Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. Transdermal and parenteral fentanyl dosage calculations. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Converting from oral morphine to fentanyl transdermal patch. For oral dilaudid hydromorphone the equivalent dose would be between 7580mgs. 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. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr.
Doses should be titrated according to individual response. Downsides constipation is a common side effect of dilaudid hydromorphone and may require the use of laxatives or stool softeners. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. When switching to methadone, the starting dose should be 10% to 25% of the. Fentanyl patch converter globalrph conversion from. Select microgram per hour dose of transdermal fentanyl based.
In an open, parallelgroup, singledose study involving 23 patients, 4mg of immediaterelease hydromorphone dilaudid ir was administered. Hydromorphone is more potent than morphine, which simply means that a smaller quantity of hydromorphone has the same pain relieving effect as a larger quantity of morphine. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Opioid conversions calc single agent equianalgesic. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Converting to transdermal fentanyl palliative care. Duragesic fentanyl transdermal dosing, indications. Opioid switching using equivalence tables saskatchewan. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent.
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. Morphine milligram equivalent mme calculator instructions. Decrease new dose 3050% to allow for incomplete crosstolerance. The amount of residual drug in the patients system must be accounted for. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. 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.
Schedule ii opioid agonists, including morphine, oxycodone, oxymorphone, fentanyl and methadone, have the highest potential for abuse and risk of fatal respiratory depression. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. The duragesic fentanyl patch provides longterm pain relief and lowers the number of times you need to take pain medications each day. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Currently, there are no empirical studies converting fentanyl to morphine.
Approximate breakthrough doses recommended for fentanyl transdermal patcha breakthrough should be 10% of the total daily opioid dose patch strength mcghour oral morphine immediate release mg oral hydromorphone immediate release mg oral oxycodone immediate release mg 12 5 1 2. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Conversion from morphine or equivalent to fentanyl transdermal. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Why would my primary care doc want to go straight from 60 mgday of morphine er to a fentanyl patch instead of dilaudid. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. To convert to oral morphine equivalent, multiply by. The fentanyl patch equivalent dose duragesic for comparison purposes is. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. 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. Select microgram per hour dose of transdermal fentanyl based on table 2. Opioid converter morphine equivalent calculator omni. Opioid switching using equivalence tables page 1 of 5.
This might explain the experience of switching to more and more. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. It can help identify patients who may be misusing prescription opioids or. Fentanyl is a synthetic pure mu opioid agonist with pharmacologic properties similar to morphine, hydromorphone, oxycodone and other opioids. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. I am taking 12 pill of the hydromorphone and 12 pill of the hydrocodone every 4 hours and the full lorazapam 1mg every 6 hours for the extra anxiety that im already feeling. The results of the study evidenced an increase in the auc corresponding with worsening of renal function. Primary doctor will be in best position to answer the question.
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. Im in a hosp so i feel a little safe if something goes wrong. National and international guidelines also support the use of a 2. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
They all interact with specific opioid receptors such as. 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. Parenteral hydromorphone is 20 times as potent as oral morphine. And just fyi hydromorphone is also known as dilaudid. Opioids opiates are a group of analgesic drugs, used primarily for pain management.
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. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. The total daily morphine milligram equivalents mme will be displayed. Cr 18 mg q12h is being switched to fentanyl patches. This is based on studies converting from morphine to fentanyl. Morphine milligram equivalent mme calculator nyc health.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. Dailymed dilaudid hydromorphone hydrochloride injection. What are the steps for converting from morphine or. Canadian guideline for safe and effective use of opioids. Remember to enter all opioids the patient is taking.
Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. The texas prescription monitoring program is an electronic database that tracks controlled substance prescriptions. What is the conversion from 150 mcg fentanyl patches every. 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. For frail elderly patients, use more conservative conversion or a lower strength patch e. 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.
Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. Degroote national pain centre opioid manager switching opioids download. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po pethidine po. Morphine is the most commonly known pain medication. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Dilaudid, exalgo hydromorphone dosing, indications. Oxycodone is available as immediate release capsules 5mg, 10mg and 20mg, liquid 1mgml or 10mgml and sustained release tablets 5mg, 10mg, 20mg, 40mg and 80mg. 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 brand names of. Equianalgesic chart changes in italics ui health care. Oral hydromorphone is about 47 times as potent as oral morphine.
Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Calculate the total 24hour morphine dose or morphineequivalent. The major discovery is that the classic opioids like morphine, oxycodone, fentanyl, and dilaudid hydromorphone break down into metabolites that are hyperalgesic, that is, molecules that can actually cause pain when they accumulate under conditions of chronic administration. 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. Dr prescribed dilaudid and fentanyl patch, is this safe. 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.
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