Opioid oral morphine milligram equivalent mme conversion. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Equianalgesic chart changes in italics ui health care. Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
Round up or down based on patient factors and available patch sizes. Do not convert mcg for mcg among fentanyl products i. Do i need a stronger dosage to not go into withdrawal. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid conversion calculator for morphine equivalents.
Im having to switch to 25 milligram fentanyl patch. Msir morphine sulfate instant release will release rapidly usually on the order of 1030 minutes whereas mscontin is a controlled release formulation that, unless crushed or chewed or. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. From to transdermal fentanyl 4 hour immediate release ir oral opioid give regular doses ir oral opioid for the first 12 hours after applying patch. Opioids may be all that a person needs for acute pain broken bone, sprained ankle but is never the primary treatment of any chronic pain. See fentanyl information below for initiating patch and patch to po dosing.
Opioid converter morphine equivalent calculator omni. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. 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 morphine sulfate ir. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose.
Oxycontin, xtampza er oxycodone dosing, indications. It should not be used to determine doses when converting a patient from one opioid to another. He is not certain this has been helping his pain very much, and it is quite expensive. For frail elderly patients, use more conservative conversion or a lower strength patch e.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Recommend an appropriate dose of transdermal fentanyl when. It must be made clear however that the methadone is being used to treat pain, and that the taper is being done for medical. In other words, the conversion factor not accounting for days of use would be 6025 or 2. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. The tablet strength closest to the calculated dose is 30 mg. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Morphine dose equivalence not reliably established. Select microgram per hour dose of transdermal fentanyl based on table 2. Transdermal fentanyl mcg hour patch size reference 30 10 to 15 300 12 3,12. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo.
Available at uihc as an immediaterelease tablet and oral. Duragesic fentanyl patch, oxycontin, methadone, ms contin, and exalgo hydromorphone, along with short acting immediate release opioids oxycodone, hydromorphone dilaudid, and morphine. Pain management in hospice care todays geriatric medicine. A number of oral and transdermal er opioid formulations are currently available table 1. Many programs use methadone, as it is less likely to produce euphoria and is inexpensive compared with the other longacting agents. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Oral opioid dosing equivalents and conversions university of. Fentanyl patch converter globalrph conversion from. Opioid switching using equivalence tables home saskatchewan. Converting from oral morphine to fentanyl transdermal patch.
Potency, defined as the dose required to produce a given effect, is typically compared relative to morphine and differs. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Calculation of oral morphine equivalent daily dose omedd. Conversion from morphine or equivalent to fentanyl transdermal. Butrans contains buprenorphine, a schedule iii controlled substance. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. In the case of converting morphine to methadone, methadone has a relative potency of 4. Update on prescription extendedrelease opioids and. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. This is my 1st post so ill give a little background.
The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. In one study, patients treated with ir morphine were randomly assigned to either switch to an er morphine ms contin or continue on their existing ir morphine formulation. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin. Transdermal fentanyl is approximately 80 times as potent as morphine. Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
Ms contin, astramorph morphine dosing, indications. Opioid dose equivalence home faculty of pain medicine. A practical guide to tapering opioids mental health. 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. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. When the opioid regimen includes modified and immediaterelease preparations. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Calculate dose needed for prn immediate release rescue opioid. Opioid dose equivalence faculty of pain medicine anzca. Equianalgesic dosing of opioids for pain management. Opioids opiates are a group of analgesic drugs, used primarily for pain management. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours.
Patients switched to ms contin reported lower pain intensity, improved strength, improved quality of life, and better adjustment to disease and treatment. This is based on studies converting from morphine to fentanyl. I did that because it says it takes the patch 8 hours to work. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice on removal of the patch, it takes approximately 17 hours for serum concentration of fentanyl to reduce by 50% and this must be considered when converting.
Transdermal and parenteral fentanyl dosage calculations. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. Demystifying opioid conversion calculations stephanie cheng, pharmd, mph, bcgp. Conversion from transdermal fentanyl to hysingla er. Follow the patient closely during conversion from transdermal fentanyl to hysingla er, as there is. What are the differences between ms contin 15mg cr and. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Each of these drugs has a different halflife, side effect and safety profile, and some are better for some people, and some are more. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Morphine milligram equivalents mme calculator mdcalc. Canadian guideline for safe and effective use of opioids. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion.
Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Equivalence between oral morphine and transdermal fentanyl. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg morphine per day, 25 mcg. Switching from 100mcg duragesic patch to ms contin or. Opioid switching using equivalence tables page 1 of 5. Some experts use this conversion in cancer patients. Switched from fentanyl patch 15mcg to mscontin 15mg. Ms contin is available in 15 mg, 30 mg, 100 mg and 200 mg controlledrelease tablets. Patches conversion doses drug name drug dose equivalent oral morphine dose fentanyl 25 patch 25microgramshour 30mg to 4mg24hours 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. Doctors give trusted answers on uses, effects, sideeffects, and cautions.
Opioid conversion ratios guide to palliative care practice. Degroote national pain centre opioid manager switching opioids download. 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. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. 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. Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extendedrelease opioid formulations, reserve oxycontin for use in patients for whom alternative treatment options e. They all interact with specific opioid receptors such as.
Calculate the total 24hour morphine dose or morphineequivalent. 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 treatment. Currently, there are no empirical studies converting fentanyl to morphine. A patient with chronic noncancer pain currently taking hydromorph contin hydromorphone cr 18 mg q12h is being switched to fentanyl patches. Calculates total daily morphine milligram equivalents. In these last 20 years ive used these longacting opioids.
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