Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. If patient develops these signs or symptoms, raise dose to the previous level and taper more slowly, either by increasing the interval between decreases, decreasing the amount of change in dose, or both do not abruptly discontinue fentanyl patch it is unknown at what dose level the fentanyl transdermal may be. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. Titrate the dose based on the daily dose of supplemental opioid analgesics required by the patient on the second or third day of the initial application. Use the lowest dose possible for the shortest time needed. A strong prescription pain medicine that contains an opioid narcotic that is used tomanage pain severe enough to require daily aroundtheclock, longterm treatment with an opioid,in people who are already regularly using. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. Duragesic transdermal patch is contraindicated in outpatient or day surgeries because there is no opportunity for proper dose titration, in the management of mild or intermittent pain, for use as an as needed analgesic, and in patients who require opioid analgesia for a short period of time. Comparative doses of oral morphine and transdermal fentanyl are given.
Duragesic patch fentanyl patch rationale for inclusion in pa. Oct 15, 2019 refer to table 2 for the range of 24hour oral morphine doses that are recommended for conversion to each duragesic dose. Aug 12, 2019 1 the lowest dose is stated as 12 ghour however, the actual dose is 12. 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.
Overdosage of the new analgesic agent is possible see dosage and administration 2. Opioid analgesic, anesthesia adjunct controlled substance schedule ii pregnancy risk category c action binds to specific opioid. There have been numerous studies which have lead to some controversy about the pharmacokinetics, conversion factors and therefore doses of fentanyl. This is especially important for fentanyl and methadone conversions. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing.
Duragesic fentanyl dose, indications, adverse effects. 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. The duragesic fentanyl patch is used to treat chronic pain by supplying a steady dose of fentanyl a powerful opioid pain medication over an extended period of timeusually up to 72 hours. 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. 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. Use recommended conversion factor to convert to new opioid. Converting from oral morphine to fentanyl transdermal patch.
Read the medication guide and, if available, the instructions for use provided by your pharmacist before you start using. 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. The fentanyl patch duragesic is a medicated skin patch used to treat moderatetosevere chronic pain. Brand names include duragesic transdermal patch, actiq lollipops, fentora effervescent buccal tablets, and oromucosal abstral.
It may not be intentional, but it happens nonetheless. The appropriate duragesic patch dose for a particular patient will depend on. There is a nasal spray under the brand name lazanda. Aug 18, 2012 the duragesic fentanyl patch is used to treat chronic pain by supplying a steady dose of fentanyl a powerful opioid pain medication over an extended period of timeusually up to 72 hours. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. 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. Fentanyl is the generic name for a synthetic opioid medication developed in the 1960s. Parenteral fentanyl is indicated for perioperative.
It should not be used to determine doses when converting a patient from one opioid to another. The patch is applied to the skin and left in place for 3 days 72 hours. Sometimes when you experience the terrible pain that some of us endure, it can easily become all about ourselves. Opioid conversion calculator for morphine equivalents. The following doses and conversion factors are a guideline only and each patient must be assessed on an. Duragesic label page 1 full prescribing information for use. Fentanyl patch conversions package insert recommendations. 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. Opioid oral morphine milligram equivalent mme conversion. Recommend an appropriate dose of transdermal fentanyl when.
After a set of successful clinical trials, duragesic fentanyl patches were introduced into medical practice. Do not prescribe fentanyl patches to those who have only taken codeine or tramadol. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Oral morphine milligram equivalent conversion table updated 8. It should only be used in people who are already using an opioid medication. Fentanyl duragesic side effects, withdrawal and faqs. Duragesic fentanyl transdermal system cii pain patch. The conversion factors for drugs prescribed or provided as part of medicationassisted treatment for opioid use disorder should not be used to benchmark against dosage thresholds meant for opioids prescribed for pain.
Durogesic dtrans 12 mcghr transdermal patch summary of. These dose conversions are estimated and cannot account for all. Side effects of duragesic fentanyl transdermal, warnings, uses. Table 2 should not be used to convert from duragesic to other therapies because this conversion to duragesic is conservative. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2.
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 patients requiring greater than an oral medd of 80 mg. Transdermal and parenteral fentanyl dosage calculations. Transdermal and parenteral fentanyl dosage calculations and. Morphine equivalent dose med opioid conversions globalrph. 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. Just one dose can cause death in someone using duragesic accidentally or improperly. See the detailed instructions for use for information about how to apply and dispose of the duragesic patch.
The initial dosage your healthcare provider recommends will mostly depend on the type and dose of the other opioids you have been taking. 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. Table 1 should not be used to convert from duragesic to other therapies because this conversion to duragesic is conservative. Calculating mme for methadone in clinical practice often involves a slidingscale approa ch whereby the conversion factor increases with increasing dose since the conversion factor of 3 for methadone could underestimate mme for a given patient. Cdc compilation of benzodiazepines, muscle relaxants, stimulants, zolpidem, and opioid analgesics with oral morphine milligram equivalent conversion factors, 2016 version. Buprenorphine transdermal delivery system butrans, ciii. Advice should be sought from the palliative care team. Do not increase the duragesic dose for the first time until at least 3 days after the initial application. Apply duragesic exactly as prescribed by your healthcare provider. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. How should conversion from oral morphine to fentanyl patches be. Abstral, actiq, duragesic, durogesic uk, fentanyl oralet, fentora, lazanda, matrifen ca, onsolis, ranfentanyl ca, ratiofentanyl ca, sublimaze pharmacologic class. Duragesic fentanyl transdermal dosing, indications.
Dose conversion from other opioids to fentanyl transdermal system table 1 should not be used to convert from fentanyl transdermal system to other therapies because this conversion to fentanyl transdermal system is conservative. Duragesic definition of duragesic by medical dictionary. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. An alternative algorithm for dosing transdermal fentanyl for. Duragesic durahgee zikfentanyl transdermalsystem, cii duragesic is. Durogesic dtrans is a translucent, rectangular transdermal patch with rounded corners. We had a discussion here not too long ago and we did a conversion from oxy and hydro to the 25ughr patch. Although there are several available strengths, your healthcare provider may prescribe 12. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Each initial duragesic dose is highly individualized. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. Methadone conversion factors increase with increasing dose. One mistake i think you are making is blaming the duragesic patch for your fathers death when the drug fentanyl was the culprit.
In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. Duragesic patches are intended for transdermal use on intact skin only. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. Use of table 1 for conversion to other analgesic therapies can overestimate the dose of the new agent. Recommend an appropriate dose of transdermal fentanyl when switching. 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.
Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. This table should not be used to convert from duragesic to other. Fentanyl patches durogesic for chronic pain nps medicinewise. Use this table to find the calculated 24hour morphine dose and the corresponding recommended initial duragesic dose. Duragesic patch dose duragesic patches are fentanyl transdermal systems that deliver extremely potent pain medication to patients via patches placed on the skin. In other words, the conversion factor not accounting for days of use would be 6025 or 2. To convert therapy from oral or parenteral opioids to transdermal fentanyl, the. The cdc mme conversion factor to calculate morphine milligram equivalents of methadone is 3. So, you use that and add 15mg for your breakthrough dose and there you have it.