If the patch is covered, only use the indicated coverings, such as tegaderm, that do not cause the patch to overheat. Opana may also be used for purposes not listed in this medication guide. Patients using both fentanyl patches and oxymorphone opana. Conversion algorithm for instructions on converting from one opioid to another. Converting from oral morphine to fentanyl transdermal patch mr. This calculator uses the following conversion factors. Round up or down based on patient factors and available patch sizes. I have pain from an 8 level back fusion from an accident. Fentanyl transdermal patch duragesic varies na hydromorphone er exalgo methadone hcl dolophine morphine sulfate er kadian, armyo er, morphabond oxycodone er oxycontin, xtampza er opana er oxymorphone er.
In the case of converting morphine to methadone, methadone has a relative potency of 4. Opioid conversions calc single agent equianalgesic globalrph. Fentanyl transdermal patch hydromorphone extendedrelease er hysingla er levorphanol morphine sulfate er capsule morphine sulfate er tablet nucynta er opana er crush resistant oxycontin oxymorphone er for generic fentanyl 37. Cyp 3a4 inhibitors amiodarone, azoles, antiretrovirals, erythromycin, clarithromycin, diltiazem, verapamil, maois, etc can lead to toxicity. Pain relief after injection begins after about 510 minutes and 1530 minutes after rectal. Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Pain medicationslong acting opioids flashcards quizlet. Choose either one but not both unless you require a rescue drug. In all patients, a transdermal patch delivering fentanyl at a rate equivalent to that of the final continuous iv infusion was applied.
Conversion factor1 dosage form2 dose interval alcohol dose dumping effect3 abuse deterrent formulation4. 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. Oxymorphone, sold under the brand names opana among others, is a opioid pain medication. If you go with the opana er, the majority of your dose will still be in pill form versus all of it within the fentanyl patch such that you wouldnt need to worry about ending up in pain should the patch fall off. The fentanyl longacting formulation is only available as a dermal patch. For many years, opana er was the second most commonly prescribed branded long acting opioid on the market. Opioid conversion other opioids compared to morphine. Oxycodone and hydrocodone rely specifically on cyp3a4 to convert their. I am not one the opana er or the oxycontin er at this time, thus why i need to know to replace that 200 mg of morphine sulf er that.
John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Opioid conversion calculator for morphine equivalents. Oxymorphone to fentanyl equivalent doctor answers on. With the fentanyl, i dont have this problem and i like being able to less pills per day.
Im prescribed both oxymorphone 40mg er 80mg every 12 hours and 10mg ir 20mg every 8 hours. Oral opioid dosing equivalents and conversions university of. Advice should be sought from the palliative care team. Because it may be difficult to determine analgesic need using a controlledrelease product, it is recommended to initiate therapy with immediaterelease products. Critical transition from shorttolongacting opioid therapy. Many online have stated that they stopped taking showers and switched to sponge baths just to keep the patches from coming off. Opioid conversion table hop16091451 croni ain anaeen tooli calculating total daily doses of opioids is important to appropriately and effectively prescribe, manage, and taper opioid. My md preferred fentanyl patches with low dose hydrocodone for breakthrough pain. All noninjectable fentanyl products are for opioidtolerant patients. Patients using both fentanyl patches and oxymorphone opana discussion in oxymorphone started by puffader, sep 12, 20. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg.
Opioid dosage conversion oregon department of consumer. The authors prospectively evaluated 15 consecutive cancer patients during the conversion from iv to transdermal fentanyl. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Sounds like your doctor was referring to the new med exalgo, with is a 24 hour long acting hydromorphone dilaudid. However, since the fentanyl patch remains in place for 3 days, we have multiplied the conversion factor by 3 2. Fentanyl is dosed in mcghr instead of mgday, and absorption is affected by heat and other factors. 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. Most of the above oral opioids are available as generics. 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. Basically its just so i increase the milligram of my oxycodone, or switch to opana ir instead. This is especially important for fentanyl and methadone conversions. Directions for prescribing and using the fentanyl patch must be followed. I have been battling severe constipation regardless of numerous methods to remedy it. I need a oxycodone to opana ir accurate conversion.
The conversion ratio of certain opioids can be dependent on the dose of the original opioid. Duragesic label page 1 full prescribing information for. 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. Schedule ii opioid substances which include fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone have the highest potential for abuse. What is the proper dose of opana er if using 50 mcg patch of. Jun 08, 2017 fda wants opioid painkiller pulled off market. Duragesic label page 1 full prescribing information for use. Buy opana online buy opana online pharmacy buy opana er where to buy opana buy opana 40mg online buy opana online without prescription. Opana er may also be preferred because of its tamperproof formulation, which keeps it from being crushed and injected.
I definitely prefer the fentanyl, no wild mood swings or sedation like the oxycodone. Side effects of opana er oxymorphone hydrochloride. I am going to try replacing that for a short time with a fentanyl patch to see if i have any improvement in pain mgmt. Opioid oral morphine milligram equivalent mme conversion factors1,2. I am currently on 50mcg fentanyl patches and have been since sept. 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. 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. Methadone conversion factors increase with increasing dose. 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. Jan 19, 2012 i need a oxycondone to opana ir accurate conversion. 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. Oxycontin, xtampza er oxycodone dosing, indications. Converting shortacting ir longacting er for wellcontrolled, chronic pain. Endo pulling opana er but global has oxymorphone er.
In other words, the conversion factor not accounting for days of use would be 6025 or 2. Compare fentanyl vs oxymorphone comprehensive analysis by. Opioid conversion calculator morphine equivalents advanced. Is there anyone here taking both the fentanyl patch and oxymorphone.
Conversion from parenteral oxymorphone to opana er. May 05, 2014 fentanyl is a low molecular weight synthetic opioid, with high potency analgesic effect in intravenous route injection. Street value fentanyl patch 25 mg fentanyl pflaster online. Longterm opioid use often begins with treatment of acute pain. That is a lot of fentanyl but i understand tolerance. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Transdermal and parenteral fentanyl dosage calculations. The drug is also created illicitly and sold on the street. Ive never even seen fentanyl before, but have had opana a few times. I am just wondering what regimen i should use to safely do this. Yes my insurance is bugging me because my opana is costing is oxymorphone cheaper.
If your doctor is willing to rx you fentanyl, go for it. A pill is also available fentanyl buccal something or other cant remember the name. Another strategy could be to add a long acting opoid agent like a fentanyl patch and decrease your need for short acting. Due to the small molecule structure and high lipid solubility, fentanyl could be a good choice for transdermal use.
Prescription fentanyl comes in many forms, including lozenges, lollipops and transdermal patches that are applied to the skin. Opana oxymorphone treats severe pain, but prolonged use can lead to dependence, tolerance, and possibly addiction. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Transdermal patch should be used only in opioid tolerant. The starting dose for patients who are not opioid tolerant is opana er 5 mg orally every 12 hours. 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. My doctor offered oxymorphone 10 mg er or fentanyl patches 25 mcghr as alternatives. Prior authorization protocol duragesic fentanyl transdermal. I used to take 30 mg of opana er twice a day but i switched to the fentanyl patch last month. You are actually getting 5 mg less of oxycodone through the switch from percocet to opana er.
Fentanyl is commonly mixed with heroin, cocaine and other chemicals in counterfeit pills. These bidirectional differences are not captured in a traditional equianalgesic table. Lots of people say fentanyl isnt that euphoric, esp. Nucynta er tapentadol opana oxymorphone oxycontin oxycodone palladone. Codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine. Patients receiving opana may be converted to opana er by administering half the patients total daily oral opana dose as opana er, every 12 hours. Buprenorphine for pain butrans, belbuca envolve health. Side effects of duragesic fentanyl transdermal, warnings, uses. Dosage use only when converting from another opioid to fentanyl patch. List of extendedrelease and longacting opioid products. The absolute oral bioavailability of opana er is approximately 10%.
Patients considered opioid tolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day. According to iv doses, fentanyl is considered to have 50 to 100 times the potency of morphine. Transdermal and parenteral fentanyl dosage calculations and conversions objectives after reading this chapter and completing all practice problems, the participant will be able to. The extendedrelease form of opana is for aroundtheclock treatment of pain. From 50mcg fentanyl patches to opana er 40mg hi, i take opana er and opana ir. The following doses and conversion factors are a guideline only and each patient must be assessed on an individual basis. Bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. When converting between certain opioids, the direction of conversion eg, morphine to hydromorphone versus hydromorphone to morphine will produce a different conversion ratio. Opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. A safe and effective method for converting cancer patients. Conversion from fentanyl transdermal 18 hr following the removal of the transdermal fentanyl patch, initiate xtampza er.
Knowledge of this pharmacokinetic parameter is of particular importance when converting a patient from tdf to another opioid. Your patient is a 45yearold man who is taking oxymorphone 10 mg 4 times a day for chronic pain. Street value fentanyl patch 25 mg fentanyl pflaster. May 31, 2017 opana er oxymorphone hydrochloride is a narcotic pain reliever used to treat moderate to severe pain. Although opana er was never approved by the fda as an.
In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Before sharing sensitive information, make sure youre on a federal government site. I am currently taking opana er 30mg 2 tid for long term spinal pain due to breaks and fusions. The closest opiates to fentanyl strength wise are opana and methadone, but theyre still very far behind. Opioid conversions based on equianalgesia potency for all of the common opioids hydrocodone, oxycodone, morphine, etc. Transdermal and parenteral fentanyl dosage calculations and. Opioid rotation from opana er following fda call for. Transdermal fentanyl patches were designed to provide longlasting opioid therapy. Compare fentanyl vs oxymorphone comprehensive analysis. You need to apply 3 patches at once as i believe fentanyl comes in up to 100 mcghr patches but there may be a 200 mcghr patch. What is the proper dose of opana er if using 50 mcg patch of fentanyl.
Im prescribed both oxymorphone 40mg er 80mg every 12 hours and 10mg ir 20mg. Jan 29, 2018 longterm opioid use often begins with treatment of acute pain. Transdermal fentanyl patches versus patientcontrolled. I was on percocet 10500 and was switched to opana er 20 mg with opana ir 5 mg for breakthrough pain. 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. Opioid equianalgesic dose chart equianalgesic dose drug ivimsq poslpr onset of action t12 h duration comments mg mg morphine avinza, embeda, kadian, ms. Avinza, kadian, ms contin, oxycontin, opana er, duragesic, and embeda are not indicated as an asneeded prn analgesic. Review of oral oxymorphone in the management of pain ncbi. Converting from oral morphine to fentanyl transdermal patch. No dosage conversions are available for converting from oxymorphone er to another. 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. How to calculate my opioid dose pain consultants usa. Hi everyone, i am new to this board, but not to taking pain meds.
All doses expressed in mg per day with exception of fentanyl. Pain study guide by ttxpb1711 includes 57 questions covering vocabulary, terms and more. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediaterelease opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Currently im on the fent patches and oxycodone for breakthrough pain. Opioid rotation from opana er following fda call for removal. Sep 12, 20 is there anyone here taking both the fentanyl patch and oxymorphone. Opioid oral morphine milligram equivalent mme conversion. It should not be used to determine doses when converting a patient from one opioid to another. Some experts use this conversion in cancer patients. It is not recommended for people who have never been prescribed opioidtype pain relief before, and deaths have been reported from improper dosing. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediaterelease opioids and should prescribe no greater quantity than needed for the expected duration. 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.
This calculator is intended for calculating the morphine equivalent dose med dose for a patient taking one or more opioid medications. Recommend an appropriate dose of transdermal fentanyl when. Opens er was what i started with, but didnt do anything so we changed opana er to fentanyl. Doctors give trusted answers on uses, effects, sideeffects, and cautions. See fentanyl information below for initiating patch and patch to po dosing. Btw 10mg er is not much drug getting to your pain over the day, due to opana s only average ba. Duragesic fentanyl transdermal patch prior authorization. Both are opiod derivitives, highly addictive, severe side effects, meant for. Equianalgesic dosing of opioids for pain management. What is the proper dose of opana er if using 50 mcg patch. Converting from oral morphine to fentanyl transdermal patch teaching exercise 2. 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. Opioid name total daily dose morphine equivalent oxycodone er 2 tablets x 60mg 120mg 180mg hydromorphone er 2 tablets x 16mg 32mg 128mg.