Pain Classification
Pain Diagnosis
Pain - Drug management
WHO Pain Guidelines
Initiating morphine
Morphine titration
Managing morphine maintenance
Adverse effects of morphine
Opioid rotation
Alternatives to morphine
Equianalgesic potencies
Golden rules of pain control
Adjuvant pain therapies
Validated 22 Oct 2016
Converting opioid doses
Converting to Transdermal Buprenorphine
Buprenorphine patches are approximately equivalent to the following 24-hour doses of oral morphine
|
Morphine salt Daily dose |
|
Patch |
Change |
|
12mg |
≡ |
BuTrans® ‘5’ patch |
7-day |
|
24mg |
≡ |
BuTrans® ‘10’ patch |
7-day |
|
48mg |
≡ |
BuTrans® ‘20’ patch |
7-day |
|
84mg |
≡ |
Transtec® ‘35’ patch |
4-day |
|
126mg |
≡ |
Transtec® ‘52.5’ patch |
4-day |
|
168mg |
≡ |
Transtec® ‘70’ patch |
4-day |
Converting from oral morphine solution
- Continue oral morphine for 12 – 24 hrs after start of buprenorphine patch until therapeutic levels are reached
- Evaluate analgesic dose after 24 – 72hrs
- Provide PRN doses of either oral morphine or sublingual buprenorphine for breakthrough pain
- It may take approx 30 hrs for the plasma concentration to decrease by 50% after patch is removed
Licence: Licensed for use in children over the age of 6 years. Cutting the patches is not recommended by manufacturers. Sublingual tablets no licensed under 6 yrs.
OPIOID POTENCY RATIOS
|
|
Route |
Relative potency to oral morphine |
|
Codeine |
Oral |
0.1 |
|
Dihydrocodeine |
Oral |
0.1 |
|
Buprenorphine |
Sublingual |
60 |
|
Pethidine |
Oral |
0.125 |
|
IM |
0.375 |
|
|
Tramadol |
Oral |
0.1-0.2 |
|
Morphine |
SC infusion |
2 |
|
Diamorphine |
SC infusion |
3 |
|
Oxycodone |
Oral |
2 |
|
SC infusion |
3-4 |
|
|
Fentanyl |
Patch |
150 |
|
SC infusion |
150 |
|
|
Alfentanil |
SC infusion |
30 |
|
Hydromorphone |
Oral |
5-10 |
See Opioid Conversion Guide in adult section
Validated 22 Oct 2016 by Ian Back
Last modified 15 Apr 2024
