What is the equivalent dose of oxycodone (oral) for a patient receiving fentanyl (transdermal) 25 micrograms (mcg) per hour (hr)?

From the Guidelines

The equivalent oral dose of oxycodone for a patient receiving fentanyl transdermal 25 mcg/hr is approximately 60 mg per day. When converting from transdermal fentanyl to oral oxycodone, we can use the conversion factors provided in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. According to this guideline, the conversion factor for fentanyl transdermal is 2.4, and for oxycodone is 1.5. However, a more direct conversion can be found in the table from the Journal of the National Comprehensive Cancer Network : JNCCN, 2010 1, which suggests that 25 mcg/h of transdermal fentanyl is equivalent to 60 mg/d of oral oxycodone.

Key Considerations

• The conversion should be adjusted according to individual patient factors, including age, renal function, and previous opioid exposure.
• Patients should be monitored closely during the transition period as fentanyl patches have a long half-life, with drug continuing to be absorbed for 12-24 hours after patch removal.
• It's essential to start at the lower end of the dosing range and titrate up as needed for pain control.
• The dose should be divided into portions taken every 4-6 hours for immediate-release oxycodone or twice daily for extended-release formulations.

Clinical Application

• Clinicians should use their judgment to titrate the dose to the desired response, considering the patient's variability and individual needs.
• The conversion is an estimate based on equianalgesic tables and should be adjusted accordingly.
• The CDC guideline 1 provides a comprehensive approach to opioid conversion, emphasizing the importance of caution and individualized care.

From the FDA Drug Label

To convert patients from oral or parenteral opioids to fentanyl transdermal system, use Table C:

TABLE C* DOSE CONVERSION GUIDELINES Current AnalgesicDaily Dosage (mg/d) Oral oxycodone 30-67 67.5-112 112.5-157 157. 5-202 ... Recommended Fentanyl Transdermal System Dose 25 mcg/hr50 mcg/hr75 mcg/hr100 mcg/hr

To convert fentanyl 25mcg/hr to oxycodone (oral), we need to find the equivalent dose of oral oxycodone that corresponds to a fentanyl transdermal system dose of 25 mcg/hr.

• According to Table C, a fentanyl transdermal system dose of 25 mcg/hr corresponds to an oral oxycodone dose of 30-67 mg/d.
• Since the question asks for the equivalent dose of oxycodone (oral) for a patient receiving fentanyl (transdermal) 25 micrograms (mcg) per hour (hr), we can use the range of 30-67 mg/d as the equivalent dose.
• To provide a more specific answer, we can take the midpoint of this range, which is approximately 48.5 mg/d.
• However, it's essential to note that this conversion should be done with caution, and the actual equivalent dose may vary depending on individual patient factors, such as opioid tolerance and medical status 2.

Key points:

• Fentanyl 25mcg/hr is equivalent to an oral oxycodone dose of 30-67 mg/d.
• The midpoint of this range is approximately 48.5 mg/d.
• This conversion should be done with caution, and the actual equivalent dose may vary depending on individual patient factors 2.

From the Research

Fentanyl to Oxycodone Conversion

To convert fentanyl 25mcg/hr to oxycodone, we need to consider the equivalent doses of these opioids.

• The study 3 describes a patient who was switched from transdermal fentanyl to oral oxycodone, and the combination of transdermal fentanyl (25 microg x hr(-1)) and oral oxycodone (60 mg x day(-1)) provided favorable pain control.
• However, this study does not provide a direct conversion ratio between fentanyl and oxycodone.
• Another study 4 provides conversion ratios for opioid switching, including a ratio of 1.5:1 between oral morphine and oral oxycodone.
• Additionally, the study 5 discusses the variability in opioid equivalence calculations and provides estimated morphine equivalents (MEQs) for different opioids, including fentanyl and oxycodone.
• The study 6 reviews the pharmacology and clinical use of oxycodone, including its equivalence to morphine, which is 1:2.

Conversion Calculation

Based on the study 4, we can estimate the conversion ratio between fentanyl and oxycodone as follows:

• First, we need to convert fentanyl to oral morphine using the ratio of 100:1 between oral morphine and transdermal fentanyl 4.
• Then, we can convert oral morphine to oral oxycodone using the ratio of 1.5:1 between oral morphine and oral oxycodone 4.
• Using these ratios, we can estimate the equivalent dose of oxycodone for a patient receiving fentanyl 25mcg/hr.

Key Points

• The conversion ratio between fentanyl and oxycodone is not directly provided in the studies.
• The estimated conversion ratio is based on the ratios between fentanyl and oral morphine, and between oral morphine and oxycodone.
• The study 3 provides a specific example of a patient who was switched from transdermal fentanyl to oral oxycodone, but this does not provide a general conversion ratio.
• The studies 4, 5, and 6 provide information on opioid equivalence calculations and conversion ratios, which can be used to estimate the equivalent dose of oxycodone for a patient receiving fentanyl 25mcg/hr.