Canadian guideline for safe and effective use of opioids for. Morphine milligram equivalent mme calculator instructions. We provide an opioid conversion table 710 for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. It should not be used to determine doses when converting a patient from one opioid to another. Continuous subcutaneous infusion fentanyl syringe driver continue the syringe driver at the same rate for 6 hours after applying the patch, then cease effective systemic analgesic concentrations are generally reached in less than 12 hours for fentanyl after applying patch 4. Initiate dosing using ms contin 15 mg orally every 8 to 12 hours. Fentanyl patches are another option, but are expensive and difficult to titrate. Although there has been no systematic assessment of such conversion, start with a conservative conversion. When rotating opioids in a patient with cancer or with escalating pain needs, i suggest a more aggressive conversion, using a shortacting agent for breakthrough. Conversion to methadone is appropriate for opioid use greater than several months, assuming opioids are effective for the patient. Converting from transdermal fentanyl to oxycontin treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Titrate liberally and rapidly to analgesic effect during first 24 hours.
For knee and back pain, i am currently on mscontin 60 twice a day with hydrocodone 10350 for breakthrough pain. What to do with oxycodone, ms contin, and fentanyl. I thought the weird flu like symptoms might be a result of the new drug, but apparently it has to be withdrawal from the morphine. Ms contin 60 mg by mouth every 12 hours, with morphine oral solution 20 mg every 2. The tablet strength closest to the calculated dose is 30 mg. Morphine sulfate 30mg er x 2 tablets24hours 60mg total daily er dose.
Buprenorphine transdermal delivery system butrans, ciii. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. Converting shortacting ir longacting er for wellcontrolled, chronic pain patients may still be experiencing a recurrence of pain before the next scheduled dose. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. Multiply the amount of each drug by its bioavailability column 4, to get a smaller number. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. There are no established conversion ratios for conversion from other opioids to ms contin defined by clinical trials. My question is, if im going to the right dosage of fentanyl patch which is 25 milligrams every 72 hours from, 60 milligrams of ms contin.
Strength per unit x number of units days supply x mme conversion factor daily med example. Patient is receiving a total of 5 mg of parenteral hydromorphone in a 24hour period via a pca pump. Morphine milligram equivalent mme calculator nyc health. Select microgram per hour dose of transdermal fentanyl. Do not initiate fentanyl patches at the end of life when the oral route is no longer available. For chronic dosing, 10 mg iv morphine 30 mg oral morphine. Oral morphine milligram equivalent conversion table updated 8. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Opioid tolerant patients are those receiving, for one week or longer, at least 60 mg po morphineday, 25 mcghr transdermal fentanyl, 30 mg po oxycodoneday, 8 mg po hydromorphoneday, 25 mg po oxymorphoneday or an equianalgesic dose of another opioid.
Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. There is no direct conversion for fentanyl lozenge to other opioids including morphine the recommended initial dose of lozenge is 200 micrograms if pain is not relieved then the dose can be increased until effective. Opioids 50mcg fentanyl patch compared to ms contin 60mg. The highest available btds strength of 20 mcgh may be equianalgesic to an oral medd of 3655 mg, whereas the product information states that the 20 mcgh patch may not provide adequate analgesia for. The proper starting dose should therefore be 30 mg of sustainedrelease morphine every. Switching from 100mcg duragesic patch to ms contin or. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption.
After the patient has been stabilized, the tapering regimen may be implemented table 3. The table is based on oral dosing for chronic noncancer pain. Pain management,pharmacists, nursing, physicians,health care providers,morphine, tylox, lortab, vicodin, fentanyl, dilaudid, meperidine, percodan, oxycodone. Jan 29, 2018 if pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone. In other words, the conversion factor not accounting for days of use would be 60 25 or 2. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. For frail elderly patients, use more conservative conversion or a lower strength patch e. Discontinue all other aroundtheclock opioid drugs when ms contin therapy is initiated.
Pain management in hospice care todays geriatric medicine. A few questions first off, i feel like the starting doses of each of these medications one pill patch is less than the common dose. Conversions with methadone methadone is inexpensive and effective in certain patient populations. They all interact with specific opioid receptors such as. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Oct 25, 2019 conversion from other opioids to ms contin. Fentanyl to ms contin conversion pain management medhelp.
Patients considered opioid tolerant are those receiving, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone hcl per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. Patients considered opioidtolerant are those taking, for one week or longer, at least 60 mg morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone daily, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. 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. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. The emr pcc grants permission to reproduce parts of this publication for clinical and educational use only, provided that the eastern metropolitan region palliative. What are the steps for converting from morphine or. The pain care plan must be flexible to respond to the constantly changing challenges of. Opioid converter morphine equivalent calculator omni. If a patient is taking ms contin 30 mg bd that is, 30 mg oral morphine x 2 dosesday or 60 mg oral morphineday then, 60 mg oral morphineday. Bedside teaching opiate conversion stacie levine md.
Fentanyl patch converter globalrph conversion from. Opioid conversion ratios guide to palliative care practice 2016. Convert each number in your list to iv morphine equivalents, by using column 2. Equianalgesic conversion for morphine morphine equivalence table for chronic dosing drug sciv mg po mg comments morphine 10 30a codeine 120 sc only 200 metabolized to morphine fentanyl patch see table below useful when po pr routes not an option fentanyl 0. Round up or down based on patient factors and available patch sizes. Equivalence between oral morphine and transdermal fentanyl. Kral safely discontinuing opioid analgesics 4 any withdrawal symptoms. The total daily morphine milligram equivalents mme will be displayed.
Opioids opiates are a group of analgesic drugs, used primarily for pain management. If a patient has not been on an equivalent of 6090mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch. Select microgram per hour dose of transdermal fentanyl based. Conversion from morphine or equivalent to fentanyl transdermal. These bidirectional differences are not captured in a traditional equianalgesic table. I did that because it says it takes the patch 8 hours to work. For a single dose, 10 mg iv morphine 60 mg oral morphine. So, can someyou please tell swim what the common dose of each of these is.
The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. The recommended dosing frequency of longacting morphine ms contin is every 12 hours 2 doses per day. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. 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. Switched from fentanyl patch 15mcg to mscontin 15mg. Opioid conversion ratios guide to palliative care practice 2016 352016 2016. 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.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. My only options are ms contin or the patch so i requested the patch after saying ms contin did work, but then again its 1. The pain care plan must be flexible to respond to the constantly changing challenges of irreversible illness. Equianalgesic chart changes in italics ui health care. Opioid conversion and brand availability in canada michael g. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100.
Opioid oral morphine milligram equivalent mme conversion. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of. Opioids 50mcg fentanyl patch compared to ms contin 60mg for. And again at least ms contin and fetanyl go up and up in dosage and over the course of my.
And again at least ms contin and fetanyl go up and up in dosage and over the course of my life, there will be options for me to increase dosages. Opioid oral morphine milligram equivalent mme conversion factors1,2. Ms contin contains morphine sulfate, an opioid agonist and a schedule ii controlled substance, with an abuse liability similar to other opioid analgesics. Parenteral oral parenteral oral parenteral oral oral.
Equianalgesic dosing of opioids for pain management. Long acting strong opiates oxycontin, ms contin, fentanyl patch should be started once pain is controlled on short acting. I donk know if its equal, but one thing is for sure with the patch, its a constant deliveryno peaks or valleys, so its. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Breakthrough doses can be given as often as every 60 min if po, 30 min if sq. Calculate the total 24hour morphine dose or morphineequivalent. Fentanyl patch converter globalrph conversion from other. Transdermal and parenteral fentanyl dosage calculations. Oxycontin, xtampza er oxycodone dosing, indications.
Morphine dose equivalence not reliably established. Advice should be sought from the palliative care team. What are the steps for converting from morphine or equivalent to. Transdermal and parenteral fentanyl dosage calculations and. There is no direct conversion for fentanyl lozenge to. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Scottish palliative care guidelines fentanyl patches. Coggins, pharmd, cgp, fascp todays geriatric medicine vol. Didnt know where else to put this, but i was recently switched from morphine 60mg er to the fentanyl duragesic patch. Opioid dose equivalence calculation of oral morphine equivalent daily dose omedd omedd mg current opioid dose x conversion factor current opioid conversion factor propietary names oral swallowed preparations note. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch.
Converting from oral morphine to fentanyl transdermal patch. Opioid conversion ratios guide to palliative care practice. This tool does not contain all of the important safety information needed to prescribe butrans. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. After application of the fentanyl patch peak plasma levels are. 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. Opioid conversion calculator for morphine equivalents. If a patient has not been on an equivalent of 60 90mg of oral morphine per 24 hrs, seek specialist palliative care advice before commencing fentanyl patch. Remember to enter all opioids the patient is taking. Ms contin morphine sulfate provides good longterm pain control without the need to take medicine frequently, but watch out for constipation. Conversion algorithm for instructions on converting from one opioid to another.
Surprisingly, crosstolerance between opioids is often incomplete. This is my 1st post so ill give a little background. Pain control, one of the central goals of hospice care, is a top priority in endoflife care. I find that the mscontin partially alleviates the pain, but certainly not for 12 hours at a stretch, so i still generally take 34 of the hydrocodone a day to be completely mobile, and even full relief from that is shortlived. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. This is the number of milligrams that actually gets into the bloodstream. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms contin.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. For instance, yesterday i took 60 milligram ms contin and at around 12 tonight i put i 25 milligram fentanyl patch on. Hi, what would be the approx correct equivalency for switching from using 100mcg duragesic patch to ms contin pills what mg dosage should the pills be at to equal the patch. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain.
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