Transdermal and parenteral fentanyl dosage calculations. This method of abuse has not previously been described in the literature. Principles of opioid management fraser health authority. My own guide on extracting nongel fentanyl patches. Residual effects from discontinued longacting formulations should also be assessed before converting a patient to a new opioid. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. Opioid conversion ratios guide to palliative care practice. Select microgram per hour dose of transdermal fentanyl based on table 2. Fentanyl will be released from the site for up to 24 hours. Dailymed fentanyl transdermal patch, extended release. When using the conversion table for injecting fentanyl from patches it is important to consider three things. The duration of fentanyl withdrawal symptoms varies depending on the individual, but the following are some general timelines that someone can expect. While this makes the conversion relatively easy, patches tend to be left on longer than needed. Fentanyl is a lipophilic opioid that is hundred times as strong as morphine.
During this time, use caution when giving other opioids. The drug is absorbed via the patients skin and makes its way into the bloodstream, where it crosses the bloodbrain barrier and binds to opioid receptors. Durogesic dtrans 25 mcghr transdermal patch summary of. Using this conversion guideline, 100mg of morphine will convert to a 50mcghr dose, however the fda guidance suggests 100mg should convert to a 25mcg dose. The doseresponse relation of intrathecal fentanyl for labor analgesia. 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. 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. Withdrawal symptoms from opioids usually begin anywhere from 12 to 30 hours after the last dose is taken. In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. Converting from oral morphine to fentanyl transdermal patch. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy.
In this chapter we will focus on conversion calculations involving switching to and. Adjusting for body weight, clearance lhkg appears to be approximately 80% higher in children 2 to 5 years old and 25% higher in children 6 to 10 years old when compared to children 11. For patients with a current fentanyl transmucosal lozenge of 200 mcg or 400 mcg, initiate fentanyl buccal dose fentoral r at 100 mcg. The relatively new 12mcg patch lets you titrate dosages up at a slower rate, an advantage for patients who are sensitive to dosage changes. For delivery rates in excess of 100 mcghour, multiple systems may be used. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Select microgram per hour dose of transdermal fentanyl.
The fentanyl patch, also known by the brand name duragesic, is designed to give aroundtheclock pain relief to people experiencing chronic and severe pain. Even the weakest of the fentanyl patches contains enough fentanyl to cause an overdose in someone who doesnt have a high tolerance for opioids. It is an extendedrelease format that dispenses the powerful opioid drug in a transdermal fashion, or through the skin, continuously during a 72hour period. Fentanyl is an opioid analgesic with predominant mu. Caution is advised when converting to methadone due. Fentanyl patch converter globalrph conversion from.
Efficacy and safety of a sixhour continuous overlap. The initial dose of sandoz fentanyl patch should be obtained or calculated from the conversion tables see dosage and administration, and must not be higher than that dose which is equivalent to the total dose of opioids the patient is receiving at the time of the switch to the patch. Fentanyl is part of the opioid class of prescription medications. Fentanyl is a potent opioid analgesic with selective action at the mu opiate receptor. Fentanyl duragesic side effects, withdrawal and faqs. Equianalgesic chart changes in italics ui health care. What every pharmacist should know about transdermal.
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. Conversion of intrathecal opioids to fentanyl in chronic. A safe and effective method for converting cancer patients from. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care. We present a case of iv fentanyl abuse after the extraction from a mylan matrix type patch. In the case of converting morphine to methadone, methadone has a relative potency of 4. Patients then can be switched from intravenous iv to transdermal fentanyl once stable pain relief has been achieved. Use of iv fentanyl is restricted to oncology, burn service, palliative care, intensive care units or based on recommendation by the pain service. Route onset peak duration fentanyltransdermal fenta.
Original research dose conversion ratio for continuous. Before applying a new fentanyl transdermal system, remove the patch you have been wearing. She recommends to convert every 2mg of morphine to 1mcg of td fentanyl. Names for fentanyl or drugs laced with fentanyl include china white, china girl, tango, cash, goodfella, friend, murder 8, jackpot, tnt, apache, dance fever, heroin popcorn, fenny, and for the transdermal form, patch, sticky, sticker, strips. Onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued. Recommend fentanyl td 25 mcghr patch not for use in treating acute pain, short term or postoperative pain or occasional pain not for mild pain or pain not expected to persist for an extended duration. Thus, fentanyls short duration of action after a single dose results from. Before conversion to a long acting opioid, use immediate release.
Fentanyl concentrations were measured in more than 250 children aged 2 to 17 years who were applied fentanyl patches in the dose range of 12. During dose titration, additional shortacting opioids should be. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Fentanyl may cause less constipation, sedation, and cognitive impairment than morphine.
According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. Duragesic fentanyl transdermal dosing, indications, interactions. In the iv form fentanyl is often used in icus for pain control due to its rapid onset of action and due to the minimal histamine release associated with fentanyl in comparison to morphine. On opioid rotation from continuous intravenous infusion of fentanyl fentanyl civ to fentanyl transdermal patch fentanyl tp, dose conversion can be based on the bioavailability of fentanyl tp because the active ingredient is the same. Fentanyl withdrawal symptoms duration the recovery village. Intravenous and epidural fentanyl provide equivalent analgesia in these surgical populations.
Dosage use only when converting another opioid to fentanyl patch. Since naloxones duration of action is considerably shorter than that of transdermal fentanyl, administration via continuous intravenous infusion at a rate titrated to the needs of the individual patient may be necessary 05. Naloxone in small titrated doses is only needed for lifethreatening respiratory depression refer to naloxone guideline. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. If at any time the patient develops symptoms of withdrawal, return to the previous rate and consider giving an iv bolus of fentanyl. A safe and effective method for converting cancer patients. The mean it morphine equivalent dose at initial conversion was 15. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Our primary purpose with this series was to define the relation between fentanyl dose and the duration and onset of labor analgesia. An allergic reaction to the patch adhesive can occur consider switching brand of patch. Both drugs work the same way in the body to relieve pain. In recent years, there have been numerous reports of fentanyl abuse that included the mixing of fentanyl in other drugs like heroin.
With this delivery system high voltage electric pulses of extremely. My experience with fentanyl patches and how i change them. Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. Used to treat chronic, severe pain, fentanyl comes in a patch form. With a fentanyl patch, since its an extended release medicine, this can be longer. What are the steps for converting from morphine or. I apply a thick lotion after its been a few hours so the lotion doesnt make it slip off. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. Do not wear more than one fentanyl transdermal system at a time unless your healthcare provider tells you to do so. So by applying the patch with the last dose of the oral morphine the chances of increasing pain during the drug transition can be avoided. Advanced opioid conversion calculator morphine equivalents. Both dilaudid and fentanyl can be habit forming even at prescribed doses. It has been known that intravenous administration leads the elimination process to be the fastest, whereas transdermal and transmucosal administration processes eliminate the drug comparatively slowly. Fentanyl transdermalsystemic drug information, professional.
The duration of fentanyl transdermal system use varied in cancer patients. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. Fentanyl patches come in 12, 25, 50, 75, and 100mcg doses. Conversion from morphine or equivalent to fentanyl transdermal. Do not begin a patient on a fentanyl transdermal patch as their first opioida small number of patients may require a 48hour dosing interval. The doseresponse relation of intrathecal fentanyl for. Duration of action is for iv intermittent, imsc, and po routes. This is based on performing a morphine to fentanyl conversion. The effects are dependent on an individuals size, weight, overall state of health, the. Describe how to transition between intravenous iv fentanyl.
One option that i dont like to use is switching patients over to a fentanyl patch. Pharmacology comparison between fentanyl and morphine in adults. How long does fentanyl stay in your system hxbenefit. Iv direct administration has shorter duration of action restricted to treatment of drug or bloodinduced rigors and postoperative shivering note that this table is unidirectional for morphine to fentanyl patch conversion only. Fentanyl has a short duration of effect just 3090 minutes. My own guide on extracting nongel fentanyl patches the following method is rarely mentioned due to the massive overdose potential of people who iv the extract, but this is how you can smoke the nongel fent patches with relative safety.
Duragesic fentanyl transdermal dosing, indications. The primary routes for fentanyl administration are transdermal patch, intravenous iv and transmucosal lozenge. Conversion oral iv opioids to fentanyl transdermal each transdermal system is worn continuously for up to 72 hr see administration tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal. Scottish palliative care guidelines fentanyl patches. Calculate the total 24hour morphine dose or morphineequivalent. However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Effects of patch last for 18 24 hours after the patch is removed. Basically me blabbing about how i change my fentanyl patches. Fentanyl is also available as a sustained release transdermal patch which when. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Fentanyl withdrawal procedures and expectations at.
The mean fentanyl dose at the end of titration was 0. Accidentally coming into contact with the fentanyl patch s sticky side can also lead to the drug being released directly into the bloodstream. Duragesic label page 1 full prescribing information for. Converting to transdermal fentanyl palliative care.