Opioid conversion ratios guide to palliative care practice 2016 352016. How does one convert a patient on the patch to iv fentanyl in cases of breakthrough pain. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. Conversion of opioid analgesics to fentanyl transdermal. Opioid conversion ratios guide to palliative care practice. I like to have a prn fentanyl bolus available for the nurse to administer if the patient begins to experience withdrawal. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl.
A safe and effective method for converting cancer patients. Pearls and pitfalls of transdermal fentanyl administration scott. The fentanyl infusion can usually be rapidly tapered off after 1 or 2 doses of methadone have been given. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose.
A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Transdermal and parenteral fentanyl dosage calculations. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. In each patient, all transdermal patches were removed, and a continuous infusion ci delivering iv fentanyl at the same hourly rate was initiated simultaneously. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Transdermal fentanyl patches were designed to provide. Fentanyl patch converter globalrph conversion from. A safe and effective method for converting patients from transdermal.
A safe and effective method for converting cancer patients from. Akin to the problem of converting patients from iv administration of fentanyl to the patch is the opposite scenario. Fentanyl is a synthetic centrally acting opioid agonist that has a rapid onset of action, short duration of effect, and lack of histamine release. Equianalgesic chart changes in italics ui health care. Converting to transdermal fentanyl palliative care network of.
For frail elderly patients, use more conservative conversion or a lower strength patch e. Fentanyl conversions mcghr to mgday globalrph convert common fentanyl patch strengths from mcghour to mg per day for dosage conversions. Duragesic fentanyl transdermal dosing, indications. Continuous subcutaneous infusion fentanyl syringe driver continue the syringe driver at the same rate for 6 hours after applying the patch, then cease.
Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. If the patient was previously on 100 mcg hr of fentanyl, ill make the prn bolus 50 mcg of fentanyl iv. Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. These bidirectional differences are not captured in a traditional equianalgesic table.