Conversion from other opioids to morphabond by using 15 mg every 12 hours and discontinuation of other opioids. Before sharing sensitive information, make sure youre on a federal government site. Convert patients receiving parenteral oxymorphone to opana er by administering 10 times the patients total daily parenteral oxymorphone dose as opana er in two equally divided doses e. The fentanyl longacting formulation is only available as a dermal patch. My doctor offered oxymorphone 10 mg er or fentanyl patches 25 mcghr as alternatives. Opioid conversion calculator for morphine equivalents. What is the proper dose of opana er if using 50 mcg patch. Dosing of fentanyl patches is in micrograms mcg per 24 hours, while morphine is in milligrams mg. Meperidine is nota recommended drug in a palliative care setting and is to be avoided. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied. The total daily morphine milligram equivalents mme will be displayed. Apply 75 microgram fentanyl patch concurrently with the last dose of long acting oral morphine 90mg.
So i was talking to the pharmacists, and he told me that a fentanyl patch is a cheaper way to go. These bidirectional differences are not captured in a traditional equianalgesic table. Just wanted to know if the opana is twice as strong as the oxycotin. How to calculate my opioid dose pain consultants usa. Remember to enter all opioids the patient is taking. It should not be used to determine doses when converting a patient from one opioid to another.
Opioid oral morphine milligram equivalent mme conversion factors1,2. Converting from oral morphine to fentanyl transdermal patch mr. Percocet contains oxycodone 5mg acetaminophen 325mg. 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. Both are easy to overdose on if taken inappropriately, but this makes fentanyl especially dangerous in illicit markets. The extendedrelease form of opana is for aroundtheclock treatment of pain. A patient is using a 25 mcg fentanyl patch every three days. The tables below are only to be used for the conversion from current opioid therapy to zohydro er or hysingla er. For each 25 mcghr fentanyl transdermal patch, a dose of hysingla er 20 mg every 24 hours represents a conservative initial dose. I think it is oxymorphone is not extended release but the opana is. Opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. Duragesic label page 1 full prescribing information for use.
Conversion back from prior opioid divides by the conversion factor shown in the table below. Morphine to fentanyl patch conversion each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Determine mmes of oxycodone oxycodone conversion factor 1. The 50, 75, and 100 mcghr patches should only be used in patients already on and tolerant to opioid therapy. Conversion from morphine or equivalent to fentanyl transdermal. Round up or down based on patient factors and available patch sizes. What is the proper dose of opana er if using 50 mcg patch of fentanyl. Treatment with oxycontin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires.
Advice should be sought from the palliative care team. Opioid conversions calc single agent equianalgesic. Converting to transdermal fentanyl palliative care. Stop long acting oral morphine after applying patch. Sep 12, 20 is there anyone here taking both the fentanyl patch and oxymorphone. Converting from oral morphine to fentanyl transdermal patch. Fentanyl can be abused and is subject to criminal diversion. In adults convert to exalgo 12 mg from oral codeine 200 mg, hydrocodone 30 mg, morphine 60 mg, oxycodone 30 mg, oxymorphone 20 mg, or transdermal fentanyl 25 mcghr. Calculate the total 24hour morphine dose or morphineequivalent.
Basically its just so i increase the milligram of my oxycodone, or switch to opana ir instead. Some experts use this conversion in cancer patients. Conversion from transdermal fentanyl to hysingla er eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Opana er is taken every 12hrs and is used for moderatesevere chronic pain requiring the use of an opioid longterm. Although there has been no systematic assessment of such conversion, start with a conservative conversion. Select microgram per hour dose of transdermal fentanyl based on table 2. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. When removing a patch, remember the analgesic effect can still last up to 24 hours buprenorphine is a partial muagonist ceiling dose for analgesia buprenorphine 20mcg patch is approximately equivalent to 15mcg fentanyl patch or. Im prescribed both oxymorphone 40mg er 80mg every 12 hours and 10mg ir 20mg every 8 hours. Conversion from transdermal fentanyl to hysingla er. Fentanyl patch converter globalrph conversion from. Currently, there are no empirical studies converting fentanyl to morphine. The tables cannotbe used to convert fromzohydro er or hysingla er. Opioid oral morphine milligram equivalent mme conversion.
Morphine milligram equivalent mme calculator nyc health. Apr 24, 2012 i did the conversion and 80 er mg of opana is about 66 mcg of fentanyl so when they get you up to the 75 mcg i think you will feel fine. The patch is fentanyl the strongest family of opiates we have. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. 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. In the case of converting morphine to methadone, methadone has a relative potency of 4. So very recently my doctor has prescribed me oxymorphone 10mg er, along with my other and i came to find out that oxymorphone is really expensive. Im finding that the oxymorphone seems to have no effect for my pain. The patch will take a little while to get in to your system. Duragesic label page 1 full prescribing information for.
Future studies should continue to document the clinical efficacy of oral oxymorphone in longterm clinical trials greater than 6 months of cancer and cnmp, and should investigate the dose conversion from oxymorphone to other common opioids in use eg, methadone, fentanyl patch. Fentanyl patch converter globalrph conversion from other. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. So far the 2 changes he made was he took me off opana er 40 mg 2 times a day and put me on 37 mcg fentanyl trans patch every 3 days 1 patch is 25 mcg and 1 patch is 12 mcg. If a patient with chronic pain is on meperidine, convert patient to an equianalgesic dose of one of the other opioids listed in this table. Think of it as filling up a pool of water,once the water reaches the top then you have an even rate,same with the patch so give it time to fill your system up. Convert to mmes oxymorphone conversion factor 3 a40 x 3 120 mme 3. Pain relief after injection begins after about 510 minutes and 1530 minutes after rectal. Opioid conversion to hysingla er hydrocodone bitartrate cii. I have pain from an 8 level back fusion from an accident. The amount of residual drug in the patients system must be accounted for. Use of this table for conversion from fentanyl to other opioids can overestimate the dose of the new agent and may result in an overdosage. Simple conversion, fentanyl patch, methadone and iv infusion doses.
Buy opana online buy opana online pharmacy buy opana er where to buy opana buy opana 40mg online buy opana online without prescription. Most people do quite well on the patch but i have severe depression and chronic fatigue syndrome so those combinef with the patch can make me never leave my room. Oxycontin, xtampza er oxycodone dosing, indications. Oxymorphone, sold under the brand names numorphan among others, is a opioid pain medication. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Currently im on the fent patches and oxycodone for breakthrough pain. Do not use this table to convert from fentanyl transdermal system to other opioid. Opioid conversions calc single agent equianalgesic globalrph. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. The web page will automatically calculate the total morphine equivalents per day. Equianalgesic dose ratios are only approximations and do not account for genetic factors, incomplete crosstolerance, and pharmacokinetics. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl.
Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Eighteen hours following the removal of the transdermal fentanyl patch, hysingla er treatment can be initiated. Oxycodone er oxycontin oxymorphone er xtampza er zohydro er. List of extendedrelease and longacting opioid products. Morphine dose equivalence not reliably established. I too use the fentanyl 75mcg patch along with the oxycodone. The is a shortageoutage of everything, i am prescriped these medication and take 540 mg of oxycodone ir for break thru pain and i am in pain management an have been for 16 years. If you respond well to the short acting form of it and can afford a brand name med, it may be a good oral med option for you. Equivalence between oral morphine and transdermal fentanyl. Fentanyl is one of the strongest pain meds on the market and it will take a high dose to reach the equivalency. Jan 19, 2012 i need a oxycondone to opana ir accurate conversion. Oct 10, 2019 conversion from parenteral oxymorphone to opana er.
Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by. Morphine milligram equivalent mme calculator instructions. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Equianalgesic chart changes in italics ui health care. 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. In 2017 the fda issued a request for opana er to be taken off the market due to its ability to be altered into a injectable form, which caused an outbreak of hiv and hepatitis c in indiana. There are many conversion tables available through the internet and doctors also use theconversion method when finding the right dose for you. Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf. I have been battling severe constipation regardless of numerous methods to remedy it. Patients using both fentanyl patches and oxymorphone opana. Oxymorphone 1 10 rectal adjust dose in renal impairment due to the potency of oxycontin, it is recommended to use the conversion factor table when converting to oral oxycodone to avoid overestimating the dose. On er pills there were also restrictions on when i could take my other medications as if taken too close to when i would take the opana er, it would interact with the opana and i would get severe dizziness and vomiting.
What is the proper dose of opana er if using 50 mcg patch of. This calculator, which is based roughly on information provided by janssen pharmaceuticals inc. I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. A patient received a quantity of fifteen tramadol 100 mg tablets. Opens er was what i started with, but didnt do anything so we changed opana er to fentanyl.
Prior authorization protocol duragesic fentanyl transdermal. Eighteen hours following the removal of the transdermal fentanyl patch, xtampza er treatment can be initiated. I need a oxycondone to opana ir accurate conversion. Oxymorphone, sold under the brand names opana among others, is a opioid pain medication. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. Oxymorphone to fentanyl equivalent doctor answers on. Do not use this table to convert from fentanyl transdermal system to other opioid analgesics because these conversion dosage recommendations are conservative. In other words, the conversion factor not accounting for days of use would be 6025 or 2. This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Although there has been no systematic assessment of such conversion, a conservative oxycodone dose, approximately 9 mg equivalent to 10 mg oxycodone hcl every 12 hours of xtampza er, should be initially substituted for each 25 mcghr fentanyl transdermal patch. Conversion back from prior opioid divides by the conversion factor shown in the table. July 2019 supportive institute upmc palliative and. I am currently on 50mcg fentanyl patches and have been since sept.
Review of oral oxymorphone in the management of pain. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg fentanyl patch 1 patch x 50mcghr 150mg. Converting from oral morphine to fentanyl transdermal patch teaching exercise 2. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Pain relief after injection begins after about 510 minutes and 1530 minutes after rectal administration, and lasts about 34 hours for immediaterelease tablets and 12 hours for extendedrelease tablets. Side effects of opana er oxymorphone hydrochloride. Hi everyone, i am new to this board, but not to taking pain meds. Wait 18 hr after patch removed, then initiate conservative dose of 10 mg q12hr oxycodone controlledrelease for each 25 mcghr fentanyl transdermal patch. With the fentanyl, i dont have this problem and i like being able to less pills per day. May 31, 2017 opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. Duragesic fentanyl is an excellent pain reliever, but should only be used by people whove tried other opioid pain medications and still need more relief. Opioid conversion and brand availability in canada michael g. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12.
For moderate pain, an opioid agonist eg, hydrocodone, oxycodone can be used. Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a. Also what is the difference between opana er and oxymorphone. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Compare fentanyl vs oxymorphone comprehensive analysis by. While there is little ability to abuse the fentanyl dermal patch, it is possible to do so by heating it after it is applied to the skin or by freezing a patch and then cutting it into pieces for oral consumption.
Hi i take oxymorphone 15 mg er for chronic nerve pain in my neck. This calculator should not be used to determine doses when converting a patient from one opioid to another. This is especially important for fentanyl and methadone conversions. 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. Equianalgesic dosing of opioids for pain management. The absolute oral bioavailability of opana er is approximately 10%. What are the differences between oxycodone and fentanyl. The most salient difference between the two drugs is their potency. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. A safe and effective method for converting cancer patients. Oral morphine milligram equivalent conversion table updated 8. Transdermal and parenteral fentanyl dosage calculations.