Fentanyl patch conversion to iv fentanyl dose

Opioid oral morphine milligram equivalent mme conversion. Analysis of fertility parameters in both studies indicated that an intravenous dose of fentanyl up to 0. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. It conversion ratio reached to give superior vas from previous it opioid.

Duragesic label page 1 full prescribing information for. 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. Fentanyl pf 100 mcg2 ml 50 mcgml intravenous syringe. Scottish palliative care guidelines fentanyl patches. Patients who experience serious adverse effects should have patches removed immediately and should be monitored for at least 24 hours after the patch is removed 412. Duragesic fentanyl transdermal dosing, indications. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. What are the steps for converting from morphine or. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient.

The delayed effects 1216 hours of transdermal fentanyl make dose titration difficult during acute exacerbations of cancer pain. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Duragesic patches are intended for transdermal use on intact skin only. If you are converting a patient to or from fentanyl i. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Look in the pdr, find the morphine conversion table. Opioid conversion ratios guide to palliative care practice. 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. Fentanyl patches durogesic for chronic pain nps medicinewise.

Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. May 29, 2003 the delayed effects 1216 hours of transdermal fentanyl make dose titration difficult during acute exacerbations of cancer pain. Particular care is required when dealing with high doses of opiates. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Current actiq dose 1600 mcg, initial abstral dose 400 mcg. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414.

Opioid equivalence chart gloucestershire hospitals nhs. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Efficacy and safety of a sixhour continuous overlap method. Transdermal and parenteral fentanyl dosage calculations. The usual dose for surgical premedication in adults is 0. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid.

Fentanyl injection can be injected into muscle intramuscular or into veins intravenous. A safe and effective method for converting cancer patients. The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much. It conversion ratio, eventual it fentanyl dose, and iv. Fentanyl patch converter globalrph conversion from other. Stop long acting oral morphine after applying patch. The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response. 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. Highdose fentanyl patch for cancer pain american board of. A safe and effective method for converting patients from. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic.

Discarded patches have the potential to be misused. Highdose fentanyl patch for cancer pain american board. 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. Conversion of intrathecal opioids to fentanyl in chronic pain.

This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. In contrast, the intravenous administration of fentanyl 0, 0. Oct 15, 2019 in contrast, the intravenous administration of fentanyl 0, 0. Fentanyl has a risk for abuse and addiction, which can lead to overdose and death. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.

After discontinuing a fentanyl patch, fentanyl levels fall gradually. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.

Actiq, fentora fentanyl transmucosal dosing, indications. Current actiq dose 400, 600, 800, or 1200 mcg, initial abstral dose 200 mcg. For frail elderly patients, use more conservative conversion or a lower strength patch e. Advanced opioid conversion calculator morphine equivalents. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg. The 50, 75, and 100 mcg hr patches should only be used in patients already on and tolerant to opioid therapy. Advice should be sought from the palliative care team.

The levy rule states that the hourly fentanyl patch strength in micrograms is half of the total daily dose of sustained release morphine in milligrams. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. Calculate the total 24hour morphine dose or morphineequivalent. 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. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Decrease new dose 3050% to allow for incomplete crosstolerance. 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 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. So by applying the patch with the last dose of the oral morphine the chances of increasing pain during the drug transition can be avoided. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3.

Transdermal and parenteral fentanyl dosage calculations and. The upper reported dose in the conversion scale between fentanyl and other strong opioids is up to 300. The fentanyl patch comes in multiples of 25 micrograms. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived. Converting to transdermal fentanyl palliative care network. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. Fentanyl patch protocol ventura county, california. Converting from oral morphine to fentanyl transdermal patch. Wilcoxon nonpaired signed rank test was used to examine the change in fentanyl dosage and iv. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Select microgram per hour dose of transdermal fentanyl based on table 2.

Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225314 315404 imiv morphine 10 to 22 2337 3852 5367. Are you taking fentanyl pf 100 mcg2 ml 50 mcgml intravenous syringe. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status. Select microgram per hour dose of transdermal fentanyl based. Dec 15, 2001 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. What every pharmacist should know about transdermal. 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. Patients at the authors institution routinely are switched from transdermal to intravenous iv fentanyl using a 1.

Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of the new agent and may result in an overdosage. B initiation of fentanyl in patients who are opioidnaive is contraindicated at any dose. Convert the oral morphine dose to transdermal fentanyl. Frail or elderly patients may need lower doses and slower titration. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. Recommend an appropriate dose of transdermal fentanyl when. Apr 10, 2020 dose may be calculated using dose conversion guidelines in the product package insert, local protocol, or another reliable reference. Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. 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. Fentanyl is a strong, synthetic manmade narcotic that is similar to morphine. Efficacy and safety of a sixhour continuous overlap. Therefore the rough fentanyl equivalent for 270 mg of morphine 5 micrograms of fentanyl hour. Twostep titration weans patients from iv to patch fentanyl.

For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoralr at 100 mcg. Duragesic label page 1 full prescribing information for use. Look in the pdr, find the morphine conversion table, it says that 5224 mg of morphine 50 mcg patch. Dose may be calculated using dose conversion guidelines in the product package insert, local protocol, or another reliable reference. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. Convert the iv dose to the equianalgesic oral morphine dose using a ratio of. Converting to transdermal fentanyl palliative care. Conversion of intrathecal opioids to fentanyl in chronic. Fentanyl may also cause severe, possibly fatal, breathing problems. Convert the oral morphine dose to duragesic there are two methods. 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. Fentora fentanyl dose, indications, adverse effects.