What are the steps for converting from morphine (or equivalent) to fentanyl transdermal?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Conversion from morphine (or equivalent) to fentanyl transdermal:

  1. Calculate the total 24-hour morphine dose (or morphine-equivalent).

  2. Select microgram per hour dose of transdermal fentanyl based on Table 2.

  3. Decrease new dose 30-50% to allow for incomplete cross-tolerance.

  4. Manage breakthrough pain with morphine/short-acting opioid PRN.

  5. Titrate patch to effect every 72 hours.

Table 2. Conversion of Opioid Analgesics to Fentanyl Transdermal

Table. (Open Table in a new window)

Current Opioid Analgesic

Daily Dosage (mg/d)

Morphine PO

60-134

135-224

225-314

315-404

Morphine IV/IM

10-22

23-37

38-52

53-67

Oxycodone PO

30-67

67.5-112

112.5-157

157.5-202

Oxycodone IV/IM

15-33

33.1-56

56.1-78

78.1-101

Codeine PO

150-447

448-747

748-1047

1048-1347

Hydromorphone PO

8-17

17.1-28

28.1-39

39.1-51

Hydromorphone IV

1.5-3.4

3.5-5.6

5.7-7.9

8-10

Meperidine IM

75-165

166-278

279-390

391-503

Methadone PO

20-44

45-74

75-104

105-134

Methadone IM

10-22

23-37

38-52

53-67

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Recommended fentanyl transdermal dose (q72h)

Fentanyl transdermal (Duragesic)

25 mcg/h

50 mcg/h

75 mcg/h

100 mcg/h


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