Primary doctor will be in best position to answer the question. 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. Opioid converter morphine equivalent calculator omni. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Opioids opiates are a group of analgesic drugs, used primarily for pain management. 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. Hydromorphone dilaudid, exalgo is an opioid used to treat moderate to severe pain. In an open, parallelgroup, singledose study involving 23 patients, 4mg of immediaterelease hydromorphone dilaudid ir was administered. Schedule ii opioid agonists, including morphine, oxycodone, oxymorphone, fentanyl and methadone, have the highest potential for abuse and risk of fatal respiratory depression. The texas prescription monitoring program is an electronic database that tracks controlled substance prescriptions. 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. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Calculate the total 24hour morphine dose or morphineequivalent.
Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. 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. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. 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. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Dilaudid hydromorphone is a powerful pain reliever that has significant risks for abuse and overdose. It fentanyl and conversion from it morphinehydromorphone to it fentanyl have been challenging given the lipophilic nature of fentanyl. Doses should be titrated according to individual response. The amount of residual drug in the patients system must be accounted for. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. 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.
Oral hydromorphone is about 47 times as potent as oral morphine. In addition to this i take 2 ibuprophen every 4 hours and several supplemental nerve formula and imflamatory formula supplements to help in this process. Select microgram per hour dose of transdermal fentanyl based on table 2. Currently, there are no empirical studies converting fentanyl to morphine. Opioid conversions calc single agent equianalgesic. Even so, converting from a patch to a pill is a tricky thing and youll probably have to just trust your doc. When switching to methadone, the starting dose should be 10% to 25% of the. Equianalgesic chart doses listed are equivalent to 10 mg of parenteral morphine. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Conversion of intrathecal opioids to fentanyl in chronic. 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.
Duragesic fentanyl transdermal dosing, indications. Dilaudid, exalgo hydromorphone dosing, indications. Morphine is the most commonly known pain medication. Fentanyl patch converter globalrph conversion from. For oral dilaudid hydromorphone the equivalent dose would be between 7580mgs.
Opioid oral morphine milligram equivalent mme conversion. This is based on studies converting from morphine to fentanyl. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. 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.
Estimates on equivalence vary but a conversion factor of 1mcg fentanylhr 2 mg. Why would my primary care doc want to go straight from 60 mgday of morphine er to a fentanyl patch instead of dilaudid. For frail elderly patients, use more conservative conversion or a lower strength patch e. Caution should be used in older adults or patients with cachexia fentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Parenteral hydromorphone is 20 times as potent as oral morphine. Opioid switching using equivalence tables saskatchewan. The total daily morphine milligram equivalents mme will be displayed. 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. 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. 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. Current 24 hour dose of hydromorphone 18 x 2 36 mg hydromorphone convert to morphine milligram equivalent o method 1 using table 1 see below, convert hydromorphone 24hour dose to oral morphine equivalent 36 x 5 180 mg morphine24 hrs. 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.
Dilaudidhp contains hydromorphone, which is a potent schedule ii, controlled opioid agonist. Dailymed dilaudid hydromorphone hydrochloride injection. 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. National and international guidelines also support the use of a 2. What are the steps for converting from morphine or. Conversion from morphine or equivalent to fentanyl transdermal. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl.
Cr 18 mg q12h is being switched to fentanyl patches. 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. What is the conversion from 150 mcg fentanyl patches every. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. It can help identify patients who may be misusing prescription opioids or. Equianalgesic chart changes in italics ui health care. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
Downsides constipation is a common side effect of dilaudid hydromorphone and may require the use of laxatives or stool softeners. In the case of converting morphine to methadone, methadone has a relative potency of 4. Start exalgo 18 hr after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24hr. Fentanyl is a synthetic pure mu opioid agonist with pharmacologic properties similar to morphine, hydromorphone, oxycodone and other opioids. Transdermal and parenteral fentanyl dosage calculations. The results of the study evidenced an increase in the auc corresponding with worsening of renal function. Start exalgo 18 hours after removal of transdermal fentanyl patch at 50% of calculated total daily dose given over 24 hours. 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. They all interact with specific opioid receptors such as. Morphine milligram equivalent mme calculator instructions. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. The next step is to convert 25 mg of oral hydromorphone to the daily oral morphine equivalent dose domed.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Opioid switching using equivalence tables page 1 of 5. Select microgram per hour dose of transdermal fentanyl based. This might explain the experience of switching to more and more.
Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. 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. Decrease new dose 3050% to allow for incomplete crosstolerance. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
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. 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. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. And just fyi hydromorphone is also known as dilaudid. Im in a hosp so i feel a little safe if something goes wrong. The fentanyl patch equivalent dose duragesic for comparison purposes is. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The duragesic fentanyl patch provides longterm pain relief and lowers the number of times you need to take pain medications each day. Converting from oral morphine to fentanyl transdermal patch. Remember to enter all opioids the patient is taking. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Morphine milligram equivalent mme calculator nyc health.
To convert to oral morphine equivalent, multiply by. Converting to transdermal fentanyl palliative care. Degroote national pain centre opioid manager switching opioids download. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches.
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