Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are. Use of butrans as the first opioid analgesic opioid naive patients initiate treatment with butrans with a 5 mcghour patch. Buprenorphine transdermal may also be used for purposes not listed in this medication guide. The data upon which the conversions are based are summarized in the table below. Conversion factors are an approximate guide only because comprehensive data are lacking and there is significant interindividual variation. Monitor the patient carefully for respiratory depression.
In other words, the conversion factor not accounting for days of use would be 95 or 1. Dosing calculator belbuca buprenorphine buccal film. Fentanyl patch converter globalrph conversion from other opioid patch conversion an alternative algorithm for dosing transdermal fentanyl an alternative algorithm for dosing transdermal fentanyl. Then use the dosing calculator below to determine the correct starting dose of belbuca for patients who are currently taking another opioid medication. Apply the fentanyl patch 12 hours after the final dose of modified release opioid. It should not be used to determine doses when converting a patient from one opioid to another. Dec, 2018 it is important to note that the addition of buprenorphine, including transdermal patches and buccal films, to this calculator came with a preprogrammed conversion ceiling and a warning that conversions to or from buprenorphine could not be recommended. Strong opioid via a continuous subcutaneous infusion. The conversion ratio of certain opioids can be dependent on the dose of the original opioid.
Calculation of oral morphine equivalent daily dose omedd. Read the medication guide and, if available, the patient information leaflet provided by. However, the opiate medication is still absorbed into the. The web page will automatically calculate the total morphine equivalents per. The conversion factor for oral to subcutaneous doses is. Definitions opioid analgesics vary in potency, side effect and pharmacokinetic profile. Pain levels and quality of life scores were recorded before and after conversion to buprenorphine sl. Opioid converter morphine equivalent calculator omni. Equianalgesic chart changes in italics ui health care. Equianalgesic dosing of opioids for pain management. Titrate liberally and rapidly to analgesic effect during first 24 hours.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. The half life of the two drugs needs to be considered when converting so that the patient does not experience breakthrough pain or receive too much opiate during the conversion period. There is a potential for buprenorphine to precipitate withdrawal in patients who are already on opioids. All conversions except methadone are made by first calculating the morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. Conversion to butrans buprenorphine transdermal system ciii. Fill in the mg per day for whichever opioids your patient is taking to automatically calculate the total morphine equivalents per day. Do not wear a skin patch on a part of your body where a child could reach or remove the patch from your skin. Calculate an opioid starting dose for an opioid naive patient. Butrans is for transdermal use on intact skin only. Narcotic equivalence converter narcotic route dose duration. Oarrs utilizes conversion factors created by the us centers for disease control and prevention.
Unlike methadone, buprenorphines opiate ingredient has a builtin ceiling effect that limits the drugs potency once a certain dosage level is reached, according to the national drug intelligence center. Opioid dose equivalence faculty of pain medicine anzca. Read the medication guide and, if available, the patient information leaflet provided by your pharmacist before you start. Each butrans patch is intended to be worn for 7 days. For buprenorphine transdermal patch butrans, see footnote k. This opioid dose calculator was developed by the washington state agency medical directors group to be used in conjunction with the interagency guideline. When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration. It usually includes information on the dosage, relative potency, and halflives, compared to morphine. In renal impairment gfr opiate conversion the dosage needs to be lowered, even by 2550%. Read the medication guide and, if available, the patient information leaflet provided by your pharmacist before you. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Some studies suggest the 75 and 100 ug patches may not provide consistent plasma levels.
If pain is controlled on current opioid, reduce the new opioid daily dose by 2550% to account for crosstolerance, dosing ratio variation, and interpatient variability. Current breakthrough opioid entered to be what the patient is actually taking rather than what has been prescribed. The side effects of patch use for elderly patients mirror those of all other patients, except there is an additional emphasis on respiratory issues. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Level of analgesia for patients who continued conversion to sublingual buprenorphine for more than 2 months. There are special considerations for calculating methadone methadose, dolophine med, please view the following page for conversion factors and references. How to use buprenorphine patch, transdermal weekly. Choose a suitable patch matrix patches allow titration in smaller increments. Therefore the opioid conversion guidelines have been developed to assist when changing opioid drug therapy.
Transdermal and parenteral fentanyl dosage calculations. Patches containing buprenorphine are sometimes used instead of fentanyl for the elderly. Opioid conversion calculator for morphine equivalents. This tool does not contain all of the important safety information needed to prescribe butrans. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Buprenorphine transdermal system btds, 520 mcgh every 7 days seems to have a small. Buprenorphine transdermal delivery system butrans, ciii. Butrans buprenorphine transdermal dosing, indications. Begin by tapering your patients current opioid total daily dose down to 30 mgd oral mme or less. Never wear more than 1 patch at a time unless your doctor has told you to. Buprenorphine transdermal skin patch uses, side effects. It is important to note that the addition of buprenorphine, including transdermal patches and buccal films, to this calculator came with a preprogrammed conversion ceiling and a warning that conversions to or from buprenorphine could not be recommended. Opioid morphine equivalent conversion factors1 cms. A common form of buprenorphine is the butrans patch.
Calculator will only allow conversion from a buprenorphine patch and not to a patch as there is limited evidence about, and experience of its use compared to other opioids. Opioid oral morphine milligram equivalent mme conversion factors1,2. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Adapted from tarascon pocket pharmacopoeia created. Patch strengths can be combined to provide an appropriate dose provided they have the same frequency of application. Starting dose will range from 75 mcg once daily or every 12 hours to 300 mcg every 12 hours depending on the patients prior opioid experience and risk for abuse potential. The transdermal fentanyl patch in these patients was replaced by a 52. The med calculator is designed to assist in the calculation of patients opioid intake. A 12 microgramhour fentanyl patch is equivalent to about 30mg to 60mg of oral morphine in 24 hours. Approximate potency equivalence with oral morphine. This opioid dose equivalence table is intended for comparison of different opioid and opioid formulations in individual patients or in patient cohorts. For example, if a user asked to convert morphine 80 mg orally to buprenorphine film belbuca. Opioid calculator opioid conversions and opioid dosing. Butrans buprenorphine 5 mcghour transdermal systems are square, beigecolored adhesive patches measuring 45 mm by 45 mm.
We used the equianalgesic chart from wikipedia to build the opioid conversion calculator. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100125%. These bidirectional differences are not captured in a traditional equianalgesic table. Scottish palliative care guidelines choosing and changing. Conversion from other opioids to butrans discontinue all other aroundtheclock opioid drugs when butrans therapy is initiated. 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. Type of opioid mme conversion factor buprenorphine patch. Oct 16, 2014 the buprenorphine transdermal patch is included under the risk evaluation and mitigation strategy rems. Until plasma concentrations are therapeutic 1824hrs breakthrough analgesia should be offered 2. This is because buprenorphine appears to have less unfavorable side effects on the elderly. Calculate the initial butrans dose for your opioidexperienced patients. Oct 14, 2019 do not use a buprenorphine transdermal skin patch if it has been cut or damaged.
Buprenorphine is a less potent opioid than fentanyl. The starting point for dose reduction from the calculated equi. Opioid equivalence chart gloucestershire hospitals. Equianalgesic doses contained in this chart are approximate, and should be used only as a.
Fentanyl is available as a transdermal patch duragesic cii in 25, 50, 75 and 100 ughour strengths. Transdermal fentanyl patches are unsuitable for opioid naive patients 1. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Convert your patients opioid daily dose to the morphine equivalent dose med by. Oral morphine milligram equivalent conversion tablei.
Buprenorphine conversions practical pain management. In renal impairment gfr morphine and diamorphine in particular can accumulate. Medicationassisted treatment with buprenorphine is as effective as methadone in terms of treatment retention and decreased opioid use when prescribed at fixed dosages of at least 7 mg per day. Converting from oral morphine to fentanyl transdermal patch. Kathys recommended starting dose for butrans, her first opioid analgesic. Opioid conversion calculator for morphine equivalents oregon. Avoid allowing children to watch you put on a skin patch. Calculate opioid dose adjustments and opioid starting doses. This calculator should not be used to determine doses when converting a patient. Standards and guidelines for the use of transdermal opioids in palliative care july 2014 4 24 hourly modified release oral strong opioid. Patients with pain diagnoses can avoid these symptoms, however, by using a fentanyl or buprenorphine patch, which minimizes or eliminates withdrawal symptoms. The buprenorphine transdermal patch butrans is fdaindicated for use in patients with pain that is severe enough to require daily, aroundtheclock, longterm opioid use for which other treatments are not adequate. Older individuals are more susceptible to these conditions. Here is a table of substance dosage and potency, related to 10 mg of intravenously administered morphine.
Patients using fentanyl transdermal system or extendedrelease hydromorphone for. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Healthcare professionals administering transdermal patches should record the location of the patch in the patients healthcare records andor on the prescription chart. In the case of converting morphine to methadone, methadone has a relative potency of 4. Buprenorphine transdermal is an opioid pain medication that is used for aroundtheclock treatment of moderate to severe chronic pain that is not controlled by other medicines. Transdermal buprenorphine patch microgramhour strength oral codeine or dihydrocodeine mgday 30 x10 subcutaneous alfentanil mgday the conversions given are comparable doses but there is wide patient intervariability relating to opioid conversion. Always ensure that an old patch has been removed before a new patch is applied. Initiate treatment with butrans with a 5 mcghour patch. Buprenorphine is a partial opiate agonist that can make opioid withdrawal easier to handle. Butrans transdermal system is supplied in cartons containing 4 individuallypackaged systems and a pouch containing 4 patch disposal units.
Dose conversion tool butrans buprenorphine transdermal. Although the butrans patch can help during withdrawals and detoxification, it isnt intended for longterm use. Dose equivalents and changing opioids faculty of pain. Oct 18, 2019 initiate treatment with butrans with a 5 mcghour patch.
Buprenorphine is not included in the calculator because it is a partial agonist and. As methadone and buprenorphine both contain opiate materials, a certain degree of risk for abuse does exist. In most cases, when switching between different opioids, the calculated doseequivalent must be reduced to ensure safety. Each dose can be selfapplied directly where it is needed most. Policy gaining expertise with the use of morphine, and other related opioids, for pain. Opioid oral morphine milligram equivalent mme conversion. Transdermal preparation conversions for transdermal preparations patches the equianalgesic oral morphine dose is listed for the lowest strength of each patch opioid patch strength. Scottish palliative care guidelines buprenorphine patches. Consider only if tolerant to opioids as this is a very potent opioid.
Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po. Conversion algorithm for instructions on converting from one opioid to another. Kathy has no history of treatment with opioid analgesics for her chronic low back pain. Gwent guidance on the use of strong opioids in non malignant pain is available at. Conversion ratios emrpcc ocr guide to practice 20141. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Buprenorphine therapy for opioid use disorder american. Conversion of chronic pain patients from full opioid. Opioid opiate equianalgesia conversion calculator hospital palliative care service.
Buprenorphine transdermal patch pg 1 butrans patch buprenorphine transdermal system btds for weekly application classification1,2 semisynthetic, highly. The formulae for converting methadone are in the footnotes of the table. Oral morphine milligram equivalent conversion table updated 8. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Opioids switching with transdermal systems in chronic cancer. Opioid equianalgesic calculator opioid switching from. Conversion from high dose full opiate agonists to sublingual buprenorphine reduces pain scores and improves quality of life for chronic pain patients after 2 months on sublingual buprenorphine, patients mean pain score decreased from 7. Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. Rescue medication with 20 mg of immediaterelease oral morphine was prescribed to each patient up to three times a day. Calculate the dose of buprenorphine from the conversion chart given here or seek advice. However, since the buprenorphine patch remains in place for 7 days, we have multiplied the conversion factor by 7 1. Although not observed in buprenorphine transdermal chronic pain clinical trials, cases of cytolytic hepatitis and hepatitis with jaundice observed in individuals receiving buprenorphine sl for opioid dependence treatment. Practical pain management is a remedy health media, llc web property.
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