Duragesic conversion tool

Consider lower doses in geriatric patients over 65 years of age. Concurrent use of opioid pain medication and benzodiazepines is likely to put patients at greater risk for potentially fatal overdose, as both medications can cause central nervous system depression and decreased respiratory drive.

CDC guideline recommendation Buprenorphine is not included in the calculator because it is a partial agonist and morphine equivalent doses are uncertain. Please refer to the label for dosing parameters. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. For further information: info oregonpainguidance.

Opioid Conversion Calculator. The daily morphine equivalent dose is calculated automatically. Conversion Factor There is limited evidence and no consensus on the conversion factors to use for methadone. The WA State AMDG calculator uses higher conversion ratios that increase at higher doses mg ratio, mg ratio, mg , over 51 mg ratio For the dose entered, these two conversion ratios are: mg this calculator.

Is the patient co-prescribed benzodiazepines? As a clinician, it is important to note that there are significant limitations to equianalgesic conversions and tables. While these equianalgesic tables are current the "best" solution, their limitations should be emphasized:. When switching between opioids, equianalgesic conversions may overestimate the potency of the new opioid due to incomplete cross-tolerance. Incomplete cross-tolerance can occur due to variability in opioid binding.

There is no evidence-based recommendation for an appropriate reduction. In patients receiving long-acting opioid formulations SR , transdermal , a "rescue" dose for breakthrough pain is recommended. In an inpatient setting, rescue doses can be provided IV every minutes.

Oral rescue doses can be offered as needed over the normal dosing interval of the drug typically every 4 hours. As stated above, because equianalgesic tables are inherently inaccurate, the availability of breakthrough doses is paramount. Because equianalgesic tables are inherently inaccurate, dose titration to optimal effect is essential. Because transdermal fentanyl has a delayed onset and onset of peak activity, consider titrating every 3 days.

Show AMA citation. Press 'Calculate' to view calculation results. Load an Example. Duragesic [package insert]. Practice guidelines for transdermal opioids in malignant pain. PMID An alternative algorithm for dosing transdermal fentanyl for cancer-related pain. Oncology Williston Park. American Pain Society. Principles of analgesic use in the treatment of acute pain and cancer pain.

Accuracy in equianalgesic dosing. J Pain Symptom Manage. Equianalgesic dose ratios for opioids. Opioid conversions in acute care. Ann Pharmacother.