Substitutes and alternatives to duragesic fentanyl for uses like cancer pain, pain after surgery and chronic pain. Fentanyl citrate is the citrate salt of fentanyl, a synthetic opioid related to the phenylpiperidines with analgesic and anesthetic properties. Determining the appropriate initial fentanyl patch size. Fentanyl may also be prescribed to people with chronic pain who have an opioid tolerance. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid.
Patients must be instructed to stop the use of actiq and dispose of. Known by its brand names actiq, duragesic, sublimaze, and ionsys, fentanyl is a highly potent, synthetic opioid analgesic. When prescribing, do not convert patients on a mcg per mcg basis from actiq. Tirf medicines contain fentanyl, an opioid agonist and a schedule ii controlled substance, with an abuse liability similar to other opioid analgesics. Swab down the pair of scissors and use them to cut the fentanyl patch into evenly sized pieces. It has a relatively low molecular weight and unlike morphine is lipophilic, which makes it suitable for transmucosal administration. Convert to fentanyl initially 11 morphine to transdermal fentanyl oral morphine mg24 hours subcutaneous morphine mg24 hrs dose ratio 3. There is a conversion between hydrocodone and fentanyl. Do this before you remove the protective liner from the patch. This is the largest dose conversion that is shown in the fentanyl prescription leaflet that comes in the box with the medication. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses.
Actiq fentanyl citrate oral transmucosal lozenge fda. Fentanyl patch converter globalrph conversion from. Side effects of duragesic fentanyl transdermal, warnings. For patients converting from actiq 1600 mcg, start abstral 400 mcgdose and titrate using multiples of 400 mcg. 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. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. The initial dose of subsys is always 100 mcg with the only exception of patients already using actiq. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. If switching because of possible opioidinduced hyperalgesia, the calculated equivalent dose should be. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people.
A while ago, before i was on anything except percocet, my doc gave me a scipt for 30 200mcg pops, in. Transdermal and parenteral fentanyl dosage calculations. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Comparative doses of oral morphine and transdermal fentanyl are given in tables 1 and 2. Try not to let the fentanyl come into contact with your skin. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. Converting to transdermal fentanyl palliative care. There are no conversion directions available for patients on any other fentanyl products, other than actiq. 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. Prescribing and dispensing tirf medicines only to appropriate patients, which includes use only in opioidtolerant patients. Fentanyl buccal tablet each tablet contains fentanyl. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Contains fentanyl, a potent opioid analgesic with a rapid onset of action do not confuse with alfentanil. Actiq, fentora fentanyl transmucosal dosing, indications.
Morphine milligram equivalents mme calculator mdcalc. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. The concentration gradient existing between the saturated solution of drug in the reservoir and the lower concentration in the skin drives drug release. This fast fact and concept is a brief outline of clinical information designed for attending physicians to use during teaching rounds or as the starting point for a conference. Opioid conversion guidelines gippsland region palliative. Duragesic fentanyl transdermal dosing, indications. Adjust doses as appropriate see dosage and administration. Tirf rems access education program materials and knowledge. 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. Current actiq dose 400, 600, 800, or 1200 mcg, initial abstral dose 200 mcg.
In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Titrate dose over consecutive episodes of breakthrough pain, as needed. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. Caution should be exercised when converting from a different opioid to fentanyl, as initial dose overestimation may lead to fatal overdose in opioidtolerant patients. Scottish palliative care guidelines fentanyl patches. Transdermal fentanyl is formulated as both a gelcontaining reservoir and a drug inadhesive matrix patch see sidebar. Scottish palliative care guidelines fentanyl sublingual. Calculates total daily morphine milligram equivalents. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. This is my 1st post so ill give a little background. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Do not abruptly discontinue fentanyl patch it is unknown at what dose level the fentanyl transdermal may be. 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.
The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Duragesic label page 1 full prescribing information for. Abstral fentanyl dose, indications, adverse effects. In other words, the conversion factor not accounting for days of use would be 6025 or 2. For patients converting from an actiq dose of 600 to 1200 mcg, start abstral at 200 mcgdose and titrate using multiples of 200 mcg. Fentanyl moves in the direction of the lower concentration at a rate.
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. Subsys is not bioequivalent with other fentanyl products. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. 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. Current actiq dose 1600 mcg, initial abstral dose 400 mcg. Importance of proper patient selection, dosing, and potential for abuse. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Do not convert patients on a mcg per mcg basis from other fentanyl products.
Preventing inappropriate conversion between tirf medicines. 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. Medscape breakthrough cancer pain dosing for actiq, fentora fentanyl. Fentanyl exerts its analgesic effect by selectively binding to the muopioid receptor in the central nervous system cns, thereby mimicking the effects of endogenous opiates. The risk of respiratory depression persists beyond patch removal due to continued drug absorption. Patient a is deriving good pain relief from oxycodone 5 mg plus acetaminophen 325 mg, 2 tablets every 4 hours, but would prefer not to take medication every 4 hours. Both drugs work the same way in the body to relieve pain. Duragesic fentanyl transdermal dosing, indications, interactions. Converting from actiq doses of 600, 800, or 1200 mcg, initiate titration with 200 mcg. You should take your vicodin with it for the first 23 days. The only exception is for actiq and its generic equivalents, which are approved for cancer.
Opioid morphine equivalent conversion factors1 cms. Preventing inappropriate conversion between fentanyl products. Fentanyl like morphine is a strong mopioid receptor agonist. In the case of converting morphine to methadone, methadone has a relative potency of 4. When prescribing, do not convert patients on a mcg per mcg basis from any other oral transmucosal fentanyl product to actiq. The goals of the tirf rems access program are to mitigate the risk of misuse, abuse, addiction, overdose and serious complications due to medication errors by. Converting tofrom transdermal fentanyl return to fast facts index.
Converting from oral morphine to fentanyl transdermal patch. 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. Because of its potency, it is reserved for the most severe types of pain, including cancer pain. Additional pharmacological effects of fentanyl include anxiolysis, euphoria. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. So your doctors thoughts that you need to keep going up on the fentanyl patch are correct. Im wondering what a 200mcg pop would be equal to in oxycodone or morphine. Opioid oral morphine milligram equivalent mme conversion. Converting fentanyl to equal 360 mg of oxycontin with the opioid calculator results in 300 mcghr. Approved risk evaluation and mitigation strategies rems. The chemical name of fentanyl is nphenyln12phenylethyl4piperidinylpropanamide. Transmucosal immediate release fentanyl tirf products.
Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. These should be used in conjunction with the summary of product characteristics for the fentanyl patch being used. Both dilaudid and fentanyl can be habit forming even at prescribed doses. Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Duragesic fentanyl transdermal system is available in generic form. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
Deaths have occurred in opioid nontolerant patients. A safe and effective method for converting cancer patients. After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. For patients being converted from actiq, prescribers must use the initial dosing recommendations for patients on actiq table below table 1. 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. How should conversion from oral morphine to fentanyl. An alternative algorithm for dosing transdermal fentanyl. Opioid conversion ratios guide to palliative care practice.203 100 31 335 26 339 1295 1333 236 1213 939 707 1360 1462 694 297 1378 780 776 693 267 227 751 1500 261 214 242 1439 78 1040 1017 1493 663 1211 696 1359