Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Duragesic fentanyl transdermal system is available in generic form. The starting dose for patients who are not opioid tolerant is opana er 5 mg orally every 12 hours.
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. In the case of converting morphine to methadone, methadone has a relative potency of 4. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. May 05, 2020 duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic 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. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. The medication comes as a tablet that is taken twice a day, with about 12 hours between doses. Some experts use this conversion in cancer patients. Fentanyl patch converter globalrph conversion from other. Methadone american society for pain management nursing. Oxymorphone opana erfentanyl patch duragesic every 72 hours. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. This table cannot be used to convert from opana er to another opioid. Advice should be sought from the palliative care team. This is especially important for fentanyl and methadone conversions.
Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose. List of extendedrelease and longacting opioid products. What is the proper dose of opana er if using 50 mcg patch. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Eighteen hours following the removal of the transdermal fentanyl patch, xtampza er treatment can be initiated. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. Meperidine is not a recommended drug in a palliative care setting and is to be avoided. Another strategy could be to add a long acting opoid agent like a fentanyl patch and decrease your need for short acting. 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.
Side effects of opana er oxymorphone hydrochloride. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Oct 10, 2019 the conversion factors in this table are only for the conversion from one of the listed oral opioid analgesics to opana er. Hi everyone, i am new to this board, but not to taking pain meds. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. Select microgram per hour dose of transdermal fentanyl based on table 2.
With the fentanyl, i dont have this problem and i like being able to less pills per day. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. I would think 12 mcg of fentanyl would cover 5 10325 mg of oxycodone. Equianalgesic dosing of opioids for pain management. Side effects of duragesic fentanyl transdermal, warnings. I had the cheap mylan patches flat and not jell filled so i ended up cutting them so i. Duragesic label page 1 full prescribing information for. Opioid conversions calc single agent equianalgesic. Conversion from other oral opioids to hysingla er chronic pain therapy for each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 opana er opioid conversion chartconversion ratios of oral opioids to opana er 1 potential for abuse similar to other opioids including fentanyl, hydrocodone, hydromorphone. It should not be used to determine doses when converting a patient from one opioid to another. Conversion back from prior opioid divides by the conversion factor shown in the table. Currently, there are no empirical studies converting fentanyl to morphine. After discontinuing a fentanyl patch, fentanyl levels fall gradually.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Although there has been no systematic assessment of such conversion, start with a conservative conversion. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Conversion of opioid analgesics to fentanyl transdermal. Oxymorphone to fentanyl equivalent doctor answers on. I have been battling severe constipation regardless of numerous methods to remedy it. I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. I am currently on 50mcg fentanyl patches and have been since sept. Opana may also be used for purposes not listed in this medication guide. Morphine milligram equivalent mme calculator instructions. Recommend an appropriate dose of transdermal fentanyl when. A patient is using a 25 mcg fentanyl patch every three days. Transdermal and parenteral fentanyl dosage calculations.
Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. It is not recommended for people who have never been prescribed opioidtype pain relief before, and deaths have been reported from improper dosing. Remember to enter all opioids the patient is taking. 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. Opana ir can be used every four hours to every 6 hours as needed. Asked in fentanyl can you take the fentanyl patch off. Jan 19, 2012 opana ir can be used every four hours to every 6 hours as needed. All noninjectable fentanyl products are for opioidtolerant patients. Even though you are on the lower dose, fentanyl is something like 80 times stronger than morphine. Fentanyl patch converter globalrph conversion from. Btw 10mg er is not much drug getting to your pain over the day, due to opana s only average ba. Btw 10mg er is not much drug getting to your pain over the day, due to opanas only average ba. The patch does take a while to kick in when you first put it on. Patients considered opioid tolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day.
Opioid conversion other opioids compared to morphine. Hello i am a fulltime student and mom to a beautiful 16 month old. Converting from oral morphine to fentanyl transdermal patch. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. The total daily morphine milligram equivalents mme will be displayed. It takes around 20 range 27 hours for the plasmafentanyl concentration to decrease by 50% 414. Thats some bad stuff to get off of and there is no easy way that i have found. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. I am having trouble with an allergy to the fentanyl patch.
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. Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Equianalgesic chart changes in italics ui health care. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. In 2017, opana manufacturer endo pharmaceuticals agreed to pull the extendedrelease formulation of drug, opana er, from the market at the request of the food and drug administration because of its high abuse potential. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Duragesic label page 1 full prescribing information for use. 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 is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction.
Prior authorization protocol duragesic fentanyl transdermal. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. The extendedrelease form of opana is for aroundtheclock treatment of pain. May 31, 2017 opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. My pharmacist actually checks the conversion on their own. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are. Conversion charts are only guidelines equianalgesic data is a good approximate. I did a conversion once when i found a table online and was shocked to find out that the 100mcg patches i was on are equivalent to over 200 mgs of oxycodone. Decrease new dose 3050% to allow for incomplete crosstolerance. The following source was used for morphine equivalent conversion factors per mg of opioid. Conversion algorithm for instructions on converting from one opioid to another. Opana er may also be preferred because of its tamperproof formulation, which keeps it from being crushed and injected. 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. Calculate the total 24hour morphine dose or morphineequivalent.
On er pills there were also restrictions on when i could take my other medications as if taken too close to when i would take the opana er, it would interact with the opana and i would get severe dizziness and vomiting. Do not use this tool to convert from one opioid to a different opioid. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The conversion factors in this table are only for the conversion from one of the listed oral opioid analgesics to opana er. Methadone conversion factors increase with increasing dose. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. This calculator should not be used to determine doses when converting a patient from one opioid to another. Most of the above oral opioids are available as generics. Directions for prescribing and using the fentanyl patch must be followed. Compare fentanyl vs oxymorphone comprehensive analysis.
It is important to take this medication on an empty stomach. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic 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 oral morphine milligram equivalent mme conversion. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Binds to various opioid receptors, producing analgesia and sedation opioid agonistavailable in following formats 12mcghr or 25mcghr or 37.
Your individual opana er dosage will depend on the type and severity of your pain, other pain medications you have taken, and other medical conditions you may have, among other factors. The pain relief is inconsistent for some reason, as well. Opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. Opioid conversion calculator for morphine equivalents. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Its available in many dosage forms, including a patch, injection, film, nasal spray, and lollipop. A patient is taking oxycontin 30 mg three times a day. Pain medicationslong acting opioids flashcards quizlet. Round up or down based on patient factors and available patch sizes. Though molecularly similar to fentanyl, this synthetic opioid is 100 times stronger than its chemical cousin and 10,000. 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. Fentanyl is a horrible drug and is 80 times stonger that morphine.
Ideally, you should be on some combination of long and short acting. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Transdermal and parenteral fentanyl dosage calculations and. Opioid conversions calc single agent equianalgesic globalrph. 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. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Butrans contains buprenorphine, a schedule iii controlled substance. If you respond well to the short acting form of it and can afford a brand name med, it may be a good oral med option for you.
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. Oxycontin, xtampza er oxycodone dosing, indications. The duragesic fentanyl patch provides longterm pain relief and lowers the number of times you need to take pain medications each day. 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. This is based on studies converting from morphine to fentanyl. For drug coverage and provider type information, see the. No dosage conversions are available for converting from oxymorphone er to another. Side effects of duragesic fentanyl transdermal, warnings, uses. What is the proper dose of opana er if using 50 mcg patch of. Conversion from morphine or equivalent to fentanyl transdermal. Transdermal fentanyl is approximately 80 times as potent as morphine. Each butrans patch is intended to be worn for 7 days butrans doses of 7. Morphine milligram equivalent mme calculator nyc health. So divide 270mg of opana to every 46 hours as you and your pain doctor decide.
267 1028 1273 558 1465 1402 1224 198 113 1118 561 487 685 222 548 572 191 900 221 912 1350 1505 1317 862 415 1217 156 1395 813 1470 277 272 1046 989 1035 767 599 1136 1123 1465 949 1143 1414 956 2