A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Thats some bad stuff to get off of and there is no easy way that i have found. We recommend using our online services, or sending an email to the appropriate divisionperson instead. Duragesic label page 1 full prescribing information for. Actiq fentanyl citrate oral transmucosal lozenge is a solid formulation of fentanyl, an opioid agonist, intended for oral transmucosal administration. An alternative algorithm for dosing transdermal fentanyl for. So i inherited a patient on actiq and fentanyl patch for 6 years. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. Fentanyl drug monograph pediatric care online aap pointof. Table 2 should not be used to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl transdermal system is conservative. Abstral fentanyl dose, indications, adverse effects. To convert patients to another opioid, remove the transdermal fentanyl patch and titrate the dose of the. It has a rapid onset and its effects generally last less than two hours. This is based on performing a morphine to fentanyl conversion.
It is also used for other types of pain that youve had for a long time when weaker painkillers have stopped working. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Do not convert patients from any other fentanyl product to actiq on a. The fentanyl skin patch is only used for opioidtolerant patients. Do not convert on a mcg per mcg basis to actiq from other fentanyl products. Buy fentanyl actiq lollipop online 20% off free express. Fentanyl films are not bioequivalent to other fentanyl preparations.
This is based on studies converting from morphine to fentanyl. Transdermal fentanyl patches should always be prescribed in mcghour, not size. Fentanyl lozenges actiq for breakthrough cancer pain. An alternative algorithm for dosing transdermal fentanyl. Frail or elderly patients may need lower doses and slower titration. In addition to the fentanyl patch, other novel delivery systems incorporating fentanyl have been developed and used by numerous clinicians both in the united states and throughout western europe. Round up or down based on patient factors and available patch sizes. Common questions and answers about actiq conversion to morphine actiq so work would need to be done to adopt a universal conversion table to make sure everyone on the same leveling plane as between the two strength conversions of oxycodone, there is a 10 mg difference in oxycodone allowed per day based on 100 mg morphine equivalency. After system removal, serum fentanyl concentrations decline gradually, falling about 50% in approximately 2027 hours. Refer to your local formulary see effentora and pecfent medicine information sheets. Fentanyl, a potent phenylpiperidine opioid agonist available as a transdermal patch, carries a black box warning cautioning health care providers on both the potency of the product and the potential for abuse and diversion. Converting to transdermal fentanyl palliative care. After a set of successful clinical trials, duragesic fentanyl patches were introduced into medical practice.
Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Equianalgesic dosing of opioids for pain management. Dose conversion guidelines for transdermal fentanyl see table below. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Patients reach and maintain a steadystate serum concentration that is determined by individual variation in skin permeability and body clearance of fentanyl. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Phone lines will have limited support, and voicemails will be returned when possible. Fentanyl is also sold as a lozenge under the brand name actiq, a tablet that goes under the tongue abstral, a film thats applied to the. Do not abruptly discontinue fentanyl patch it is unknown at what dose level the fentanyl transdermal may be. Both dilaudid and fentanyl can be habit forming even at prescribed doses.
Actiq is formulated as a white to offwhite solid drug matrix on a handle that is fracture resistant abs plastic under normal conditions when used as directed. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Conversion from continuous iv infusion of fentanyl. For instance, if you store the fentanyl patch in a place with excessive heat, it tends to release of higher fentanyl those results in an overdose. Duragesic patches are intended for transdermal use on intact skin only.
Option for converting final output into an equivalent fentanyl patch strength as long as published guidelines exist for the current dose. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Fentanyl can be abused and is subject to criminal diversion. Converting from oral morphine to fentanyl transdermal patch. How should conversion from oral morphine to fentanyl. Its used to treat severe pain, for example during or after an operation or a serious injury, or pain from cancer. Fentanyl buccal tablet each tablet contains fentanyl. A safe and effective method for converting cancer patients. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Duragesic fentanyl transdermal dosing, indications.
In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. Kornick said the research team is now looking into the best procedure for accomplishing that task. 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. Check with your doctor if you have questions about this. The education program and enrollment can be completed online at the enrollment. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Exposure to external heat increases drug absorption from patch. Management of an oral ingestion of transdermal fentanyl. When prescribing, do not convert patients on a mcg per mcg basis from any other fentanyl products to actiq see dosage and administration 2. Substitution of actiq for any other fentanyl product may result in fatal overdose. Palliative care specialists may recommend an individualised titration regimen.
Currently, there are no empirical studies converting fentanyl to morphine. Transmucosal immediate release fentanyl tirf products risk. Actiq, commonly known as the fentanyl lollipop, was also approved in. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse and associated risk of fatal overdose due to respiratory depression. 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 overdosage. Six hours after the application of the first patch, decrease. Oral morphine milligram equivalent conversion table updated 8. Actiq is not a generic version of other transmucosal immediate release fentanyl tirf formulations. Opioid conversion guidelines gippsland region palliative care.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioid conversion ratios guide to palliative care practice. The mme conversion factor for fentanyl patches is based on the assumption that one milligram of parenteral fentanyl is equivalent to 100 milligrams of oral morphine and that one patch delivers the dispensed micrograms per hour over a 24 hour day. The cii rate was decreased by 50% 6 hours after application of the fentanyl. Fentanyl patch converter globalrph conversion from. Many people remove the narcotic gel from the patch, heat it to melt it, or mix it with water. Actiq fentanyl citrate dose, indications, adverse effects. Fentanyl actiq side effects, dosage, interactions drugs.
Actiq, fentora fentanyl transmucosal dosing, indications. Individuals mostly abuse fentanyl patches, which leads to deaths. According to palliative treatment charts, the transdermal skin patch of fentanyl is approximately 80 times more potent than a similar form of morphine. How should conversion from oral morphine to fentanyl patches be carried out. I was wondering if a break through med needs to be a different med to work and help because it is a different chemical or if the same med for bt is o. Fentora contains fentanyl, an opioid agonist and a schedule ii controlled. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to fentanyl transdermal system. This medicine is not for treating pain that is not cancerrelated, such as migraine headaches or pain after surgery. Subcutaneous transdermal conversion ratio example reference fentanyl fentanyl 1.
Numerous consumer internet websites describe means for abusing fentanyl patches, such as smoking, chewing, freezing, or intravenous injection of. Injecting fentanyl carries a significant risk of overdose. Fentanyl lozenge actiq or fentanyl sublingual abstral for procedural pain in an acute pain setting reference number. Fda approved indications transmucosal immediate release fentanyl products are indicated for the management of breakthrough pain in cancer patients. There are no conversion directions available for patients on any other fentanyl products, other than actiq. In australia fentanyl is available in injectable form sublimaze, as lozenges actiq, as a nasal spray, and in transdermal patches durogesic and generic versions.
Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Transdermal and parenteral fentanyl dosage calculations and. Buy actiq lollipop lozenges fentanyl citrate online. The actiq unit should be sucked, not chewed, as absorption of fentanyl via the buccal mucosa is rapid in comparison with systemic absorption via the gastrointestinal tract. People use actiq to treat severe, ongoing pain that other medicines cannot control. Opioid morphine equivalent conversion factors1 cms. This includes oral, transdermal, or parenteral formulations of fentanyl. I did a conversion once when i found a table online and was shocked to find out that the 100mcg patches i was on are equivalent to over 200 mgs of oxycodone. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Some experts use this conversion in cancer patients.
As a result of these differences, the conversion of a tirf medicine for any other tirf medicine may result in fatal overdose. Fentanyl lozenge actiq or fentanyl sublingual abstral. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. I told her actiq is usually only for cancer pain and she showed me the rems registration that says it can be used for non cancer pain. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. I like the fentanyl drug, so i was wondering if actiq would be a good bt med. Opioid conversion calculator morphine equivalents advanced. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Conversion instructions are not available for any other fentanyl product other than actiq. It is very important that you understand the rules of the opioid analgesic rems program to prevent addiction, abuse, and misuse of. Fentanyl lozenges actiq for breakthrough cancer pain nps. Medically, fentanyl is used by injection, as a patch on the skin. Buy fentanyl actiq lollipop online, the fentanyl actiq lollipops comes in different dosages and flavors.
This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Table 1 should not be used to convert from fentanyl patches to other therapies because this conversion to fentanyl patches is conservative. Preventing inappropriate conversion between fentanyl products. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Compare actiq vs fentanyl headtohead with other drugs for uses, ratings, cost, side effects, interactions and more.
Transdermal and parenteral fentanyl dosage calculations. Preventing accidental exposure to children and others for whom it was not prescribed. In patients who have adequate pain relief with iv fentanyl infusion, may convert to transdermal dosing at a rate equivalent to the iv rate using a 2step taper of the infusion to be completed over 12 hours after the patch is applied. Water may be used to moisten the buccal mucosa in patients with a dry mouth. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Scottish palliative care guidelines fentanyl patches. Fentanyl is a horrible drug and is 80 times stonger that morphine. Duragesic fentanyl transdermal dosing, indications, interactions. The collateral use of actiq for sale and cyp3a4 inhibitors can raise the plasma concentration of fentanyl which consequence extend medication effects. Fentanyl oral transmucosal lozenges and fentanyl injectables are also diverted. Opioid oral morphine milligram equivalent mme conversion.
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. Fentanyl buccal tablet each tablet contains fentanyl citrate equivalent to fentanyl base. The transmucosal immediate release fentanyl tirf risk evaluation and mitigation strategy rems program is an fdarequired program designed to ensure informed riskbenefit decisions before initiating treatment, and while patients are treated to ensure appropriate use of tirf medicines. Fentanyl patch converter globalrph conversion from other. A patient is opioidtolerant if oral narcotics have already been used for severe pain. Duragesic label page 1 full prescribing information for use. When prescribing, do not convert a patient to actiq from any other fentanyl product on a mcg per mcg basis as actiq and other fentanyl products are not equivalent on a microgram per microgram basis. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain.
Using damaged or cut duragesic patches can lead to the rapid release of the contents of the duragesic patch and absorption of a potentially fatal dose of fentanyl. Methadone conversion algorithm including the ability to edit equianalgesic conversion factors if necessary in order to reflect. Do not substitute actiq prescription for other fentanyl products. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. Following the patch, a flavoured lollipop of fentanyl citrate mixed with inert fillers was introduced in 1998 under the brand name of actiq, becoming the first quickacting formation of fentanyl for use with chronic breakthrough pain. Oral morphine milligram equivalent conversion tablei. Dilaudid hydrolmorphone and fentanyl are narcotic opioid drugs used to manage of severe chronic pain, for example cancerrelated pain. I like the fentanyl patch and it seems to be a great option for me. Nov 04, 2019 actiq fentanyl citrate is an opioid pain medication, sometimes called a narcotic actiq treats breakthrough cancer pain that is not controlled by other medicines. When dispensing, do not substitute an actiq prescription for other fentanyl. Buy actiq lollipop lozenges fentanyl citrate online 200mcg to 1600mcg. However, its important to note that the estimate above only considers legitimate prescriptions of fentanyl. Both drugs work the same way in the body to relieve pain.
To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Do not convert patients on a mcg per mcg basis from other fentanyl products. Buy fentanyl citrate, buy fentanyl citrate injection, buy fentanyl citrate patch. A maximum of 4 episodes of breakthrough pain in 24 hours should be treated with sublingual fentanyl tablets. Substantial differences exist in the pharmacokinetic profiles of different fentanyl products that result in clinically important differences in the extent of absorption of fentanyl that could result in a fatal overdose. Most nhs boards have only approved one or two rapid acting fentanyl products for use in their area. Buy actiq lollipops online actiq for sale actiq cost. Assess patients risk before prescribing and monitor closely for these behaviors and conditions. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. This guideline is for the use of abstral a dispersible, sublingual fentanyl tablet available as 100, 200, 300, 400, 600, 800 micrograms. To protect the health and safety of the public and our employees, dcp employees will no longer be at 450 columbus blvd. Fentanyl is about 80100 times stronger than intravenous morphine. Fentanyl is, however, far more potent than heroin, and this method of rapid drug onset can also lead to rapid overdose.