Transdermal and parenteral fentanyl dosage calculations. Id like opinions on switching from butrans to fentanyl, in patch form only. An alternative algorithm for dosing transdermal fentanyl. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Switching from 100mcg duragesic patch to ms contin or. You wish to convert the therapy to transdermal fentanyl. Generic fentanyl is covered by some medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a. Scottish palliative care guidelines fentanyl patches. Jan 09, 2017 so im reading about the duragesic fentanyl patch.
So, you use that and add 15mg for your breakthrough dose and there you have it. A void exposing the duragesic application site and surrounding area to direct external heat sources, such as heating pads or electric blankets, heat. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Durogesic dtrans 25 mcghr transdermal patch summary of. In general, the 12 mcgh dose, which allows for smaller dose. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Duragesic fentanyl transdermal drugs requiring prior authorization drugs requiring prior authorization label name gcn duragesic 12 mcghr patch 24635 duragesic 25 mcghr patch 19200 duragesic 50 mcghr patch 19201 duragesic 75 mcghr patch 19202 duragesic 100 mcghr patch 19203 fentanyl 12 mcghr patch 24635.
Skin areas where the fentanyl transdermal system may be applied. Converting to transdermal fentanyl palliative care. Duragesic is a prescription skin patch approved to treat moderatetosevere pain. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl is in a class of medications called opiate narcotic analgesics. Durogesic dtrans is a translucent, rectangular transdermal patch with rounded corners. In two paediatric studies, the required fentanyl transdermal patch dose was calculated conservatively. Use the lowest effective dosage for the shortest duration consistent with.
Analysis of fertility parameters in both studies indicated that an intravenous dose of fentanyl up to 0. Safety of fentanyl initiation according to past opioid. People who are on the 25ughr patch feel they are on the lowest dose, so they can just drop off right from there. Im wondering if there are more effective placements for the patches, and where they are. 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. This tool does not contain all of the important safety information needed to prescribe butrans. This calculator should not be used to determine doses when converting a patient from one opioid to another. Fentanyl patches durogesic for chronic pain nps medicinewise. Fentanyl patch conversions package insert recommendations. Fentanyl transdermal system fentanyl transdermal system for. Duragesic definition of duragesic by medical dictionary. Converting to transdermal fentanyl palliative care network of. It is suggested that for conversions from oral morphine to fentanyl patches, the. Transdermal td fentanyl is a self adhesive skin patch which provides continuous systemic delivery during the 72 hour application period.
Caution is required if opioid dose equivalence tables are used to guide opioid switching, as the administration of a calculated equivalent dose of the replacement opioid may lead to. 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. Blood was collected from 21 japanese cancer patients treated with a 24hour transdermal fentanyl patch during the steady state of fentanyl plasma concentration. It works by changing the way the brain and nervous system respond to pain. Aug 12, 2019 1 the lowest dose is stated as 12 ghour however, the actual dose is 12. The amount of fentanyl released from each system per hour is proportional to the surface area 25 mcgh per 10. Opioid oral morphine milligram equivalent mme conversion. Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. Duragesic fentanyl transdermal system for transdermal administration is an opioid analgesic indicated for the management of pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment and for which alternative treatment options are inadequate. This page of the emedtv web site gives an indepth overview of this medication, describing how it works and offering information on how to use the skin patch properly.
This is my 1st post so ill give a little background. Recommend an appropriate dose of transdermal fentanyl when. Duragesic fentanyl dose, indications, adverse effects. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. This is especially important for fentanyl and methadone conversions. The conversion doses in these tables are only for the conversion from one of the listed oral or parenteral opioid analgesics to duragesic. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Opioid analgesic, anesthesia adjunct controlled substance schedule ii pregnancy risk category c action binds to specific opioid. Do not use a duragesic patch if the pouch seal is broken or the patch is cut, damaged, or changed in any way. Side effects of duragesic fentanyl transdermal, warnings, uses. Duragesic patch dose duragesic patches are fentanyl transdermal systems that deliver extremely potent pain medication to patients via patches placed on the skin. Duragesic patch fentanyl patch rationale for inclusion in pa. Refer to table 2 for the range of 24hour oral morphine doses that are recommended for conversion to each fentanyl transdermal system dose. 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.
Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Plasma fentanyl concentrations were analyzed using liquid chromatography with tandem mass spectrometry lcmsms, and the levels were adjusted with the dose of fentanyl. Nonparenteral fentanyl products are contraindicated for use in patients with acute or severe bronchial asthma e. Duragesic label page 1 full prescribing information for use. Fencino doses should be individualised based upon the status of the patient and should be assessed at regular intervals after application. Important information about duragesic get emergency help right away if you use too much duragesic overdose. Fentanyl transdermal patch 72 hour 100mcg drug medication dosage information. It has a rapid onset and its effects generally last less than two hours. An alternative algorithm for dosing transdermal fentanyl for. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications. An alternative ratio of oral morphine to transdermal fentanyl of 150. Refractory cachexia is associated with increased plasma. Please refer to the full prescribing information and the dosing section for more information.
Nov 20, 2019 analysis of fertility parameters in both studies indicated that an intravenous dose of fentanyl up to 0. In the case of converting morphine to methadone, methadone has a relative potency of 4. The initial dosage your healthcare provider recommends will mostly depend on the type and dose of the other opioids you have been taking. Fentanyl dose conversion guidelines current analgesic daily dosage mgd oral morphine 604 5224 225. Fentanyl interacts predominately with the opioid mureceptor. The patches are used to treat moderate to severe chronic pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment. Opioid conversion calculator for morphine equivalents. Duragesic is a skin patch containing fentanyl, an opioid pain medication. From my understanding it is much stronger but i was thinking i could try a low dose. When you first start taking duragesic, when your dose is changed, or if you take too much overdose, serious or lifethreatening breathing problems that can lead to death may occur.
Stronger dosed duragesic patches may be available for particularly severe cases of chronic pain. I am no expert, but from being on the fentanyl patch for over 10 years, at doses from 75 mcg to 125 mcg i can tell you that 12 mcg is a very low dose. Learn about the reported side effects, related class drugs, and how these medications will affect your daily lifestyle. Two parallel dosage conversion ratios are currently recommended by. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Treatment of cancer pain with transdermal fentanyl the. Medically, fentanyl is used by injection, as a patch on the skin. The stronger the dose, the larger the patch, as more area of skin needs to be covered to ensure that more of the drug is being absorbed over the same period of time. Side effects of duragesic fentanyl transdermal, warnings. Jan 06, 2017 make sure you have the right dose patch or patches that have been prescribed for you. The patch is applied to the skin and left in place for 3 days 72 hours. Its too bad the 25 mcg dose makes you sick the fentanyl patch is a very effective pain reliever. Even if you take your dose correctly as prescribed you are at risk for opioid addiction, abuse, and misuse that can lead to overdose or death.
Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Does the placement of a duragesic patch affect the amount of. Description duragesic fentanyl transdermal system is a transdermal system providing continuous systemic delivery of fentanyl, a potent opioid analgesic, for 72 hours. I recently started on pain managment therapy utilizing duragesic patches.
Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. Optimal conversion ratio of oral morphine to transdermal fentanyl. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. Fencino 12 microgramshour transdermal patch summary of. Converting from oral morphine to fentanyl transdermal patch. Use this table to find the calculated 24hour morphine dose and the corresponding recommended initial fentanyl transdermal system dose. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine.
You should be followed by a pain specialist closely if you require such amount of medication. The patches are used to treat moderate to severe chronic pain in opioidtolerant patients, severe enough to require daily, aroundtheclock, longterm opioid treatment duragesic patches are used when other pain. Convert the iv dose to the equianalgesic oral morphine dose using a ratio. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Dailymed fentanyl transdermal patch, extended release.
Stop long acting oral morphine after applying patch. Pain is a feature of many cancers, particularly in the advanced stages at which the palliative care approach to symptom control achieves the best outcomes. Duragesic label page 1 full prescribing information for. It should not be used to determine doses when converting a patient from one opioid to another. Duragesic fda prescribing information, side effects and uses. Duragesic patches are a strong prescription pain medicine. Each initial duragesic dose is highly individualized. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Abstral, actiq, duragesic, durogesic uk, fentanyl oralet, fentora, lazanda, matrifen ca, onsolis, ranfentanyl ca, ratiofentanyl ca, sublimaze pharmacologic class. The initial dose of sandoz fentanyl patch should be obtained or calculated from the conversion tables see dosage and administration, and must not be higher than that dose which is equivalent to the total dose of opioids the patient is receiving at the time of the switch to the patch. The larger the dose of fentanyl delivered, the larger the patch as of the skins surface area has to be covered to ensure that. Fentanyl patches are used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. Serious or lifethreatening breathing problems that can lead to death can.
Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write fentanyl 25 patches to prescribe patches that release fentanyl 25 micrograms per hour. The percocets wont do much for you as they are a very weak drug compared to the fentanyl patch your on. Fentanyl patch converter globalrph conversion from. Find out what health conditions may be a health risk when taken with duragesic transdermal. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Fentanyl duragesic patches come in six different sizes and doses, including. Transdermal and parenteral fentanyl dosage calculations and. Fentanyl duragesic is a moderately priced drug used to treat chronic pain. Duragesic fentanyl transdermal system cii pain patch.
The dose conversion ratio of morphine injection to fentanyl patch was different at the low doses and high doses of morphine. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. Durogesic dtrans 12 mcghr transdermal patch summary of. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Dose adjusted plasma fentanyl concentration v cachexia mean bmi 16 kg m 2 vs.
Advanced opioid conversion calculator morphine equivalents. Adults and children 2 years of age and olderyour doctor will decide which dose of the patch you need based on your present daily narcotic dose. If your prescribed dose is for more than one patch, make sure the edges of the patches do not touch or overlap. Duragesic should only be used in people who are already using an opioid pain medication, at a dose equivalent to at least duragesic 25 mcg. Duragesic fentanyl transdermal dosing, indications. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc.
The amount of residual drug in the patients system must be accounted for. The fentanyl patch duragesic is a medicated skin patch used to treat moderatetosevere chronic pain. Dose conversion in opioid rotation from continuous intravenous. The duragesic transdermal system patch is used for the management of persistent, moderate to severe chronic pain in opioidtolerant patients when a continuous, aroundtheclock opioid analgesic is needed for an extended period of time. What is the maximum dose of fentanyl patches for chronic.
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. Duragesic patches typically come in the following doses. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e. Ive suffered severe chronic pain from interstitial cystitis for 8 yrs. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on single dose studies, and there is substantial individual variation in response. Jun 21, 2006 does the placement of a duragesic patch affect the amount of medicine transferred into my system. Duragesic patches are intended for transdermal use on intact skin only. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Made by orthomcneil, duragesic patches are nearly 100 more potent than morphine and can provide up to 72 hours 3 days of pain relieve when used as directed. Duragesic transdermal system orthomcneil, drug reference. Im on my 3rd patch, and each time, ive gotten different amounts of pain relief. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. How should conversion from oral morphine to fentanyl patches be.
Pain, which invariably increases with disease progression, is treated with opioids and. I wont boar you with details of my medical condition, but i assure you it is quite bad. It should only be used in people who are already using an opioid medication. Duragesic fentanyl transdermal system is available in generic form.
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. The maximum dose is 100 microgramhr transdermal patch which needs to be changed every 72 hours. Fentanyl patch protocol please use the following chart to determine whether or not the prescribed fentanyl dose is appropriate for your patient. Duragesic is a longacting extendedrelease opioid pain medicine narcotic that can put you at risk for overdose and death. The patches are designed to deliver approximately 12, 25, 50, 75, and 100 mcgh fentanyl to the systemic circulation, which represent about 0. Medically, fentanyl is used by injection, as a patch on the skin, as a nasal spray, or in the mouth.