Fentanyl patch conversion to dilaudid iv

Effects of patch last for 18 24 hours after the patch is removed. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Opioid doses equivalent to 25mcghr fentanyl patch drug oral iv morphine 45mg24hr 15mg24hr hydromorphone 10mg24hr 2mg24hr patch duration. Listed below are methods for common conversions using standard published conversion ratios. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po.

Age of the patient or presence of coexisting conditions. Fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. There are many opioids and many formulations available e. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Note this dose should not be decreased further as it is already conservative. Do not use this tool to convert from one opioid to a different opioid. The examples assume a change in drug or route at a time of stable pain control using equianalgesic. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch.

Both drugs work the same way in the body to relieve pain. For frail elderly patients, use more conservative conversion or a lower strength patch e. 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. Introduction a variety of published conversion tables exist to provide clinicians a rough guide for making calculations when switching between different opioid routes or preparations. Sickle cell pain crisis guidlines virginia premier.

Apr 20, 2012 what is the conversion from 150 mcg fentanyl patches every 3. Opioid oral morphine milligram equivalent mme conversion. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. Tjuh opioid infusion guidelines for palliative care other considerations zonce patient is started on an opioid infusion, do not abruptly stop the infusion or give naloxone. Fentanyl patches are another option, but are expensive and difficult to titrate. Because transdermal fentanyl has a delayed onset and onset of peak. What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. However, variation among patients in bioavailability of.

Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. They all interact with specific opioid receptors such as. Opioid switching using equivalence tables page 1 of 5. Select microgram per hour dose of transdermal fentanyl based on table 2. Opioid equianalgesic dose chart equianalgesic dose drug iv imsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Factors that must be addressed during the conversion process include. Dailymed dilaudid hydromorphone hydrochloride injection. Thank you for downloading opioid manager switching opioid form. How lipophilic the drug is, as well as in part by its molecular weight, and possibly structure, affect meningeal permeability.

Opioids opiates are a group of analgesic drugs, used primarily for pain management. The table is based on oral dosing for chronic noncancer pain. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. The formulae for converting methadone are in the footnotes of the table. Pain got worse so doc increased me to 6 mgs dil every 3 hrs and started fentanyl patch 25 mgs today to last 3 days. Narcotic pain relievers also can be addictive and abused. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. For chronic dosing, 10 mg iv morphine 30 mg oral morphine. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sc iv hydromorphone po hydromorphone sc iv buprenorphine sl buprenorphine td buprenorphine sc iv fentanyl td fentanyl sc iv alfentanyl sc iv sufentanyl sc iv codeine po tramadol po tapentadol po dihydrocodeine po. 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. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr.

Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. Opioid equianalgesic calculator opioid switching from. When available, patientcontrolled analgesia pca pumps should be used, per iv if access available, and per sq if no iv access is available. Provide 100% of expected med morphine equivalents in long acting form, as well as 15% prn option for breakthrough pain with dosing interval comparable to medication half life q34h for oral meds, and retitrate daily. Iv drugs in order of choice are morphine, dilaudid, fentanyl, and sq drugs in order of choice are morphine, dilaudid. Degroote national pain centre opioid manager switching opioids download.

Kornick said the research team is now looking into the best procedure for accomplishing that task. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Opioid conversion and brand availability in canada. There are differences in the literature regarding opioid conversion ratios. Dilaudid, exalgo hydromorphone dosing, indications. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service.

What are the steps for converting from morphine or. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. 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 pain. Opioid converter morphine equivalent calculator omni. Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. 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. Canadian guideline for safe and effective use of opioids for. Equianalgesic dosing of opioids for pain management. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Equianalgesic chart changes in italics ui health care.

John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The following source was used for morphine equivalent conversion factors per mg of opioid. Converting from oral morphine to fentanyl transdermal patch. The total daily morphine milligram equivalents mme will be displayed. Fentanyl patch converter globalrph conversion from other. Remember to enter all opioids the patient is taking. The goal is to convert this to oral morphine for discharge. Oxycodone solution for injection is available in 10mgml and 50mgml strengths. The mme conversion factor for fentanyl patches is based on the assumption that one milligram of parenteral fentanyl is equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour day. Transdermal and parenteral fentanyl dosage calculations and. If you prefer to not use the rounded off conversion, the full. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Your equation would look like this based on conversion table.

Round up or down based on patient factors and available patch sizes. Morphine milligram equivalent mme calculator nyc health. Dosage use only when converting another opioid to fentanyl patch. The equianalgesic conversion ratio for iv to epidural to intrathecal opioids varies depending upon the meningeal permeability of the opioid in question. Transdermal patch should be used only in opioid tolerant patients. As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain fentanyl is often used for the management of breakthrough pain in cancer patients 18 years of age and older who are already receiving and who are tolerant to aroundtheclock opioid therapy for their underlying persistent cancer pain.

Decrease new dose 3050% to allow for incomplete crosstolerance. Fentanyl and dilaudid hydromorphone hydrochloride are opioid analgesics used for control of moderate to severe pain. Opioid conversion tips changing to another oral opioid question. Convert 180 mg morphine equivalent to fentanyl using table 1 50 mcghr. Fentanyl patch converter globalrph conversion from. Transdermal and parenteral fentanyl dosage calculations. Dr prescribed dilaudid and fentanyl patch, is this safe, don. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Oral morphine milligram equivalent conversion table updated 8. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain.

Conversion from morphine or equivalent to fentanyl transdermal. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. Calculating opioid dose conversions palliative care. Im in a hosp so i feel a little safe if something goes wrong. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. Currently, there are no empirical studies converting fentanyl to morphine. Opioid conversion guide these conversion factors are approximations.

Oct 01, 2018 dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Changing an oral or iv opioid to transdermal fentanyl 1. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Twostep titration weans patients from iv to patch fentanyl. Oral, 1mg 2mg 1,3,4, potency if switching from hydromorphone to. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sc iv 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. Dec 15, 2001 the cii rate was decreased by 50% 6 hours after application of the fentanyl patch and then discontinued after another 6 hours. Oral opioid dosing equivalents and conversions university of. Morphine milligram equivalent mme calculator instructions.

Select microgram per hour dose of transdermal fentanyl based. Narcotic equivalence converter narcotic route dose. It fentanyl and conversion from it morphine hydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Can a patient be given dilaudid by iv while on a fentanyl patch. Use additional caution with elderly patients 65 years and older, and in patients with liver, renal, or pulmonary disease. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Converting to transdermal fentanyl palliative care. The cii rate was decreased by 50% 6 hours after application of the fentanyl.

Opioid conversion ratios guide to palliative care practice. What is the conversion from 150 mcg fentanyl patches every. Surprisingly, crosstolerance between opioids is often incomplete. Canadian guideline for safe and effective use of opioids. And just fyi hydromorphone is also known as dilaudid. Patient is receiving a total of 5 mg of parenteral hydromorphone in a 24hour period via a pca pump. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Opioid equivalence chart gloucestershire hospitals. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. She would like to try an immediaterelease opioid agent, hydromorphone. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs.

Conversion of intrathecal opioids to fentanyl in chronic pain. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. 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. 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. 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. These bidirectional differences are not captured in a traditional equianalgesic table.

Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. If the form does not start downloading in 10 seconds, please click here. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. Conversion of opioid analgesics to fentanyl transdermal. Some experts use this conversion in cancer patients. A safe and effective method for converting cancer patients. When switching patients to a different opioid agent, equivalence tables are used to estimate an equipotent dose of the target opioid. A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Conversion from transdermal fentanyl to exalgo eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Conversion of intrathecal opioids to fentanyl in chronic. Calculate the total 24hour morphine dose or morphineequivalent. What is the conversion from 150 mcg fentanyl patches every 3. 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.