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. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Calculate the total 24hour morphine dose or morphineequivalent.
For transdermal preparations patches the equianalgesic oral morphine dose is listed for the lowest strength of each patch opioid patch strength. Some experts use this conversion in cancer patients. Determine doses when converting a patient from one opioid to another. They all interact with specific opioid receptors such as. Opioid conversion ratios guide to palliative care practice 2016. If the form does not start downloading in 10 seconds, please click here. I did that because it says it takes the patch 8 hours to work. The calculation of opioid conversion is a crucial step in intensive care and is. There is no direct conversion for fentanyl lozenge to. Effects of patch last for 18 24 hours after the patch is removed.
Dose conversion from other oral opioids to oncedaily hysingla er conversion recommendations for managing your patients transition to hysingla er from a nonhydrocodone oral opioid or a transdermal opioid medication conversion from other oral opioids to hysingla er chronic pain therapy. Opioid conversion ratios guide to palliative care practice 2016 352016 2016. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Thank you for downloading opioid manager switching opioid form. Because it may be difficult to determine analgesic need using a controlledrelease product, it is recommended to initiate therapy with immediaterelease products. Switching from 100mcg duragesic patch to ms contin or. In conversion from transdermal fentanyl to oxycodone er, for each 25 mcghour transdermal dose, substitute 10 mg oxycodone er every 12 hours. Calculate opioid dose adjustments and opioid starting doses. I went off the patch and started ms contin in place of it 15mgs 3 xs daily, oxycodone 4 xs daily and ambien cr. These bidirectional differences are not captured in a traditional equianalgesic table. Conversion from transdermal fentanyl to hysingla er.
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. Remember to enter all opioids the patient is taking. Opioid calculator opioid conversions and opioid dosing. Do not convert mcg for mcg among fentanyl products i. The table is based on oral dosing for chronic noncancer pain. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Dispose of the unused part of the patch safely as described in the fentanyl patch care section.
Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Calculate an opioid starting dose for an opioidnaive patient. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Transdermal and parenteral fentanyl dosage calculations and. Morphine milligram equivalent mme calculator instructions. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms contin, oramorph sr, roxanol, msir 10 30. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. 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. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose.
Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. Parenteral oral parenteral oral parenteral oral oral. Apr 21, 2020 conversion from morphine or equivalent to fentanyl transdermal. All noninjectable fentanyl products are for opioidtolerant patients only. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. It should not be used to determine doses when converting a patient from one opioid to another. Select microgram per hour dose of transdermal fentanyl based. Manage breakthrough pain with morphineshortacting opioid prn. My question is, if im going to the right dosage of fentanyl patch which is 25 milligrams every 72 hours from, 60 milligrams of ms contin. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its. Tapentadol dose conversion chart doses in this conversion chart are approximate equivalent doses only. Morphine milligram equivalent mme calculator nyc health. Converting shortacting ir longacting er for wellcontrolled, chronic pain patients may still be experiencing a recurrence of pain before the next scheduled dose. Switched from fentanyl patch 15mcg to mscontin 15mg.
Opioid conversion calculator for morphine equivalents. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. The next opiate step would be a long acting oral med oxycontin or ms contin. Transdermal patch should be used only in opioid tolerant patients. Do not initiate fentanyl patches at the end of life when the oral route is no longer available. Canadian guideline for safe and effective use of opioids.
Avinza, kadian, ms contin, oxycontin, opana er, duragesic, and embeda are not indicated as an asneeded prn analgesic. A few questions first off, i feel like the starting doses of each of these medications one pill patch is less than the common dose. Round up or down based on patient factors and available patch sizes. Opioid dose equivalence calculation of oral morphine equivalent daily dose omedd omedd mg current opioid dose x conversion factor current opioid conversion factor propietary names oral swallowed preparations note. This is my 1st post so ill give a little background. 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.
Opioid oral morphine milligram equivalent mme conversion factors1,2. And suggesting these seems to be such an awful thing to do, so compare that to what a fentanyl patch would be. Practical pain management is a remedy health media, llc. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs.
Opioid conversion ratios guide to palliative care practice. Doses of oxycodone er should be initiated 18 hours after the removal of the fentanyl patch. Oral morphine milligram equivalent conversion table updated 8. Patch duration of effect 48 72 hrs takes 1224 hrs before full analgesic effect of patch occurs after application.
Common questions and answers about convert duragesic to oxycontin. Canadian guideline for safe and effective use of opioids for. Modified release formulations are marked mr morphine mgday 1 anamorph, kapanol mr, ms contin. How to calculate equivalent morphine dosage when changing the method of administration. Oct 25, 2019 conversion from other opioids to ms contin. There is no direct conversion for fentanyl lozenge to other opioids. Only in exceptional circumstances should the buprenorphine or fentanyl patch be removed and the equivalent opioid dose given in a syringe driver, and only. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Ms contin morphine sulfate provides good longterm pain control without the need to take.
There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. This opioid dose equivalence table is intended for comparison of different opioids and opioid formulations in individual patients or in patient cohorts. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 9 mg equivalent to 10 mg oxycodone hcl every 12 hours of xtampza er, should be initially substituted for each 25 mcghr fentanyl transdermal patch. Effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4, subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Opioid oral morphine milligram equivalent mme conversion. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Pain management in hospice care todays geriatric medicine.
Opioids opiates are a group of analgesic drugs, used primarily for pain management. The tablet strength closest to the calculated dose is 30 mg. Fentanyl 25 patch 25microgramshour 30mg to 4mg24hours. What are the steps for converting from morphine or. Pain control, one of the central goals of hospice care, is a top priority in endoflife care. Fentanyl patch converter globalrph conversion from other. So, can someyou please tell swim what the common dose of each of these is. The total daily morphine milligram equivalents mme will be displayed. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. It should be noted that these equivalent doses relate to analgesic equivalence and not opioid equivalence due to the dual mechanism of action of tapentadol muopioid receptor agonist and noradrenaline reuptake. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. Opioid conversion table parenteral mg oral mg morphine 1 3 hydromorphone 1 0.
The following source was used for morphine equivalent conversion factors per mg of opioid. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. The pain care plan must be flexible to respond to the constantly changing challenges of irreversible illness. If a patient is taking ms contin 30 mg bd that is, 30 mg oral morphine x 2 dosesday or 60 mg oral morphineday then, 60 mg oral morphineday. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative. I felt a lot more like myself but i persoanlly don. Scottish palliative care guidelines fentanyl patches. 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.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Converting from transdermal fentanyl to oxycontin treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Dr colin rae, lead for mcn chronic pain dr moutaz burwaiss, chair, education subgroup ms camilla young, mcn coordinator ms lyn watson, nurse representative, education subgroup. This tool does not contain all of the important safety information needed to prescribe butrans. Equianalgesic dosing of opioids for pain management. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian. Transdermal and parenteral fentanyl dosage calculations. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Coggins, pharmd, cgp, fascp todays geriatric medicine vol.
Discontinue all other aroundtheclock opioid drugs when ms contin therapy is initiated. Opioid dose equivalence faculty of pain medicine anzca. Opioid conversions calc single agent equianalgesic. Opioid converter morphine equivalent calculator omni.
Opioid conversion and brand availability in canada michael g. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Opioid conversion to hysingla er hydrocodone bitartrate cii. Equianalgesic dose ratios are only approximations and do not account for genetic factors. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
Converting from oral morphine to fentanyl transdermal patch. Conversion from morphine or equivalent to fentanyl transdermal. Oxycontin, xtampza er oxycodone dosing, indications. 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. Do not use this tool to convert from one opioid to a different opioid. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Must prescribe shortacting opioid for breakthrough pain. Equianalgesic chart changes in italics ui health care. 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. What to do with oxycodone, ms contin, and fentanyl.