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PROCEDURE
Policy
When rotating opioids for intolerable side effects or inadequate analgesia, it is
advisable to reduce the dose of the new opioid by 25-50% due to incomplete cross-
tolerance. There shouid be adequate provision made for breakthrough medication and
the patient should be monitored closely.
Please note that all conversions in these guidelines are a guide only.
Medication doses should be modified in response ~ the patients' clinical
condition and previous exposure to opioids.
Oral to Oral
I
"';...'.'
" :'
, Oral Codeine to Oral Morphine I 8:1 , Oral Codeine 60mg = Oral Morphine 7.5mg
; Oral Morphine to Oral Hydrcimoqjhone ; 5: 1 : Oral Morphine 5mg = Oral Hydromorphone 1mg
Oral to Subcutaneous
I, --~-----_._-~'
Oral Methado~e to SC Methadon~~ l~~.~-~
•• ------~'
I
-------------------~
Oral Methadone 20mg = SC Methadone 15mg
Subcutaneous to Subcutaneous
I Norspan5 Buprenorphine .5
I i 9 - 13 : 5 - 10
, ---- ._------ ,
I Norspan 10 - .
,Buprenorphine 10
II ' 10 - 20
~--l
----~ I
I After application of the fentanyl patch peak plasma levels are achieved 24 hours (significant N plasma levels
I occur in 12 to 16 hours). Buprenorph.ine patch takes 3 days to achieve its steady state.
: On removal serum elimination half lives are: fentanyl 15 - 20 hours: buprenorphine 12 hours. Oral opiates should
, not be started until at least 12 hours following removal of either patch (excluding breakthroughs). Regular oral
analgesia needs to be continued for 12-24 hours after commencing either patch.
!. FORMULAfor calculating SUFENTANIL Break-Through Doses (BTD) for a given Fentanyl Patch
.
; Release Rate
,
0;. \", .'
,.
Usual, frequency
.
Presentation
MS Contin Slow Release I Every~2 hour~ 120, 30, 100mg sachet '!
Suspension , _J
,
",.1 MS Mono I Slow Release I Every 24 hours I 30, 60, 90, 120mg
I capsule
I
I Kapanol :, Slow Release Every 12-24 hours I
I
10, 20, 50, 100mg
i I capsule
Ii Anamorph I
! Immediate
!
I Every 4-6 hours , 30mg ta blet
,L
I Sevredol
;
I Immediate I
I
Every 4-6 hou rs ; 10, 20mg tablets l
! Ordine : Immediate I Every 2-4 hours ~ 1mg,2mg, I
I[
,I ; Smg,10mg/ml mixt~
I Oxycodone i OxyContin
,
I Slow Release l Every 12 hours I 5, 10, 20, 40, 80mg
I tablet
:
I
I I
I I Endone
I
I Immediate i Every 4-6 hours Ismg tablet .
i ,
I
I , i [tSmg/sml Liquid