These should be used in conjunction with the summary of product characteristics for the fentanyl patch being used. Transdermal and parenteral fentanyl dosage calculations. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Each duragesic patch may be worn continuously for 72 hours. Opioid daily dosage conversion to fentanyl transdermal patch. Fentanyl patches are a quick and easy but powerful way to dispense pain medication. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Subsys fentanyl sublingual spray is an opioid agonist, available as a sublingual spray designed to deliver doses of 100, 200, 400, 600, 800, 1200 and 1800 mcg of fentanyl. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Transmucosal immediate release fentanyl tirf products. It has a role as an opioid analgesic, a muopioid receptor agonist, an anaesthesia adjuvant, an.
Fentanyl accumulates to form a depot in the skin below the. Fentanyl is a monocarboxylic acid amide resulting from the formal condensation of the aryl amino group of nphenyl12phenylethylpiperidin4amine with propanoic acid. The fentanyl skin patch is only used for opioidtolerant patients. Sandoz transdermal patches, fentanyl inj astrazeneca, dbl, sublimaze fentanyl is a potent semisynthetic opioid analgesic. Contains fentanyl, a potent opioid analgesic with a rapid onset of action do not confuse with alfentanil. The table is based on oral dosing for chronic noncancer pain. Fentanyl nasal spray is used to treat breakthrough pain sudden episodes of pain that occur despite round the clock treatment with pain medication in cancer patients 18 years of age or older who are taking regularly scheduled doses of another narcotic opiate pain medication, and who are tolerant used to the effects of the medication to narcotic pain medications.
Two parallel dosage conversion ratios are currently recommended by most manufacturers of fentanyl patches. Patients or carers should be given advice on how to administer fentanyl nasal spray. Phoenixa twostep approach to converting patients from intravenous fentanyl to transdermal patches can prevent occurrence of breakthrough pain episodes, according to data presented at the 20th annual scientific meeting of the american pain society, held here at the end of april. Fentanyl transdermal patch is available as a generic drug and as a brandname drug. In other words, the conversion factor not accounting for days of use would be 6025 or 2. A safe and effective method for converting cancer patients. A shortacting opioid, such as hydrocodone 5 mg every 4 hours, should be fentanyl patch to oxycodone conversionconverting from oral morphine to fentanyl transdermal patch opioid for moderate pain, an opioid agonist eg, hydrocodone, oxycodone can be used. Lazanda fentanyl nasal spray is a liquid formulation of fentanyl citrate, an opioid agonist, intended for intranasal transmucosal administration. Transdermal fentanyl comes as a patch to apply to the skin.
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. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. However, since the fentanyl patch remains in place for 3 days, we multiplied the conversion factor by 3 2. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Transmucosal immediate release fentanyl tirf products risk. Opioid conversion ratios guide to palliative care practice. The patch is usually applied to the skin once every 72 hours. If one holds that it is a partial mu agonist, this would limit the opioid effect.
Duragesic label page 1 full prescribing information for use. Fentanyl patches durogesic for chronic pain nps medicinewise. Seek advice from a specialist about use of rapid acting fentanyl products. The transdermal system is pressed firmly in place with the palm of the hand for 30 seconds, making sure the contact is complete, especially around the edges. Illicitlymanufactured fentanyl is often in the form of powder. Opioid morphine equivalent conversion factors1 cms.
How should conversion from oral morphine to fentanyl. Opioids dosage conversion on the app store itunes 8 oct 2014 opioids by norris. Abstral fentanyl dose, indications, adverse effects. Duragesic patches are intended for transdermal use on intact skin only. Scottish palliative care guidelines fentanyl sublingual. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. The chemical name of fentanyl is nphenyln12phenylethyl4piperidinylpropanamide. Fentanyl duragesic side effects, withdrawal and faqs. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Nonparenteral fentanyl products are contraindicated for use in patients with acute or severe bronchial asthma e. Rapid acting fentanyl should be discontinued if it is ineffective or no longer needed. How to apply a fentanyl patch with pictures wikihow.
Check with your doctor if you have questions about this. Scottish palliative care guidelines fentanyl patches. Comparative doses of oral morphine and transdermal fentanyl are given in tables 1 and 2. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief.
The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. Fentanyl alternatives, side effects, withdrawal and faqs home medications withdrawal opiates fentanyl fentanyl is a synthetic opiate 50 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray. Fentanyl is 100 to 150 times more potent than oral morphine.
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. Opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. 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. This reflects a 40% greater bioavailability for films compared. Recommended doses of fentanyl are presented in the table typically, fentanyl is administered as a continuous iv infusion anesthesia for cardiac surgery. Fentanyl also comes as a buccal and sublingual tablet, oral lozenge, sublingual spray.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. This is based on performing a morphine to fentanyl conversion. Subsys fentanyl sublingual spray is an opioid agonist, available as a sublingual spray designed to deliver doses of 100, 200, 400, 600, 800, 1200 and 1600 mcg of fentanyl. Current actiq dose 1600 mcg, initial abstral dose 400 mcg. Fentanyl and its analogs come in several legal forms including powder, patches, tablets, and spray. Converting to transdermal fentanyl palliative care. Transdermal and parenteral fentanyl dosage calculations and. However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci.
Recommend an appropriate dose of transdermal fentanyl when. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Opioid conversion calculator morphine equivalents advanced. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
Converting from oral morphine to fentanyl transdermal patch. Transdermal fentanyl patches were designed to provide longlasting opioid. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Nov 28, 2016 fentanyl and its analogs come in several legal forms including powder, patches, tablets, and spray. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Abstral fentanyl sublingual tablets actiq fentanyl citrate oral transmucosal lozenge fentora fentanyl buccal tablet lazanda fentanyl nasal spray onsolis fentanyl buccal soluble film subsys fentanyl sublingual spray approved generic equivalents of these products are also covered under this program. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Canadian guideline for safe and effective use of opioids.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Fentanyl citrate intranasal spray as well as oral transmucosal lozenges, buccal. General principles shortacting intravenous iv benzodiazepine anxiolytic eg, midazolam 1 to 2 mg andor opioid eg, fentanyl 50 mcg, administered under the anesthesiologist. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Change your patch at about the same time of day every time you change it. Duragesic fentanyl transdermal dosing, indications. Data from two small studies has shown that conversion of oral morphine to transdermal fentanyl with a ratio of 100. Opioid oral morphine milligram equivalent mme conversion. Duragesic label page 1 full prescribing information for.
In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. That is a lot of fentanyl but i understand tolerance. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl patch converter globalrph conversion from. Even the lowest strength preparations can accumulate and cause opioid toxicity. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. Actiq, fentora fentanyl transmucosal dosing, indications. This conversion factor should be multiplied by the number of micrograms in a given lozengetroche. Current actiq dose 400, 600, 800, or 1200 mcg, initial abstral dose 200 mcg. Illegal use is often in the form of powder used for inhalation or injection, blotter paper, and patches. If you stick with switching the patch every 2 days, you would need around 250 mcghr of fentanyl. The mme conversion factor for fentanyl patches is based on the assumption that one.
The product consists of a practically clear to clear, colorless, aqueous solution of fentanyl citrate in a glass multidose container to which is attached a metereddose nasal spray pump with a. Fentanyl products are not interchangeable and conservative conversion from other opioids to fentanyl is recommended. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Oral morphine milligram equivalent conversion table updated 8.
Legally prescribed fentanyl is typically administered in patches or lozenges. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. They should only be used by people who have longterm chronic pain and are already prescribed a high dose of opioids. Canadian guideline for safe and effective use of opioids for. How should conversion from oral morphine to fentanyl patches. Fentanyl fentanyl is a synthetic opiate 50 100 times more potent than morphine and is administered by injection, lozenges, transdermal patches and oral spray. 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. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be. Fentanyl alternatives, side effects, withdrawal and faqs home. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The amount of fentanyl in a used skin patch can be fatal to a child or pet who accidentally sucks or chews on the patch. In the case of converting morphine to methadone, methadone has a relative potency of 4.