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