Table 11: Oral Opioids for Acute Pain in Opioid-Naïve Adults (Continued) Medication Available Oral Strengths Dosage
Clinical Considerations
Tapentadol, extended-release tablets • Nucynta ER
Tablets: 50 mg 100 mg 150 mg 200 mg 250 mg
Conversion from immediate release tapentadol: • Calculate total daily tapentadol dose. • Divide into two equal doses and give orally every 12 hours. • Titrate by no more than 100 mg/day every 3 days. Conversion from a different opiate agonist to Duragesic: • Convert the 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. previous 24-hour opioid analgesic requirement to
There are no established dosage ratios for direct conversion from other opioids to tapentadol. Generally, recommended to start at 50 mg PO twice daily and titrate by no more than 100 mg/day every 3 days. The maximum dose of tapentadol extended- release is 500 mg/day (250 mg PO twice daily). 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 use to 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.
Fentanyl, transdermal patch (72-hour) • Duragesic
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
* Note : While many ER/LA opioid analgesics are FDA-approved (at specific dosages) for opioid-naive or non- opioid-tolerant patients, current guidelines for chronic pain management do not recommend these products to patients. 103 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. Opioid patient education and safety
Patient education about the effects of these medications is critical and necessary when prescribing opioids to treat acute or chronic pain. Advise both patient and family about the common side effects and best practices related to dosing. Planning should include provision of prescriptions
or distribution of naloxone to use in the event of overdose or respiratory depression. In addition, whenever an opioid is prescribed, the patient and family should be educated about the safe use and storage of the medications. Safe use refers to adherence to clinician instructions about dosing,
Page 74
Book Code: MDCO1025
Powered by FlippingBook