We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Select microgram per hour dose of transdermal fentanyl based. Clinical pharmacist, university of new mexico hospitals. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Methadose methadone is a cheap and effective treatment for severe chronic pain, but has serious risks for fatal overdose and drug dependence. Stop long acting oral morphine after applying patch. 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. I have been on methadone maintenance for six years and would like to know if the duragesic patch would be an okay alternative to methadone. I am on a slow detox from sixty milligrams of methadone and would like to attempt the remainder of my detox using the duragesic patch.
Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. This calculator should not be used to determine doses when converting a patient from one opioid to another. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Opioid conversion ratios guide to palliative care practice 2016. Methadone american society for pain management nursing.
Transdermal and parenteral fentanyl dosage calculations and. Conversion from morphine or equivalent to fentanyl transdermal calculate the total 24hour morphine dose or morphineequivalent. 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. Toxicities related to methadone can occur when conversion doses are too high, titration is too rapid andor short dosing intervals. Equianalgesic chart changes in italics ui health care. Conversions with methadone methadone is inexpensive and effective in certain patient populations.
Morphine milligram equivalent mme calculator nyc health. Ideally, methadone conversions especially patients who were. 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. Once conversion is calculated, ensure opioid dose is prescribed in divided doses as appropriate. Pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Fentanyl transdermal dosage use only when converting another opioid to fentanyl patch.
Opioid switching from transdermal fentanyl to oral methadone. It is important that clinicians be conversant with methadoneequivalent doses of. What are the steps for converting from morphine or. Use of iv fentanyl is restricted to oncology, burn service, palliative care. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. There are long acting versions of morphine, oxycodone, and opana, as well as levorphanol, methadone, and the fentanyl skin patch.
Opioid conversion chart methadone standard pharmacological profiles and opioid conversion tables who fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for. Converting to transdermal fentanyl palliative care. Buprenorphine suboxone is an option if opioid abuse, misuse or extreme opioid tolerance is a. Therefore, as opposed to these extendedrelease agents, methadone is the. Methadone dosing guidelines iowa medicaid drug utilization. Rapid switching between transdermal fentanyl and methadone in. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect any changes in the literature.
Opioid conversion ratios guide to palliative care practice. Oral morphine milligram equivalent conversion table updated 8. Oral methadone dosing recommendations for the treatment. Transdermal patch should be used only in opioid tolerant patients.
Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. The methadone conversion table indicates that a conversion factor for a domed of 360mg equals 8. Rapid switching between transdermal fentanyl and methadone.
Pain and symptom intensity, expressed as distress score, were recorded before switching doses of the two opioids and after subsequent doses. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. I cant remember off hand what all the drugs are that you have tried. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Converting from oral morphine to fentanyl transdermal patch. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Effects of patch last for 18 24 hours after the patch is removed. Jul 28, 2005 transdermal fentanyl to methadone conversion.
Doctors give trusted answers on uses, effects, sideeffects, and cautions. The following source was used for morphine equivalent conversion factors per mg of opioid. Opioid conversion calculator morphine equivalents advanced. In the case of converting morphine to methadone, methadone has a relative potency of 4. Fentanyl patch converter globalrph conversion from other. Methadones longduration of effect is not dependent upon a specialized delivery system, as is the case with transdermal fentanyl or sustained release formulations of morphine, hydromorphone or oxycodone. Oct 15, 2019 the conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Another site i looked at says a conversion from fentanyl to methadone is 1. Opioid switching from transdermal fentanyl to oral. Do not use this tool to convert from one opioid to a different opioid. Aug 01, 2005 a fixed conversion ratio of fentanyl to methadone of 1. Home medical calculator opioid conversion calculator. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. 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.
Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. 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. The correlation between previous fentanyl dose and the final methadone dose or the fentanyl. Opioids and methadone equivalents for clinicians ncbi. Subcutaneous morphine mgday subcutaneous oxycodone mgday. Longacting opioids fentanyl transdermal, methadone should not be used in opioid naive patients. Convert daily oral morphine equivalent dose domed to oral methadone. Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. We provide an opioid conversion table appendix 1 for commonly used. Mar 25, 2011 neurosis, pain, fentanyl, methadone, breakthrough pain my dr just switched me to 10 mg methadone from 50 mcg fentanyl. Duragesic label page 1 full prescribing information for use. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Converting to transdermal fentanyl palliative care network.
A fixed conversion ratio of fentanyl to methadone of 1. Methadone, fentanyl lozenges and neuraxial opioids are not included in this table due to their complex and variable pharmacokinetics. This is especially important for fentanyl and methadone conversions. From what i have read online 50mcghour of fentanyl is equivilent to around 140190mgs of morphine. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain miguel angel bentezrosario, m. See methadone conversion on p8 for more information. It blocks certain opiate receptors and acts as a analgesic or pain medicine. There is no dose equivalence between fentanyl lozenges and other opioid formulations. Starting dose onset peak duration half life codeine 30 60 mg q 4 hr 30 min 1. Methadone has a long halflife and can accumulate in the plasma. Effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4, subcutaneous fentanyl to transdermal fentanyl same drug to same drug subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1. Opioid oral morphine milligram equivalent mme conversion.
The tables cannot be used to convert from duragesic to another opioid because these conversions will result in an overestimation of the dose of the new opioid these conversions are conservative and may. Previous opioid should be tapered over first 12 hours of fentanyl as absorption is delayed. Transdermal fentanyl to methadone conversion pallimed. Fentanyl patch converter globalrph conversion from. Prescribers should wait at least 3 days before altering doses, as methadone has a long halflife when changing from other opioids to methadone, dose should be reduced by 50% for cross tolerance f. 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.
Scottish palliative care guidelines fentanyl patches. Opioid conversion calculator for morphine equivalents. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain miguel angel ben. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. The patients domed of 360 mg is equal to 30 mg of methadone daily. No it is not drive from opium, opium is a natural occurring plant that produces, among other things, heroin.
Methadone conversion factors increase with increasing dose. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Methadone dose conversion guidelines endoflife and. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Proper conversion is dependent upon a variety of factors drug dosage. Fentanyl patches are another option, but are expensive and difficult to titrate. Duragesic label page 1 full prescribing information for. Transdermal and parenteral fentanyl dosage calculations.
Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Although the ratio of oral methadone to intravenous methadone may vary from 1. In a recent experience, a similar initial conversion ratio between tts fentanyl and oral methadone was used. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Based on the information from this website 50mgs of methadone is equivilent to 39 mcghour. The starting methadone dose was calculated according to a 2. The current j of clinical oncology has a nice little article about one groups experience converting tts fentanyl to methadone or vice versa. Methadone is a naturally long acting med and is generally used on a set schedule, rather than as needed.
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