Durogesic dtrans is a translucent, rectangular transdermal patch with rounded corners. Fentanyl duragesic side effects, withdrawal and faqs. Duragesic patch dose duragesic patches are fentanyl transdermal systems that deliver extremely potent pain medication to patients via patches placed on the skin. Opioidnaive patients should not be given sandoz fentanyl patch at any dose, inclusive of 12 mcgh see contraindications. Each initial duragesic dose is highly individualized. Doses should be increased or decreased by 2550% of the current 24hour dose. The patch is applied to the skin and left in place for 3 days 72 hours. 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.
Buprenorphine transdermal delivery system butrans, ciii. Opioid conversion and brand availability in canada michael g. The table is based on oral dosing for chronic noncancer pain. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. In the case of converting morphine to methadone, methadone has a relative potency of 4.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. A study to assess the safety, dose conversion, and dose individualization of duragesic fentanyl transdermal patch in the treatment of children with chronic pain requiring narcotic pain relief therapy full text view. Duragesic patch fentanyl patch rationale for inclusion in pa. Opioid oral morphine milligram equivalent mme conversion.
Choose a suitable patch matrix patch allows titration in smaller increments. Webmd provides common contraindications for duragesic transdermal. Quickwhat dose of the transdermal fentanyl patch duragesica is equianalgesic to a 3 mghr morphine continuous infusion. Instructions for use duragesic instructions for applying a. In clinical trials, these ranges of daily oral morphine doses were used as a basis for conversion to duragesic. Initial fentanyl transdermal dosage use only when converting another opioid to fentanyl. 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. Apr 21, 2020 decrease new dose 3050% to allow for incomplete crosstolerance. In other words, the conversion factor not accounting for days of use would be 6025 or 2.
Conversions to and from duragesic are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology and a generous dose of common sense. Transdermal and parenteral fentanyl dosage calculations and. 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. Patch strengths can be combined to provide an appropriate dose. The recommended upward dose titration interval is every 72 hours. Duragesic fentanyl transdermal system cii pain patch. 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.
This table should not be used to convert from duragesic to other. Calculate 24hr morphine dose and find the corresponding recommended initial fentanyl transdermal dose. Select microgram per hour dose of transdermal fentanyl based on. Oral morphine milligram equivalent conversion table updated 8. Calculate the dose of fentanyl from the conversion chart given here or seek advice. Tables found in prescribing information cannot be used to convert from fentanyl transdermal to another opioid because conversions will result in an overestimation of the dose of new opioid and may result in fatal overdosage. Advice should be sought from the palliative care team. So, you use that and add 15mg for your breakthrough dose and there you have it.
Unused fentanyl patches should be kept in a secure location out. The appropriate duragesic patch dose for a particular patient will depend on. Dosing for fentanyl patches the initial dose of fentanyl should be the lowest possible dose based on the patients opioid history and current medical status. The fentanyl patch is one of a few medications that may be especially harmful, and in some cases fatal, with just one dose, if used by someone other than the person for whom the medication was prescribed.
The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. 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. Quickwhat dose of duragesic patch fentanyl transdermal is equianalgesic to a 3 mghr morphine drip. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications.
Patients who are opioidexperienced are those receiving, for one week or longer, daily opioid doses up to 80 mgday of oral morphine or an equianalgesic dose of. Transdermal fentanyl patches were designed to provide longlasting opioid. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Duragesic patches have a boxed warning regarding the abuse potential, fatal respiratory depression even in opioid tolerant patients, accidental exposure, cytochrome p450 3a4 interaction. When converting to methadone dose reduction of 75 to 90% should be considered. Decrease new dose 3050% to allow for incomplete crosstolerance. Stronger dosed duragesic patches may be available for particularly severe cases of chronic pain. 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 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. What are the steps for converting from morphine or. Manage breakthrough pain with morphineshortacting opioid prn. Find out what health conditions may be a health risk when taken with duragesic transdermal.
Dose may be calculated using dose conversion guidelines in the product package insert, local protocol, or another reliable reference. Opioid conversion calculator for morphine equivalents. Fentanyl patch converter globalrph conversion from. Equianalgesic chart changes in italics ui health care.
In the case example above, 216 mg of oral morphine per day is approximately equianalgesic to the 100 mcghr fentanyl patch. 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 initial dosage your healthcare provider recommends will mostly depend on the type and dose of the other opioids you have been taking. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Tables 1, 2, and 3 should only be used to convert from other opioids to durogesic dtrans and not from durogesic dtrans to other therapies. 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.
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. We had a discussion here not too long ago and we did a conversion from oxy and hydro to the 25ughr patch. Overestimating the duragesic dose when converting patients from. There is a nasal spray under the brand name lazanda. Duragesic fentanyl dose, indications, adverse effects. The larger the dose of fentanyl delivered, the larger the patch as of the skins surface area has to be covered to ensure that larger amounts of pain medication are being absorbed. Duragesic patch and absorption of a potentially fatal dose of fentanyl. Duragesic patches are available in 5 different doses and patch sizes. 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. Serious or lifethreatening breathing problems that can lead to death can. Make sure you have the right dose patch or patches that have been. 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. These dose conversions are estimated and cannot account for all individual. Transdermal and parenteral fentanyl dosage calculations.
Patients should always work closely with their doctors before. An alternative algorithm for dosing transdermal fentanyl for. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. This tool does not contain all of the important safety information needed to prescribe butrans. Scottish palliative care guidelines fentanyl patches. The cdc mme conversion factor to calculate morphine milligram equivalents of methadone is 3. An alternative algorithm for dosing transdermal fentanyl.
Opioidnaive patients should unot u be given duragesic at any dose, inclusive of 12 mcgh see contraindications. Fentanyl patch converter globalrph conversion from other. In general, the 12 mcgh dose, which allows for smaller dose increases than does the 25 mcgh patch, is to be. To determine the dose conversion to initiate treatment with a transdermal fentanyl patch, convert the total daily oxycodone dose 5 mg. Patches are licensed for dose initiation and titration. Duragesic is a longacting extendedrelease opioid pain medicine narcotic that can put you at risk for overdose and death. 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.
Transdermal patch should be used only in opioid tolerant patients. The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Discarded patches have the potential to be misused. A study to assess the safety, dose conversion, and dose. Divide the calculated 24 hour dose of fentanyl by 24 to calculate the hourly dose of fentanyl. Do not remove a duragesic patch from the pouch until you are ready to use it. Opioid withdrawal symptoms are possible in some patients after conversion or dose adjustment. Converting to transdermal fentanyl palliative care. Fentanyl patches durogesic for chronic pain nps medicinewise. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer.
Duragesic fentanyl transdermal dosing, indications. Recommend an appropriate dose of transdermal fentanyl when. Conversion from morphine or equivalent to fentanyl transdermal. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Unused fentanyl patches should be kept in a secure location out of childrens sight and reach, such as a locked cabinet. In general, the 12 mcgh dose, which allows for smaller dose. See chart a1 fentanyl transdermal patch equianlagesic conversion. 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. Side effects may include profuse sweating, coughing, nausea, diarrhea, and tearing. Fentanyl is the generic name for a synthetic opioid medication developed in the 1960s. What are the steps for converting from morphine or equivalent to. Duragesic fentanyl transdermal system is available in generic form. Find patient medical information for fentanyl transdermal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Fentanyl patch conversions package insert recommendations.
Side effects of duragesic fentanyl transdermal, warnings, uses. Converting from oral morphine to fentanyl transdermal patch. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. It should not be used to determine doses when converting a patient from one opioid to another. Parenteral fentanyl is indicated for perioperative. Side effects of duragesic fentanyl transdermal, warnings.
Brand names include duragesic transdermal patch, actiq lollipops, fentora effervescent buccal tablets, and oromucosal abstral. Fentanyl patches need to be disposed of carefully because a significant amount of fentanyl is left in the patch after three days. Principles of opioid management fraser health authority. The fentanyl will continue to be effective for 24 hours after the patch is removed as a part of the drug is already depot in the adipose tissue. Durogesic dtrans 12 mcghr transdermal patch summary of product characteristics smpc by janssencilag ltd. When changing patients from another opioid to fentanyl, remember that drug equivalence information is often based on singledose studies, and there is substantial individual variation in response. Duragesic label page 1 full prescribing information for. Doses in each column are considered equianalgesic and interchangeable at the.
Converting to transdermal fentanyl palliative care network. Durogesic dtrans 12 mcghr transdermal patch summary of. Duragesic patches are intended for transdermal use on intact skin only. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Aug 12, 2019 1 the lowest dose is stated as 12 ghour however, the actual dose is 12. Table 2 should not be used to convert from duragesic to other therapies because this conversion to duragesic is conservative. Do not use a duragesic patch if the pouch seal is broken or the patch is cut, damaged or changed in any way.