Iv dilaudid to fentanyl patch conversion

Use the morphine to fentanyl equivalents chart to determine the equianalgesic dose of transdermal fentanyl. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. If the form does not start downloading in 10 seconds, please click here. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Cr has a history of itching with oxycodone and morphine. Can a patient be given dilaudid by iv while on a fentanyl patch. Dr prescribed dilaudid and fentanyl patch, is this safe. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. 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. Monitor patients closely for respiratory depression, especially within the first 2472 hours of initiating therapy and following dosage increases with dilaudid injection or dilaudidhp injection and adjust the dosage accordingly. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. Use the dosing and conversion chart for opioid analgesics to calculate the equivalent total daily morphine dose.

Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. An alternative algorithm for dosing transdermal fentanyl for. Calculate the total 24hour morphine dose or morphineequivalent. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Conversion of opioid analgesics to fentanyl transdermal. Fentanyl patch converter globalrph conversion from. If you prefer to not use the rounded off conversion, the full. 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. Your equation would look like this based on conversion table. For example, if the bioavailable codeine dose is 100 mg, the iv morphine equivalent is 10mg. 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. Dilaudid, exalgo hydromorphone dosing, indications.

Account for residual drug in the patients system if any during the conversion process. 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. Adapted from tarascon pocket pharmacopoeia created. Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. Kornick said the research team is now looking into the best procedure for accomplishing that task. Opioid conversion and brand availability in canada. These bidirectional differences are not captured in a traditional equianalgesic table.

What is the conversion from 150 mcg fentanyl patches every 3. Opioid conversion and brand availability in canada michael g. Canadian guideline for safe and effective use of opioids for chronic noncancer pain site map toc back appendix b8. 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. Longterm opioid use often begins with treatment of acute pain. They all interact with specific opioid receptors such as. Thank you for downloading opioid manager switching opioid form. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch.

In other words, the conversion factor not accounting for days of use would be 6025 or 2. This is particularly important if converting from longacting oral opioids or fentanyl patches. A safe and effective method for converting cancer patients. Day 1 hydromorphone 12 mg iv day 2 hydromorphone 11mg iv day 3 hydromorphone 8 mg iv he reports his pain as 3 after taking hydromorphone. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. For example, when administered as a prolonged infusion, hydrophobic epidural opioids such as fentanyl will reach plasma levels similar to iv infusions. Conversion from morphine or equivalent to fentanyl transdermal. Conversion of intrathecal opioids to fentanyl in chronic. The total daily morphine milligram equivalents mme will be displayed. This is the number of milligrams that actually gets into the bloodstream. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Canadian guideline for safe and effective use of opioids. What is the conversion from 150 mcg fentanyl patches every. Morphine milligram equivalent mme calculator instructions.

Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. 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. When administered directly into the intrathecal space, hydrophilic opioids are more likely to bind specific receptors in the dorsal horn, where. Online calculator to convert equianalgesic doses of opioid narcotic analgesics. Fentanyl pediatric dose iv iv fentanyl conversion to patch. Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. For frail elderly patients, use more conservative conversion or a lower strength patch e. Opioid converter morphine equivalent calculator omni. Effects of patch last for 18 24 hours after the patch is removed. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Converting from oral morphine to fentanyl transdermal patch.

In order to increase knowledge about how best to respond to and alleviate the suffering of. Changing an oral or iv opioid to transdermal fentanyl 1. 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. Equianalgesic chart changes in italics ui health care. The palliative response opioid equianalgesic conversion table dosing in mg unless listed oral opioid agent ivimsq 30 morphine msc, osr, roxanoltm 10 8 hydromorphone dilaudidtm 2 20 methadone dolophinetm 300. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. And just fyi hydromorphone is also known as dilaudid. Both drugs work the same way in the body to relieve pain. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Convert each number in your list to iv morphine equivalents, by using column 2. 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.

Narcotic pain relievers also can be addictive and abused. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. There are differences in the literature regarding opioid conversion ratios. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Im in a hosp so i feel a little safe if something goes wrong. Equianalgesic dosing its not just about the math mechele fillman, np pain management.

Opioid conversion guide these conversion factors are approximations. Overdosage may occur if an equivalent dose, based on a conversion table. Opioid equianalgesic calculator opioid switching from. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediaterelease opioids and should prescribe no greater quantity than needed for the expected duration. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Transdermal and parenteral fentanyl dosage calculations. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Dosage use only when converting another opioid to fentanyl patch. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. What are the steps for converting from morphine or. Opioid oral morphine milligram equivalent mme conversion.

Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. In an inpatient setting, rescue doses can be provided iv every 1530 minutes. Use of opioids including dilaudid and fentanyl can easily lead to dependency. 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. Both dilaudid and fentanyl can be habit forming even at prescribed doses. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Remember to enter all opioids the patient is taking.