A dose reduction of at least 50% is recommended when. Opioid converter morphine equivalent calculator omni. Fentanyl and buprenorphine patches are third line opioids and should be restricted to patients who have. If you are addicted to a low dose say, 100mg morphine equivalent po by mouth daily, i believe cold turkey is the best option. Conversion from other opioids to butrans discontinue all other aroundtheclock opioid drugs when butrans therapy is initiated. Can a buprenorphine transdermal system butrans be used. Do not allow the medicine to come into contact with your eyes, nose, mouth, or lips. Oral morphine milligram equivalent conversion tablei updated 8162017 opioid strength in mg except where noted mme conversion factor buprenorphine, transdermal patch mcghr 12. Butrans buprenorphine dose, indications, adverse effects. Scottish palliative care guidelines buprenorphine patches.
Previous opioid analgesic daily dose oral morphine equivalent 80 oral morphine equivalentsday should consider an alternate analgesic. The formulae for converting methadone are in the footnotes of the table. A dose reduction of at least 50% is recommended when switching at high doses eg, oral morphine or equivalent doses of 500mg24 hours or more, in elderly or frail patients. Opioid oral morphine milligram equivalent mme conversion. 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. Webmd provides common contraindications for butrans transdermal. 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. Medscape pain dosing for butrans buprenorphine transdermal, frequencybased. Use the dose conversion tool calculate the initial butrans dose for your opioidexperienced patients. The patch should be worn for 3 full days before increasing the dose, this is when the maximum effect of a given dose is established. The buprenorphine parent molecule is considered a partial muagonist, but will nevertheless overcome receptor binding by concomitant full agonist use. Dose equivalents and changing opioids faculty of pain medicine.
Once the conversion has occurred, the dose of new opioid should be titrated carefully. Titration should occur every 4 to 8 days, based on the pharmacokinetic profile and time to reach steadystate plasma levels. Dose conversion tool butrans buprenorphine transdermal. Buprenorphine conversions practical pain management. Do not use shortacting buprenorphine products for example temgesic for breakthrough pain. Consideration should be given to the previous opioid history of the patient see section 4. Butrans 5, 10 and 20ugh transdermal patch summary of. Butrans should be administered every 7th day patients aged 18 years and over the lowest butrans dose butrans 5 microgramhour transdermal patch should be used as the initial dose. Find medication information including related drug classes, side effects, patient statistics and answers to frequently asked questions. Dose equivalence and switching between opioids specialist. Buprenorphine, sold under the brand name subutex, among others, is an opioid used to treat opioid use disorder, acute pain, and chronic pain. It can be used under the tongue, in the cheek, by injection, as a skin patch, or as an implant.
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. Dose equivalents and changing opioids faculty of pain. Medscape pain dosing for butrans buprenorphine transdermal, frequency based. In most cases, when switching between different opioids, the calculated doseequivalent must be reduced to ensure safety. Opioids opiates are a group of analgesic drugs, used primarily for pain management. Butrans is for transdermal use on intact skin only. The starting point for dose reduction from the calculated equianalgesic dose is around 2550%. Use caution when prescribing to opioidexperienced patients requiring high doses of opioids ie, 80 mgday oral morphine equivalent. Consider the need to adjust dose for conditions that increase opiate risk eg elderly, comorbidities, renal or hepatic impairment. Use the lowest effective dose for the shortest time needed. Patients under 18 years of age butrans patches should not be used in patients below the age of 18 years.
Although butrans buprenorphine patch comes in the form of a skin patch, it is possible to overdose on this drug. Buprenorphine transdermal delivery system butrans, ciii. Equianalgesic dosing of opioids for pain management. Apply first dose of equivalent dose buprenorphine patch at same time as taking. 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. The withdrawal symptoms will likely manifest in the event you try to suddenly quit or simply delay taking a fresh dose. 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. See the detailed instructions for use for information about how to apply the butrans patch. Keep both used and unused butrans patches out of the reach of children or pets. Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary. 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. For example, butrans is dosed based on oral morphine equivalents per day when converted from another opioid therapy.
The data upon which the conversions are based are summarized in the table below. Use the conversion above to calculate the approximate equivalent strength of buprenorphine patch, but note patients on a dose equivalent to less than 120mg morphine should usually be started on transtec 35 microgramhr every 4 days. Butrans withdrawal occurs when you have developed a physical dependence or addiction to the drug. Butrans patch fda prescribing information, side effects. Lowdose buprenorphine patch for pain palliative care. Fentanyl patch strength microgramhr, oral morphine mgday. A total of 1,160 patients on chronic opioid therapy total daily dose 3080 mg morphine equivalent entered an openlabel, dosetitration period with butrans for up to 3 weeks, following taper of prior opioids. This article further discusses dosing guidelines and tips for using this patch. Do not apply a butrans patch if the pouch seal is broken, or the patch is cut, damaged, or changed in.
As this emedtv page explains, the initial butrans dosage for people who have not already been using an opioid medicine is one 5mcghour patch applied every seven days. In other words, the conversion factor not accounting for days of use would be 95 or 1. Use of higher starting doses in patients who are not opioid. Tell your doctor if you have serious side effects of butrans including. One thousand one hundred and sixty 1,160 patients on chronic opioid therapy total daily dose 3080 mg morphine equivalent entered an openlabel, dose titration period with butrans for up to 3 weeks, following taper of prior opioids. The calculation of opioid conversion is a crucial step in intensive care and is necessary throughout all the medical branches. This tool does not contain all of the important safety information needed to prescribe butrans. Criteria for drug coverage buprenorphine transdermal. They all interact with specific opioid receptors such as. Apply butrans exactly as prescribed by your healthcare provider. Texas prior authorization program clinical criteria morphine equivalent dosing. Even the amount of buprenorphine in a used skin patch could be fatal to a child or pet who accidentally sucks or chews on the patch. Find out what health conditions may be a health risk when taken with butrans transdermal.
Opioid equivalence chart gloucestershire hospitals. Texas prior authorization program clinical criteria morphine equivalent dosing unspecified. The dose of butrans is individualized and based on the patients medical condition, the severity of the pain, and other factors. Butrans coupon save 75% with our coupons april 2020. The correct 4 hourly equivalent dose should be used. Patients initiated therapy with butrans 10 mcghour for three days. Butrans withdrawal symptoms can vary in severity, depending on the level of your addiction. Butrans buprenorphine transdermal dosing, indications.
For opioid use disorder, it is typically started when withdrawal symptoms have begun and for the first two days of treatment under direct observation of a. 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. Just one dose can cause death in someone using this medicine accidentally or. Butrans transdermal patch weekly drug information, side.
A dose of 10mg oxycodone intravenously is equivalent to 7. Review the buprenorphine patch dose after 72 hours. If the patients oral morphine equivalents per day were less than 30 mg, then the 5mcghour patch should be initiated. Or new member to kpnw and patient is currently using butrans patch and dose does not exceed one 20 mcghr patch per 7 days.
9 1113 1169 1215 939 54 1381 589 333 1340 955 413 814 1180 26 131 1000 1266 325 458 688 309 14 975 1027 1026 1206 1496 1112 519 1256 730 804 1419