Dilaudid, hydromorph contin, hydromorphone hcl, hydromorphone hp 10, 20, 50, forte, jurnista, pmshydromorphone morphine sulfate. Calculate the approximate starting dose of exalgo to be given every 24 hours, which is 50% of the converted dose. They all interact with specific opioid receptors such as. 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. Canadian pharmacists association 2008 drug generic name fentanyl transdermal hydromorphone hcl. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Oxycodone er 60mg bid, hydromorphone er 16mg bid, fentanyl patch 50mcghr, and morphine sulfate ir 15mg q6hr prn pain. Morphine equivalent dose med opioid conversions globalrph. Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mgday morphine, 25 mcgday transdermal fentanyl, 30 mgday po oxycodone, 8 mgday po hydromorphone, 25 mgday po oxymorphone, 60 mgday po hydrocodone, or an equianalgesic dose of another opioid. Fentanyl patch conversions package insert recommendations fentanyl patch dosing determination based on current11 jun 2017 using the table below, the equivalent dose of fentanyl patch would be 25 mcg.
Prescribing in palliative care medicines guidance bnf. 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. Conversion ratios of morphine to and from other opioids. Dilaudid injection hydromorphone hydrochloride is supplied in clear and colorless singledose prefilled syringes. Dailymed dilaudid hydromorphone hydrochloride injection. Exalgo hydromorphone hydrochloride extended release. These bidirectional differences are not captured in a traditional equianalgesic table. Route, dose equivalent to 10mg oral morphine, comments. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Medically, fentanyl is used by injection, as a patch on the skin. Oct 23, 2019 conversion from transdermal fentanyl to hydromorphone hydrochloride extendedrelease tablets. Conversion factor1 dosage form2 dose interval alcohol dose dumping effect3 abuse deterrent formulation4.
Transdermal fentanyl isapproximately 80 times as potent as morphine this is based on studies converting from morphine to fentanyl. Compare fentanyl vs hydromorphone comprehensive analysis. Typically, longterm use is only recommended for pain due to cancer. Then reduce the hydromorphone hydrochloride extendedrelease tablets dose by 50%. I am taking 12 pill of the hydromorphone and 12 pill of the hydrocodone every 4 hours and the full lorazapam 1mg every 6 hours for the extra anxiety that im already feeling. Alternatives to morphine, including transdermal buprenorphine, transdermal fentanyl, hydromorphone hydrochloride, methadone hydrochloride, or oxycodone hydrochloride, should be initiated by those with experience in palliative care. To calculate the 24hour hydromorphone hydrochloride extendedrelease tablets dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of hydromorphone hydrochloride extendedrelease tablets. Patients are considered opiate tolerant if they have been receiving aroundtheclock opiate therapy consisting of at least 60 mg of oral morphine sulfate daily, 25 mcg of transdermal fentanyl per hour, 30 mg of oral oxycodone daily, 8 mg of oral hydromorphone hydrochloride daily, 25 mg of oral oxymorphone hydrochloride daily, or an equianalgesic dosage of another opiate daily for at least 1 week. Initiation of an opioid analgesic should not be delayed by concern over a theoretical likelihood of psychological. Oral hydromorphone is about 47 times as potent as oral morphine. Eighteen hours following the removal of the transdermal fentanyl patch, hydromorphone hydrochloride extendedrelease tablets treatment can be initiated.
Surprisingly, crosstolerance between opioids is often incomplete. Dailymed hydromorphone hydrochloride tablet, extended release. This is based on studies converting from morphine to fentanyl. To calculate the 24hour exalgo dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo. Parenteral hydromorphone is 20 times as potent as oral morphine. Equivalence between oral morphine and transdermal fentanyl. Hydromorphone oral tablet is a prescription opioid medication thats used to treat severe pain that isnt controlled by other opioid drugs.
Dilaudid hydromorphone hydrochloride is an opioid narcotic pain reliever similar to oxycodone, morphine, methadone, fentanyl, and other opioid narcotic drugs. Degroote national pain centre opioid manager switching opioids download. The hydrochloride salt is soluble in three parts of water, whereas a gram of morphine hydrochloride dissolves in 16 ml of water. The tablet strengths describe the amount of hydromorphone hydrochloride in each tablet. Medically, fentanyl is used by injection, as a patch on the skin, as a nasal spray, or absorbed through the cheek. Exalgo hydromorphone hydrochloride extended release tablets. Each 2 mg po morphine approximately equivalent to 1 mcghr fentanyl patch e. Start hydromorphone extendedrelease oral tablet at 50% of converted dose and. Fentanyl patch converter globalrph conversion from. Opioid switching using equivalence tables saskatchewan. There can be variation in the licensing of different medicines containing the same drug.
Advanced opioid conversion calculator morphine equivalents. However, it is rare for a person to go directly from norco to fentanyl, and so, it just not listed. Jan 23, 2020 to calculate the 24hour hydromorphone hydrochloride extendedrelease tablets dose, use a conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of hydromorphone hydrochloride extendedrelease tablets. Dilaudid oral solution is supplied as 5mg5 ml 1 mgml viscous liquid. Transdermal and parenteral fentanyl dosage calculations. Dose conversion in opioid rotation from continuous intravenous infusion of morphine hydrochloride injection to fentanyl patch in the management of cancer pain. Identification of the substancemixture and of the companyundertaking product name. Opioid converter morphine equivalent calculator omni. The amount of residual drug in the patients system must be accounted for. Hydromorphone mgday 15 dilaudid fi, dilaudidhp fi codeine mgday 0. Patients or carers should be given advice on how to administer hydromorphone hydrochloride capsules and modifiedrelease capsules. Forms available from specialorder manufacturers include. Dose conversion in opioid rotation from continuous intravenous.
You should take your vicodin with it for the first 23 days. Recommend an appropriate dose of transdermal fentanyl when. Each singledose prefilled syringe of sterile, aqueous solution contains 0. Opioid equivalence chart gloucestershire hospitals. Jul 12, 2019 conversion from transdermal fentanyl to exalgo. Calculate the total daily dose of hydromorphone extendedrelease oral tablet using a conversion factor of 12 mg hydromorphone extendedrelease oral tablet for each 25 mcghour fentanyl transdermal patch. For drug coverage and provider type information, see the. In this example, mmeday for ten 25 ghr fentanyl patches dispensed for use over 30 days would work out as follows. Its available as both a generic drug and as the brand. Eighteen hours following the removal of the transdermal fentanyl patch, hydromorphone er treatment can be initiated. Dilaudid tablets are supplied in 2 mg, 4 mg, and 8 mg tablets for oral administration. In addition to this i take 2 ibuprophen every 4 hours and several supplemental nerve formula and imflamatory formula supplements to help in this process. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the pain. Fentanyl is a monocarboxylic acid amide resulting from the formal condensation of the aryl amino group of nphenyl1 2phenylethylpiperidin4amine with propanoic acid.
Hydromorphone, also known as dihydromorphinone, and sold under the brand name dilaudid among others, is an opioid used to treat moderate to severe pain. Caution should be used in older adults or patients with cachexiafentanyl is lipid soluble and requires subcutaneous fat for proper absorption. Conversion from transdermal fentanyl to hydromorphone hydrochloride extendedrelease tablets. Transdermal and parenteral fentanyl dosage calculations and. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Hydromorphone hydrochloride extended release tablets. The mechanism of action of fentanyl is as a full opioid agonist. Both morphine and hydromorphone are used to treat moderate to severe pain. The fentanyl patch is 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 patients considered opioidtolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at. Fentanyl patch converter fentanyl patch dosage determination select a narcotic analgesic to convert codiene imsc codeine oral hydromorphone oral hydromorphone im meperidine im methadone imsc methadone oral morphine imsc morphine oral oyxcodone imsc oxycodone oral. Use the conversion factor of 25 mcghr fentanyl transdermal patch to 12 mg of exalgo.
Hydromorphone hydrochloride extendedrelease information. For example, someone taking 10 mg of morphine may be switched to 1 or 2 mg of hydromorphone. Practical management of opioid rotation and equianalgesia ncbi. Opioid oral morphine milligram equivalent mme conversion. Dilaudid, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain increasing the amount of stimulation it takes to feel pain and reduce the perception of pain the perceived importance of the.
Describe the pharmacokinetics of transdermal fentanyl, and variables that can influence dosing. Duragesic fentanyl transdermal dosing, indications. Hydromorphone hydrochloride oral solution drug information. Effects generally begin within half an hour and last for up to five hours. Oxycodone is available as immediate release capsules 5mg, 10mg and 20mg, liquid 1mgml or 10mgml and sustained release tablets 5mg, 10mg, 20mg, 40mg and 80mg.
Hydromorphone hydrochloride oral solution drug summary. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. Canadian guideline for safe and effective use of opioids for. It may be used by mouth or by injection into a vein, muscle, or under the skin. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Conversion from transdermal fentanyl to hydromorphone er. Dailymed hydromorphone hydrochloride extendedrelease. Converting from oral morphine to fentanyl transdermal patch. Find medication information including related drug classes, side effects, patient statistics and answers to frequently asked questions. National and international guidelines also support the use of a 2. Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Hydromorphone is more soluble in water than morphine. Canadian guideline for safe and effective use of opioids.
Dilaudid hydromorphone hydrochloride, a hydrogenated ketone of morphine, is an opioid agonist. Opioids opiates are a group of analgesic drugs, used primarily for pain management. For each 25 mcghr fentanyl transdermal dose the equianalgesic dose of hydromorphone er is 12 mg every 24 hours. Fentanyl, fentanyl citrate, fentanyl hydrochloride monograph.
Eighteen hours following the removal of the transdermal fentanyl patch, exalgo treatment can be initiated. Hydromorphone 6, cii hydromorphone hcl 2 mg, 4 mg, 8 mg 4 ir tablet 46 hours 8 mg 12. Dilaudidhydromorphone hydrochloridesimplist dilaudid intramuscular sol. Enter 24hour total doses below, then click the convert button to display 24hour equianalgesic doses. Oct 09, 2018 dilaudid hydromorphone hydrochloride, a hydrogenated ketone of morphine, is an opioid agonist. In other words, the conversion factor not accounting for days of use would be 6025 or 2. There is a conversion between hydrocodone and fentanyl. Take particular care if converting high doses of oral opiates to subcutaneous s. If you are converting a patient to or from fentanyl i. 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. Opioid oral morphine milligram equivalent mme conversion factors1,2. Compare fentanyl vs hydromorphone comprehensive analysis by. Currently, there are no empirical studies converting fentanyl to morphine. Exalgo hydromorphone hydrochloride dose, indications.
Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids. Practical management of opioid rotation and equianalgesia. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. Thank you for downloading opioid manager switching opioid form if the form does not start downloading in 10 seconds, please click here. Fentanyl, fentanyl citrate, fentanyl hydrochloride. For some patients, however, hydromorphone may be a better first choice. Dailymed hydromorphone hydrochloride tablet, extended. It has a rapid onset and its effects generally last less than two hours.
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