A safe and effective method for converting cancer patients from. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Change your patch at about the same time of day every time you change it. Threedaytype transdermal fentanyl patch conversion by rapid. 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. Converting from oral morphine to fentanyl transdermal patch mr. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Duragesic fentanyl transdermal system releases fentanyl from the reservoir at a nearly constant amount per unit time. The manufacturer of duragesic brand transdermal fentanyl recommends that unused patches should be folded in half so the adhesive side adheres to itself, and. Transdermal fentanyl comes as a patch to apply to the skin. Opioid conversion ratios guide to palliative care practice 2016.
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. Twostep titration weans patients from iv to patch fentanyl. Duragesic label page 1 full prescribing information for. Recommendations based on data contained in the package insert. 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. The following source was used for morphine equivalent conversion factors per mg of opioid. The fentanyl skin patch is only used for opioidtolerant patients. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people.
Durogesic dtrans 50 mcghr transdermal patch summary of. Duragesic fentanyl transdermal dosing, indications. Converting from oral morphine to fentanyl transdermal patch. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Fentanyl patch dosing determination based on current opioid therapy. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose.
Duragesic label page 1 full prescribing information for use. The chemical name is nphenyln12phenylethyl4piperidinyl propanamide. Select microgram per hour dose of transdermal fentanyl based. Considering patient has not been compliant recently, in addition to recent weight loss indicating cachexia, reducing the dose to a 100mcg patch applied topically. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to.
Subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Scottish palliative care guidelines fentanyl patches. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Sandoz fentanyl patch fentanyl transdermal system is indicated for the management of pain severe enough to require daily, continuous, longterm opioid treatment, and. The cii rate was decreased by 50% 6 hours after application of the fentanyl. May 01, 2020 conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. An alternative algorithm for dosing transdermal fentanyl for. Transdermal td fentanyl is a self adhesive skin patch which provides continuous systemic delivery during the 72 hour application period. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Administer onehalf of the patients total daily taken. 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. Fentanyl may also cause severe, possibly fatal, breathing problems. Fentanyl patch converter globalrph conversion from other opiates. 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. Dailymed fentanyl transdermal patch, extended release. Transdermal and parenteral fentanyl dosage calculations and. Transdermal and parenteral fentanyl dosage calculations.
The cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. In patients receiving longacting opioid formulations sr, transdermal, a rescue dose for breakthrough pain is recommended. Threedaytype transdermal fentanyl patch conversion by rapid titration method with shortacting oral oxycodone. Converting from oral morphine to fentanyl transdermal patch teaching exercise 2. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. The cachectic group had a longer median duration of disease than the normal weight group 5. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Opioid oral morphine milligram equivalent mme conversion. What are the steps for converting from morphine or.
Conversion of opioid analgesics to fentanyl transdermal. The patch is usually applied to the skin once every 72 hours. A safe and effective method for converting cancer patients. A study to assess the safety, dose conversion, and dose. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100. Dosing considerations with transdermal formulations of. 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.
Buprenorphine is a less potent opioid than fentanyl. Recommend an appropriate dose of transdermal fentanyl when. Bernardine newhouse november 14, 2017 uncategorized leave a. Cachexia and absorption of transdermal fentanyl pallimed. Converting to transdermal fentanyl palliative care network of. Durogesic dtrans is a translucent, rectangular transdermal patch with rounded corners. Morphine milligram equivalent mme calculator nyc health. Duragesic fentanyl transdermal system is a transdermal system providing continuous systemic delivery of fentanyl, a potent opioid analgesic, for 72 hours. The size of the breakthrough dose should be 515% of the patients 24hour baseline dose. Transdermal fentanyl patches are unsuitable for opioid naive patients 1. 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. 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. Converting to transdermal fentanyl palliative care. For patients that require more than 100 mcghour, several transdermal systems may be used.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. 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. Opioid conversion ratios guide to palliative care practice. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. Remove transdermal and titrate dose of new analgesic based upon patients report of pain until adequate analgesia has been attained. Converting to transdermal fentanyl palliative care network. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period.
Do not use this tool to convert from one opioid to a different opioid. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Each butrans patch is intended to be worn for 7 days. Fentanyl patch converter globalrph conversion from other. The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Fentanyl moves in the direction of the lower concentration at a rate. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. When using this chart, calculate the total daily dose of morphine.
Oral morphine milligram equivalent conversion table updated 8. Significant amounts of fentanyl continue to be absorbed from the skin for. The conversion doses in these tables are only for the conversion from one of the. Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2. Efficacy and safety of a sixhour continuous overlap. 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. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. 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. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing.
The conversion ratios are approximate and are intended as a guide only. 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. 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. Using standard conversion table example below, 300mgday of morphine is equivalent to 125mcghr of fentanyl. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate. Oct 15, 2019 it is available as fentanyl transdermal system. Each patch is marked in coloured printing ink as follows.
Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. 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. Butrans is for transdermal use on intact skin only. Subcutaneous morphine mgday subcutaneous oxycodone mgday. Fencino 12 microgramshour transdermal patch summary of. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Fentanyl patch converter globalrph conversion from. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Check with your doctor if you have questions about this. 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.
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