Hydromorphone injection fda prescribing information. Calculate the total daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for each 25 mcghour fentanyl transdermal patch. She would like to try an immediaterelease opioid agent, hydromorphone. Morphine milligram equivalent mme calculator instructions. Stop long acting oral morphine after applying patch. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. Opioid converter morphine equivalent calculator omni. Hydromorphone hydrochloride injection is indicated for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate. 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. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Hydromorphone injection may also be used for purposes not listed in this medication guide.
If the patch is stopped it may take 12h or longer before the effect of the fentanyl wears off. You should take your vicodin with it for the first 23 days. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. In contrast, the newer generic patch by mylan lacks a reservoir, with the fentanyl instead being suspended in a gel matrix within the. Convert to equivalent dose of fentanyl by dividing total 24 hour oral dose by 100 parenteral fentanyl is 100 times more potent than oral morphine 180 mg 100 1. Use of iv fentanyl is restricted to oncology, burn service, palliative care. If the form does not start downloading in 10 seconds, please click here. Oxycodone is available as immediate release capsules 5mg, 10mg and 20mg, liquid 1mgml or 10mgml and sustained release tablets 5mg, 10mg, 20mg, 40mg and 80mg.
Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Opioid conversion tips changing to another oral opioid question. Jan 01, 2020 hydromorphone hydrochloride injection is indicated for the management of pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate.
The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Conversion from other oral hydromorphone formulations. While transdermal patches of fentanyl in gel form e. Demand boluses of iv fentanyl equivalent in dosage to 50100% of the final cii rate remained available via pca during the 24 hours after patch application. National and international guidelines also support the use of a 2.
The original system, duragesic, has a reservoir which contains fentanyl in a fluid state. Drug equivalency to 1 mg iv morphine conversion factor hydromorphone iv 0. Opioids are sought by drug abusers and people with addiction disorders and are subject to criminal diversion. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Duragesic label page 1 full prescribing information for. What are the possible side effects of hydromorphone injection. Hydromorphone hydrochloride injection high potency formulation hpf is indicated for use in opioidtolerant patients who require higher doses of opioids for the. For frail elderly patients, use more conservative conversion or a lower strength patch e. Scottish palliative care guidelines fentanyl patches.
Start hydromorphone extendedrelease oral tablet at 50% of converted dose and give po daily beginning 18 hours after removal of the fentanyl. Get emergency medical help if you have signs of an allergic reaction. Opioid dose equivalence faculty of pain medicine anzca. After 24 hours, the breakthrough doses of morphine given in that period can be totalled and this dose of morphine administered as a sc infusion in a syringe pump over the next 24 hours in addition to the fentanyl patch. This is based on studies converting from morphine to fentanyl. Morphine milligram equivalent mme calculator nyc health. Medically, fentanyl is used by injection, as a patch on the skin, as a nasal spray, or absorbed through the cheek. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Opiate bioavailability and response are highly variable. A withdrawal syndrome may also occur when switching to fentanyl, which responds to tapering doses of the previous opioid. Opioid conversion calculator morphine equivalents advanced. Meperidine is nota recommended drug in a palliative care setting and is to be avoided.
It has a rapid onset and its effects generally last less than two hours. Duragesic label page 1 full prescribing information for use in opioidtolerant patients only duragesic contains a high concentration of a potent schedule ii opioid agonist, fentanyl. Transdermal and parenteral fentanyl dosage calculations. There is a conversion between hydrocodone and fentanyl.
Recommended conversion from oral daily hydromorphone equivalent to fentanyl is as follows. Dilaudid injection can be abused and is subject to misuse, addiction, and criminal diversion see warnings and precautions. Opioid switching using equivalence tables saskatchewan. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Advanced opioid conversion calculator morphine equivalents. Parenteral hydromorphone is 20 times as potent as oral morphine. Opioid oral morphine milligram equivalent mme conversion. When switching to methadone, the starting dose should be 10% to 25% of the equianalgesic dose. Duragesic fentanyl transdermal dosing, indications. Ivs fentantyl is included in this table to assist with opioid rotation from fentanyl where patients are. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pms hydromorphone morphine sulfate.
Amount of drug administered to patient multiplied by the conversion factor equals the equianalgesic morphine equivalency. The total daily morphine milligram equivalents mme will be displayed. Practical management of opioid rotation and equianalgesia. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Fentanyl citrate injection, usp is a sterile, nonpyrogenic, preservative free aqueous solution for intravenous or intramuscular injection. It may be 812h or longer after putting on the first patch before pain relief is experienced. Demystifying opioid conversion calculations 87 n in patients who are not opioidtolerant note.
As an opioid, fentanyl citrate injection exposes users to the risks of addiction, abuse, and misuse see drug abuse and dependence. Generic name conversion factor to mme per day buprenorphine patch 12. The amount of residual drug in the patients system must be accounted for. Convert patient from morphine 30mg po q4h to hydromorphone iv. What to do with oxycodone, ms contin, and fentanyl. If switching from a fentanyl patch to any other strong opioid by any other route, specialist. Intrathecal injection delivers the drug directly into the cerebral spinal fluid. Fentanyl citrate injection contains fentanyl, a schedule ii controlled substance. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. The ld50 in humans, by intravenous injection, is 0. Currently, there are no empirical studies converting fentanyl to morphine. What is if possible the exact dose when switching from fentanyl to dilute hyrmorphone.
These bidirectional differences are not captured in a traditional equianalgesic table. Oral hydromorphone is about 47 times as potent as oral. Canadian guideline for safe and effective use of opioids. Apr 18, 2015 the original system, duragesic, has a reservoir which contains fentanyl in a fluid state. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg. Oral hydromorphone is about 47 times as potent as oral morphine. You wish to convert the therapy to transdermal fentanyl. Thank you for downloading opioid manager switching opioid form. Dailymed dilaudid hydromorphone hydrochloride injection.
A patient is taking sustainedrelease oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. There are many opioids and many formulations available e. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. They all interact with specific opioid receptors such as. Pain intensity on a scale of 010, sedation on a scale of 03, and hourly pca administration microghr were assessed and recorded immediately prior to application of the fentanyl patch. 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. Doseranging study of oxycodone for chronic pain in advanced cancer. Using multiple patches injecting fentanyl drinking boiled liquid chewing patches smoking snorting for young children and adults, the contact can be lifethreatening. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e.
In the united states, fentanyl is a schedule ii drug. Dilaudidhp hydromorphone hydrochloride injection side. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Here is another wikipedia article hydromorphone s oral to intravenous effectiveness ratio is 5. Fentanyl mcghr 3 denpax, durogesic, dutran, fenpatch, fentanyl sandoz parenteral preparations morphine mgday 3 dbl morphine sulphate injection, dbl morphine tartrate injection oxycodone mgday 3 oxynorm fi hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. Round up to and begin treatment with transdermal fentanyl using a patch size of 50 gh. Fentanyl is a strong, synthetic manmade narcotic that is similar to morphine. A safe and effective method for converting cancer patients. Principles of opioid management fraser health authority. Fentanyl patch converter globalrph conversion from. What are the steps for converting from morphine or equivalent to. 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. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid.
Calculation of oral morphine equivalent daily dose omedd. Medically, fentanyl is used by injection, as a patch on the skin. Asked 9 mar 2012 by mhh updated 9 march 2012 topics neurosis, pain, fentanyl, hydromorphone. How long before the fentanyl patch to absorb into the system and starts to. Conversion from morphine or equivalent to fentanyl transdermal. 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. Sublimaze fentanyl dosing, indications, interactions. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided.
Converting from oral morphine to fentanyl transdermal patch. Prescribing information does not exclude the 12 mcgh tdf patch from this contraindication n in the management of acute pain or in patients who require opioid analgesia for a short period of time n in the management of postoperative pain, including use after outpatient or day. Previous case reports describe intravenous iv injection after the extraction of liquid fentanyl from this reservoir 27. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. Remember to enter all opioids the patient is taking. Equianalgesic chart changes in italics ui health care. Due to the risk of respiratory depression, the transdermal patch is for use in opioidtolerant patients only. Opioid conversions calc single agent equianalgesic. When converting to methadone dose reduction of 75 to 90% should be considered. The medline database was searched with terms cancer pain, opioid rotation, opioid switching, opioid ratio, opioid conversion ratio, and opioid equianalgesia for the major opioids morphine, oxycodone, fentanyl, and hydromorphone and the intravenous, subcutaneous, oral, and transdermal administration routes.
An alternative algorithm for dosing transdermal fentanyl. Dbl morphine sulphate injection, dbl morphine tartrate injection. Oct 01, 2018 dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. Dilaudid injection contains hydromorphone hydrochloride, a substance with a high potential for abuse similar to other opioids including fentanyl, hydrocodone, methadone, morphine, oxycodone, oxymorphone, and tapentadol. 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. The hydromorphone is equianalgesic to a dose of 96 mgd of oral morphine. Oct 09, 2018 hydromorphone injection may also be used for purposes not listed in this medication guide. If you are converting a patient to or from fentanyl i.