Morphine milligram equivalent mme calculator nyc health. There is no completely safe opioid dose, and this calculator does not substitute for clinical judgment. There is no dose equivalence between fentanyl lozenges and other opioid formulations. It should not be used to determine doses when converting a patient from one opioid to another. Opioid conversion calculator for morphine equivalents. They all interact with specific opioid receptors such as. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only.
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. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er. Fentanyl patch converter globalrph conversion from other opiates. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
Fentanyl patch converter globalrph conversion from. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. The optimal dose cannot be predicted by the dose of regular opioid or pervious breakthrough opioid. Do not use this tool to convert from one opioid to a different. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. 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. Opioid converter morphine equivalent calculator omni. For patients previously taking oral mme 160 mg, consider an alternate analgesic. If you are converting a patient to or from fentanyl i. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics.
Scottish palliative care guidelines fentanyl patches. The table is based on oral dosing for chronic noncancer pain. Literature suggests for a 24 hour morphine dose of 604mg you would need a 25mcg fentanyl patch. Opioid oral morphine milligram equivalent mme conversion. Fentanyl patch dosing determination based on current opioid therapy. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Calculate the total 24hour morphine dose or morphineequivalent. Transdermal fentanyl patches should not be initiated in patients with unstable pain. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Because extendedrelease products such as butrans deliver the opioid over an extended period of time, there is a greater risk for overdose and death, due to the larger amount of buprenorphine present.
Calculates total daily morphine milligram equivalents. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. The fentanyl patch strength in micrograms is equal to half of the total dose of sustained release morphine given over 24 hours. Morphine milligram equivalent mme calculator instructions. If i were you and truly considering patch, i wouldnt start any higher than a 50mcg. Butrans contains buprenorphine, a schedule iii controlled substance. The transdermal patch is a longacting formulation with a delayed onset of effect initially and a prolonged duration of action. Opioid equivalence chart gloucestershire hospitals nhs.
Use caution when prescribing opioids at any dosage, and prescribe the lowest effective dose. Converting from oral morphine to fentanyl transdermal patch. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Opioid conversion ratios guide to palliative care practice. The chemical name is nphenyln12phenylethyl4piperidinyl propanamide. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
This calculator should not be used to determine doses when converting a patient from one opioid to another. Opioid opiate equianalgesia conversion calculator hospital palliative care service 68 logical fentanyl patch placement chart palliation of pain. Carrying out this conversion correctly can be challenging and it is advisable to seek specialist palliative care advice. The total daily morphine milligram equivalents mme will be displayed. Conversion from morphine or equivalent to fentanyl transdermal.
Fentanyl buccal or sl tablets, or lozengetroche5 mcg. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. In the study, the patients each received a fentanyl patch while continuing to be maintained on the same dose of intravenous fentanyl. A safe and effective method for converting cancer patients. So you would be right around a starting patch of 50mcg. Opioid conversion calculator morphine equivalents advanced. 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. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Butrans exposes users to the risks of opioid addiction, abuse, and misuse. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. 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.
All patients should be titrated no more frequently than every 4 days, and dosed in q12h intervals. Stop long acting oral morphine after applying patch. 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. After six hours, the dose of intravenous fentanyl was decreased 50 percent, and after 12 hours the iv drug was discontinued.
Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Remember to enter all opioids the patient is taking. Opiate bioavailability and response are highly variable. 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 hydrocodone. Opioid opiate equianalgesia conversion calculator 12 mar 2017 online calculator to convert equianalgesic doses of opioid narcotic because transdermal fentanyl has a delayed onset and onset of peak oral opioid dosing equivalents and conversions university ofhydrocodone vicodin, norco, lorcet morphine to methadone conversion each 2 mg po morphine approximately equivalent to 1. Oxycontin, xtampza er oxycodone dosing, indications. Advanced opioid conversion calculator morphine equivalents. Bernardine newhouse november 14, 2017 uncategorized leave a comment 76 views. As you can clearly see, a 100mcg patch is at least double the amount you would need. C the conversion table is unidirectional only and should only be used to convert adult patients from their current oral or parenteral opioid analgesic to the approximate fentanyl transdermal patch for use in chronic pain. Canadian guideline for safe and effective use of opioids.
Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. What are the steps for converting from morphine or. Transdermal and parenteral fentanyl dosage calculations. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. It should be individually titrated by starting at the lowest dose 200 micrograms summary of changes. Fentanyl parenteral patch sliding scale conversion fentanyl mcghr x 24hr morphine po mg 25. This is especially important for fentanyl and methadone conversions. Fentanyl accumulates to form a depot in the skin below the. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Recommend an appropriate dose of transdermal fentanyl when. Morphine milligram equivalents mme calculator mdcalc.
It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Levys rule to convert from oral morphine to transdermal fentanyl. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Select microgram per hour dose of transdermal fentanyl based on table 2. Duragesic label page 1 full prescribing information for. 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.
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