Initiate with 5 mcghr patch oral morphine equivalent 3080 mgday. Transdermal patch system butrans transdermal system. Also, its for pain and i read that people sometimes need to take something besides the patch for break through pain. Do not exceed dose of one 20 mcghr transdermal system risk of qt prolongation with higher doses conversion from other opioids. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients.
Previous opioid analgesic daily dose oral morphine equivalent dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. Opioids opiates are a group of analgesic drugs, used primarily for pain management. In the uk, a morphinetobtds equivalence ratio of 75. Optimal dose was defined as a dose of medication that 5. Buprenorphine transdermal delivery system butrans, ciii. 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. May supplement with promptacting opioid and nonopioid analgesic for break. Do not apply more than 1 patch at the same time unless your healthcare provider tells you to. Because butrans and suboxone are approved for different indications, initiation of dosing differs between the products.
Previous opioid analgesic daily dose oral morphine equivalent butrans starting dose 5 mcghour 10 mcghour. The data upon which the conversions are based are summarized in the table below. Frail or elderly patients may need lower doses and slower titration. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Oral morphine milligram equivalent conversion table updated 8. Heatpyrexia increases the absorption of buprenorphine and can cause toxicity. Particular care is required when dealing with high doses of opiates.
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. Monitor patients for symptoms of opioidinduced endocrinopathy, particularly those receiving a daily dose equivalent to 100 mg or more of morphine. Equivalent doses are based on the 24 hour dose of fentanyl or buprenorphine received from a patch. Oct 18, 2019 conversion from methadone to butrans close monitoring is of particular importance when converting from methadone to other opioid agonists. May supplement with promptacting opioid and nonopioid analgesic for breakthrough pain. A 25 microgramhour fentanyl patch is equivalent to about 60mg to 90mg of oral morphine in 24 hours. Some of the potential symptoms a person might experience from using too much of this medicine include extreme drowsiness, breathing problems, and weakness. Use of butrans as the first opioid analgesic opioidnaive patients initiate treatment with butrans with a 5 mcghour patch.
Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. In other words, the conversion factor not accounting for days of use would be 6025 or 2. Dose equivalents and changing opioids faculty of pain. For example, butrans is dosed based on oral morphine equivalents per day when converted from another opioid therapy. When switching patients from oral medds of 30 to 80 mg to btds, a patch. Butrans can be used as an alternative to treatment with other opioids. The pure buprenorphine that i take is dosageequivalent, so 10 butrans equals ten buprenorphine sublingual. Review the buprenorphine patch dose after 72 hours. Each butrans patch is intended to be worn for 7 days. Patients presenting with signs or symptoms of androgen deficiency should undergo laboratory evaluation.
Butrans is for transdermal use on intact skin only. Initial dosage use of butrans as the first opioid analgesic opioidnaive patients initiate treatment with butrans with a 5 mcghour patch. Dose conversion tool butrans buprenorphine transdermal. From a practical perspective, buprenorphine cannot have a linear conversion tofrom morphine or an equivalent because of its complex pharmacology and pharmacokinetics, including. 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.
Butrans 5, 10 and 20ugh transdermal patch summary of. Patients on morphine 80 mg po or equivalent or higher, must not receive buprenorphine bf due to possible opioid withdrawal risk. Do not use if the pouch seal is broken or the patch is cut, damaged, or changed in any way. 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. 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. Scottish palliative care guidelines buprenorphine patches. Buprenorphine conversions practical pain management. When converting from one opioid to another, the initial dose depends on the relative. 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. 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.
Transdermal patch system butrans transdermal system apply to intact skin only. When i looked at the conversion chart it said 20 mcg patch is equivalent to 60 methadone. Although butrans buprenorphine patch comes in the form of a skin patch, it is possible to overdose on this drug. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. Butrans 5 5microgramshour 60mg24hours 10mg24hours butrans 10 10microgramshour 120mg24hours 20mg24hours butrans 20 20microgramshour 240mg24hours 40mg24hours strong opiate conversion doses. Do not use shortacting buprenorphine products for example temgesic for breakthrough pain. Opioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects.
Can a buprenorphine transdermal system butrans be used. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. 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. Opioid converter morphine equivalent calculator omni. Fentanyl patch strength microgramhr, oral morphine mgday. The pure buprenorphine that i take is dosage equivalent, so 10 butrans equals ten buprenorphine sublingual. Instruct patients to apply immediately after removal from the individually sealed pouch. 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. Conversion of high dose opioid to buprenorphine article. Determine equivalent daily dose of new opioid by dividing. Oct 16, 2014 the buprenorphine transdermal patch is included under the risk evaluation and mitigation strategy rems. Opioid oral morphine milligram equivalent mme conversion. Conversion to butrans buprenorphine transdermal system ciii. Apply first dose of equivalent dose buprenorphine patch at same time as.
When converting from one opioid to another, the initial dose depends on the relative potency of the two drugs and route of administration. Such patients should be started on the lowest available dose butrans 5 microgramhour transdermal patch and continue taking shortacting supplemental analgesics see section 4. In most cases, when switching between different opioids, the calculated doseequivalent must be reduced to ensure safety. Close monitoring is of particular importance when converting from methadone to other opioid agonists. 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. Buprenorphine has a higher binding affinity to mureceptors compared to every fullagonist opioid prescribed for inhome use as well as naloxone narcan. 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. Convert each dose into mmes by multiplying the dose by the conversion factor. Opioid equianalgesic calculator opioid switching from. Do not apply a butrans patch if the pouch seal is broken, or the patch is cut, damaged, or changed in any way. The starting point for dose reduction from the calculated equi.
Patients reported their numerical pain level via an 1 1 point numeri. These highlights do not include all the information needed to. Oral morphine milligram equivalent conversion tablei. You should wear 1 butrans patch continuously for 7 days. Please please let me know if i read it wrong or any info. Can a buprenorphine transdermal system butrans be used to. You can input this value in the incomplete crosstolerance field in the opioid conversion calculator.
In most cases, when switching between different opioids, the calculated dose equivalent must be reduced to ensure safety. This tool does not contain all of the important safety information needed to prescribe butrans. Conversion from other opioids to butrans discontinue all other aroundtheclock opioid drugs when butrans therapy is initiated. The transdermal patch carries a warning against exceeding 20 mcghour due to the. Drug name dosing regimen maximum dose buprenorphine butrans 1 patch applied topically for 7 days opioid naive patients. They all interact with specific opioid receptors such as. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. In practice, it means that after opiate conversion the dosage needs to be lowered, even by 2550%.
Fentanyl and buprenorphine patches are third line opioids and should be. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure. Conversion factors are an approximate guide only because comprehensive data are lacking and there is significant interindividual variation. Dose equivalents and changing opioids faculty of pain medicine.
Calculate the dose of buprenorphine from the conversion chart given. The correct 4 hourly equivalent dose should be used. 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. 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. Butrans buprenorphine dose, indications, adverse effects. Surprisingly, crosstolerance between opioids is often incomplete. 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.