Dose conversion tool butrans buprenorphine transdermal. Conversion from other opioids to butrans discontinue all other aroundtheclock opioid drugs when butrans therapy is initiated. Butrans is for transdermal use on intact skin only. Scottish palliative care guidelines fentanyl patches.
Dose equivalents and changing opioids faculty of pain. Opioid conversion table american academy of family. Opioids opiates are a group of analgesic drugs, used primarily for pain management. The starting point for dose reduction from the calculated equi. Use of butrans as the first opioid analgesic opioidnaive patients initiate treatment with butrans with a 5 mcghour patch. In most cases, when switching between different opioids, the calculated doseequivalent must be reduced to ensure safety. Dose equivalence and switching between opioids specialist. Previous opioid analgesic daily dose oral morphine equivalent dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Drug name drug dose equivalent oral morphine dose codeine 30mg 4.
May supplement with promptacting opioid and nonopioid analgesic for breakthrough pain. Close monitoring is of particular importance when converting from methadone to other opioid agonists. Transdermal patch system butrans transdermal system. The highest available btds strength of 20 mcgh may be equianalgesic to an oral medd of 3655 mg, whereas the product information states that the 20 mcgh patch may not provide adequate analgesia for patients requiring greater than an oral medd of 80 mg.
Oral morphine milligram equivalent conversion table updated 8. Opioid converter morphine equivalent calculator omni. Previous opioid analgesic daily dose oral morphine equivalent butrans starting dose 5 mcghour 10 mcghour. This tool does not contain all of the important safety information needed to prescribe butrans. Review the buprenorphine patch dose after 72 hours. The buprenorphine transdermal patch butrans is fdaindicated for use in patients with pain that is severe enough to require daily, aroundtheclock, longterm opioid use for which other treatments are not adequate. Dec, 2018 from a practical perspective, buprenorphine cannot have a linear conversion tofrom morphine or an equivalent because of its complex pharmacology and pharmacokinetics, including.
Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Butrans butrans is a buprenorphine transdermal patch indicated for the management of pain requiring aroundtheclock, longterm opioid treatment that is not adequately controlled with alternatives. Oct 16, 2014 the buprenorphine transdermal patch is included under the risk evaluation and mitigation strategy rems. All conversions except methadone are made by first calculating the morphine equivalent of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. Butrans 5 5microgramshour 60mg24hours 10mg24hours butrans 10 10microgramshour 120mg24hours 20mg24hours butrans 20 20microgramshour 240mg24hours 40mg24hours strong opiate conversion doses. Do not exceed dose of one 20 mcghr transdermal system risk of qt prolongation with higher doses conversion from other opioids. Opioid equianalgesic calculator opioid switching from. Calculate the dose of buprenorphine from the conversion chart given. If you need more than 80mgday of morphine, butrans is not appropriate, therefore, 20mcg means making an assumption that you would need 80mg of morphine or less.
Frail or elderly patients may need lower doses and slower titration. Please please let me know if i read it wrong or any info. Initiate with 5 mcghr patch oral morphine equivalent 3080 mgday. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure. Do not apply more than 1 patch at the same time unless your healthcare provider tells you to. Fentanyl patch strength microgramhr, oral morphine mgday. Opioid oral morphine milligram equivalent mme conversion. Call your healthcare provider if the dose you are using does not control your pain. Apply first dose of equivalent dose buprenorphine patch at same time as. Heatpyrexia increases the absorption of buprenorphine and can cause toxicity. Buprenorphine patches scottish palliative care guidelines. If your prescribed dose is for more than one patch, apply them right next to each other but make sure the edges of the patches do not touch or overlap.
Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Drug drug dose approximate codeine equivalence approximate oral morphine equivalence butrans 5 5microgramshour 60mg24hours 10mg24hours butrans 10 10microgramshour 120mg24hours 20mg24hours butrans 20 20microgramshour 240mg24hours 40mg24hours strong opiate conversion doses drug name drug dose equivalent oral morphine dose. Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. Butrans buprenorphine transdermal dosing, indications. Convert each dose into mmes by multiplying the dose by the conversion factor.
These highlights do not include all the information needed to. For example, butrans is dosed based on oral morphine equivalents per day when converted from another opioid therapy. Can a buprenorphine transdermal system butrans be used. The correct 4 hourly equivalent dose should be used.
Also, its for pain and i read that people sometimes need to take something besides the patch for break through pain. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Dose equivalents and changing opioids faculty of pain medicine. Although butrans buprenorphine patch comes in the form of a skin patch, it is possible to overdose on this drug. Patients reported their numerical pain level via an 1 1 point numeri. Buprenorphine is an awesome medication, and i want you to know that i think you are going to have better pain relief that ever, and give you comfort. When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration.
In the uk, a morphinetobtds equivalence ratio of 75. Optimal dose was defined as a dose of medication that 5. Conversion of high dose opioid to buprenorphine article. Conversion from methadone to butrans close monitoring is of particular importance when converting from methadone to other opioid agonists. In most cases, when switching between different opioids, the calculated dose equivalent must be reduced to ensure safety.
Butrans buprenorphine dose, indications, adverse effects. Such patients should be started on the lowest available dose butrans 5 microgramhour transdermal patch and continue taking shortacting supplemental analgesics see section 4. Because butrans and suboxone are approved for different indications, initiation of dosing differs between the products. Patients presenting with signs or symptoms of androgen deficiency should undergo laboratory evaluation. Fentanyl and buprenorphine patches are third line opioids and should be.
For example, if a user asked to convert morphine 80 mg orally to buprenorphine film belbuca, they would receive a warning result exceeds maximum daily dose. Surprisingly, crosstolerance between opioids is often incomplete. They all interact with specific opioid receptors such as. Patients found satisfactory for both analgesia and tolerability preferably without the need for rescue medication and no more than 1 dose of 5325 mg hcapap per day 1 or 2 tablets per dose patients were willing to continue at the same dose for the 12week doubleblind treatment phase. When converting from one opioid to another, the initial dose depends on the relative. When switching patients from oral medds of 30 to 80 mg to btds, a patch.
Drug name dosing regimen maximum dose buprenorphine butrans 1 patch applied topically for 7 days opioid naive patients. When i looked at the conversion chart it said 20 mcg patch is equivalent to 60 methadone. The pure buprenorphine that i take is dosageequivalent, so 10 butrans equals ten buprenorphine sublingual. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po tramadol po tapentadol po dihydrocodeine po. Conversion to butrans buprenorphine transdermal system ciii. Buprenorphine transdermal delivery system butrans, ciii. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Particular care is required when dealing with high doses of opiates. Can a buprenorphine transdermal system butrans be used to. The pure buprenorphine that i take is dosage equivalent, so 10 butrans equals ten buprenorphine sublingual. Do not apply a butrans patch if the pouch seal is broken, or the patch is cut, damaged, or changed in any way. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects.
From a practical perspective, buprenorphine cannot have a linear conversion tofrom morphine or an equivalent because of its complex pharmacology and pharmacokinetics, including. Drug drug dose approximate codeine equivalence approximate oral morphine equivalence butrans 5 5microgramshour 60mg24hours 10mg24hours butrans 10 10microgramshour 120mg24hours 20mg24hours butrans 20 20microgramshour 240mg24hours 40mg24hours strong opiate conversion doses drug name drug dose. Select opioid morphine po morphine sc morphine iv oxycodone po oxycodone sciv hydromorphone po hydromorphone sciv buprenorphine sl buprenorphine td buprenorphine sciv fentanyl td fentanyl sciv alfentanyl sciv sufentanyl sciv codeine po. Do not use if the pouch seal is broken or the patch is cut, damaged, or changed in any way.
Oct 18, 2019 conversion from methadone to butrans close monitoring is of particular importance when converting from methadone to other opioid agonists. Patients on morphine 80 mg po or equivalent or higher, must not receive buprenorphine bf due to possible opioid withdrawal risk. May supplement with promptacting opioid and nonopioid analgesic for break. Determine equivalent daily dose of new opioid by dividing. Do not use shortacting buprenorphine products for example temgesic for breakthrough pain. Conversion factors are an approximate guide only because comprehensive data are lacking and there is significant interindividual variation. Monitor patients for symptoms of opioidinduced endocrinopathy, particularly those receiving a daily dose equivalent to 100 mg or more of morphine. Buprenorphine conversions practical pain management. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator. Scottish palliative care guidelines buprenorphine patches.
Starting dose will range from 75 mcg once daily or every 12 hours to 300 mcg every 12 hours depending on the patients prior opioid experience and risk for abuse potential. Initial dosage use of butrans as the first opioid analgesic opioidnaive patients initiate treatment with butrans with a 5 mcghour patch. Some of the potential symptoms a person might experience from using too much of this medicine include extreme drowsiness, breathing problems, and weakness. When converting this morphine equivalent to belbucca, a person on 3089mgday of morphine would follow a schedule of 150mg every 12 hours. Butrans can be used as an alternative to treatment with other opioids. Oral morphine milligram equivalent conversion tablei. The data upon which the conversions are based are summarized in the table below. Instruct patients to apply immediately after removal from the individually sealed pouch. You should wear 1 butrans patch continuously for 7 days. Buprenorphine has a higher binding affinity to mureceptors compared to every fullagonist opioid prescribed for inhome use as well as naloxone narcan. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%. Each butrans patch is intended to be worn for 7 days. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. Butrans 5, 10 and 20ugh transdermal patch summary of.
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