Table 7: Common Opioids for Chronic Pain Management
Available Oral Strengths Patch Strength • 12 mcg/hour • 25 mcg/hour • 37.5 mcg/ hour • 50 mcg/hour • 62.5 mcg/ hour • 75 mcg/hour • 87.5 mcg/ hour • 100 mcg/hour
Medication
Dosage
Clinical Considerations
Fentanyl, transdermal patch (72-hour) • Duragesic
Conversion from a different opiate agonist to Duragesic: • Convert the previous 24-hour opioid analgesic requirement to an equianalgesic morphine dose. • Use conversion chart to determine Duragesic initial dosage. • Change the patch every 72 hours. • May titrate ate initial dosage after 3 days (72 hours). • Subsequent dose titrations should be made no more frequently than every 6 days. Monitor patients closely for respiratory depression the first 24 to 72 hours after initiating therapy or dose escalation Supplemental doses may be required
Recommended initial Duragesic based on daily morphine dose: • Morphine 60 to 134 mg/day PO: Fentanyl transdermal patch 25 mcg/hour. • Morphine 135 to 224 mg/day PO: Fentanyl, transdermal patch 50 mcg/hour. • Morphine 225 to 314 mg/day PO: Fentanyl transdermal patch 75 mcg/hour. • Morphine 315 to 404 mg/day PO: Fentanyl transdermal patch 100 mcg/hour. • Morphine 405 to 494 mg/day PO: Fentanyl transdermal patch 125 mcg/hour. • Morphine 495 to 584 mg/day PO: Fentanyl transdermal patch 150 mcg/hour. • Morphine 585 to 674 mg/day PO: Fentanyl transdermal patch 175 mcg/hour. • Morphine 675 to 764 mg/day PO: Fentanyl transdermal patch 200 mcg/hour. • Morphine 765 to 854 mg/day PO: Fentanyl transdermal patch 225 mcg/hour. • Morphine 855 to 944 mg/day PO: Fentanyl transdermal patch 250 mcg/hour. • Morphine 945 to 1034 mg/day PO: Fentanyl transdermal patch 275 mcg/hour. • Morphine 1035 to 1124 mg/day PO: Fentanyl transdermal patch 300 mcg/hour. Do not convert fentanyl transdermal patches to other opioids, as this will result in overestimation and possible fatal overdose. During treatment with extended- release formulations, immediate- release formulations may be required for breakthrough pain. Due to the unique properties of methadone, dosage ratios for direct conversion to methadone are variable and can be inconsistent between patients. The duration of action of methadone is 4 to 8 hours, while the elimination half- life ranges from 8 to 59 hours. Increased monitoring for delayed adverse effects (i.e., respiratory depression) is required, especially during the first 24 to 72 hours after initiation or dose increase. The potency of methadone increases with repeated dosing. Immediate- release opioids may be required for breakthrough pain.
Methadone, immediate release • Dolophine, Methadose
Tablets: • 5 mg • 10 mg
Conversion from a different opiate agonist to methadone: • 30 to 40 mg/day (divided into 2 to 3 doses). • Titrated every 5 to 7 days in doses of 5 to 10 mg/day.
Oral solution: • 5 mg/5 mL • 10 mg/5mL
* Note : While many ER/LA opioid analgesics are FDA-approved (at specific dosages) for opioid-naïve or non-opioid-tolerant patients, current guidelines for chronic pain management do not recommend these products to patients (Dowell et al., 2016); therefore, those doses are not provided in the table. It is recommended to stop all other around-the-clock opioid drugs upon initiation of a new ER/LA product. Equianalgesic dosing of opioids
consider individual patient factors and the characteristics of the opioid medications and delivery systems when converting between opioid products. Closely monitor patients following conversion for efficacy and potential adverse effects.
Opioid medications have differing potencies. When converting from one opioid medication to another, it is critical to understand the equivalent analgesic (equianalgesic) dose to ensure continued efficacy without untoward side effects (see Table 8). The dose, administration route, and therapy duration must be considered. Multiple opioid conversion charts are available. Clinicians must
EliteLearning.com/Dental
Page 67
Powered by FlippingBook