Compare fentanyl vs hydromorphone comprehensive analysis by. Conversion from highdose fullopioid agonists to sublingual. Dilaudid, exalgo hydromorphone dosing, indications. In the case of converting morphine to methadone, methadone has a relative potency of 4.
Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. In other terms, a patient must have been on the aforementioned milligrams. Opioid oral morphine milligram equivalent mme conversion factors1,2. Pain and symptom management pain management 2017 3 3. What every pharmacist should know about transdermal fentanyl. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Demystifying opioid conversion calculations, guide for effective dosing. Morphine sulfate 15mg ir x 4 tablets24hours 60mg total daily ir dose.
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