What is the equianalgesic dose of fentanyl (transdermal fentanyl) patch for 2.5mg of intravenous (IV) hydromorphone?

From the Guidelines

The equianalgesic dose of transdermal fentanyl patch for 2.5mg of IV hydromorphone is approximately 50-62.5 mcg/hour, but based on the most recent and highest quality study, a more precise conversion is necessary. To convert between these medications, first convert IV hydromorphone to oral morphine equivalent: 2.5mg IV hydromorphone is equivalent to about 10mg IV morphine (using a 1:4 ratio) 1, which equals approximately 30mg oral morphine (using a 1:3 IV to oral conversion). For transdermal fentanyl, the general conversion guideline is that 60mg of oral morphine daily is roughly equivalent to a 25 mcg/hour fentanyl patch 1. Therefore, 30mg of oral morphine would convert to a fentanyl patch delivering between 12.5 mcg/hour. However, since fentanyl patches typically come in 12,25,50,75, and 100 mcg/hour strengths, the closest available option would be a 25 mcg/hour patch, but considering the context of opioid conversion and the goal of minimizing risk, a dose of 50-62.5 mcg/hour may be more appropriate for some patients, but this should be approached with caution and careful consideration of the patient's opioid tolerance and medical history.

Some key points to consider when converting to transdermal fentanyl include:

• The time it takes to reach steady-state plasma levels, which is 12-24 hours, and the potential need for breakthrough pain medication during this period 1.
• The importance of using fentanyl patches only in opioid-tolerant patients due to the risk of respiratory depression 1.
• The unique characteristics of transdermal fentanyl, including its complex absorption and pharmacodynamics, which can increase the risk for fatal overdose if not properly understood and managed by both clinicians and patients 1.

Given the complexities and risks associated with opioid conversion and the use of transdermal fentanyl, it is crucial to prioritize caution and carefully assess each patient's individual needs and risk factors. This includes considering the patient's medical history, current medications, and potential for opioid misuse or overdose, as well as providing thorough education on the safe use of transdermal fentanyl patches 1.

From the FDA Drug Label

TABLE D*,† EQUIANALGESIC POTENCY CONVERSION Name Equianalgesic Dose (mg) IM‡,§ PO Hydromorphone (Dilaudid®) 1.5 7.5

TABLE E* RECOMMENDED INITIAL FENTANYL TRANSDERMAL SYSTEM DOSE BASED UPON DAILY ORAL MORPHINE DOSE Oral 24-hour Morphine (mg/day) Fentanyl Transdermal System Dose (mcg/hr) 60-134 25 135-224 50 225-314 75 315-404 100

To determine the equianalgesic dose of fentanyl (transdermal fentanyl) patch for 2.5mg of intravenous (IV) hydromorphone, we need to follow these steps:

• First, we find the equianalgesic dose of oral morphine for 2.5mg of IV hydromorphone.
• According to Table D, 1.5mg of IV hydromorphone is equivalent to 7.5mg of oral morphine.
• Therefore, 2.5mg of IV hydromorphone would be equivalent to (2.5mg / 1.5mg) * 7.5mg = 12.5mg of oral morphine.
• Next, we use Table E to find the recommended initial fentanyl transdermal system dose based on the daily oral morphine dose.
• Since 12.5mg of oral morphine is less than 60mg, the recommended initial fentanyl transdermal system dose would be 25mcg/hr.

The equianalgesic dose of fentanyl transdermal system for 2.5mg of IV hydromorphone is 25mcg/hr 2.

From the Research

Equianalgesic Dose of Fentanyl Patch for 2.5mg IV Hydromorphone

• The provided studies do not directly address the equianalgesic dose of fentanyl patch for 2.5mg of intravenous (IV) hydromorphone.
• However, it is known that opioid dose conversions are complex and can vary depending on several factors, including the specific opioids being compared, the route of administration, and individual patient characteristics 3, 4.
• Studies have shown that hydromorphone and fentanyl are both potent analgesics, but the equianalgesic ratios between them are not well established 4.
• One study noted that fentanyl is commonly used for the management of chronic pain, and it can be administered via various routes, including transdermally 5.
• Another study discussed the rotation of intrathecal hydromorphone or morphine to fentanyl in patients with peripheral edema, but it did not provide information on equianalgesic dosing 6.
• Due to the lack of direct evidence, it is not possible to provide a specific equianalgesic dose of fentanyl patch for 2.5mg IV hydromorphone based on the provided studies.