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Switching from another µ agonist (e.g. morphine) may cause low-grade opioid withdrawal. When switching from an alternative opioid to BuTrans®, the manufacturer recommends starting with the lowest strength patch and using additional short-acting analgesia during titration, as required. (8)
icb.nhs.uk DownloadWhen a patient’s equivalent morphine use, is in between two strengths, the lower strength patch should be used and response monitored. Consider seeking advice from local pain or palliative care teams if converting to high strength opioid patches to reduce any associated risks.
northernlincolnshireapc.nhs.uk DownloadIn renal impairment (GFR <30ml/min) morphine and diamorphine in particular can accumulate. Alternative opioids of choice are oxycodone po/sc, fentanyl and buprenorphine patches. If using other options use low doses and increase the dose interval, and regularly monitor and review. subcutaneous alfentanil may be considered - seek specialist advice.
*Approximate mid-range oral morphine doses are described here; prescribers should note that manufacturers describe a range of oral morphine doses for each strength of patch. Use the links below for further information about Transdermal Opioids:
A guide to dose conversions FROM morphine TO second-line opioid analgesics used for moderate to severe pain. Use the tables above as a guide. The doses are approximate (≈) and not exact equivalent doses.
It may be necessary to change a patient from one opioid to another to achieve optimum analgesia with fewer side effects or if a route becomes compromised. The table below gives an approximate (≈) conversion for different opioids and be used as a guide.
Fentanyl buccal/ sublingual 150 0.1mg x 150 = 15mg morphine equivalent 20 micrograms / hour 48mg / day Hydromorphone 5 1.3mg x 5 = 6.5mg morphine equivalent Buprenorphine patch changed twice a WEEK every 3 - 4 days Meptid (meptazinol) 0.04 200mg x 0.04 = 8mg morphine equivalent 35 micrograms / hour 84mg / day ...
A dose reduction of at least 50% is recommended when switching at high doses (eg, oral morphine or equivalent doses of 500mg/24 hours or more), in elderly or frail patients, or because of intolerable undesirable effects.
salisbury.nhs.uk DownloadAt higher doses e.g. the equivalent of 180mg of oral Morphine in 24 hours or more, consider reducing the equianalgesic dose by 30-50% if converting from a less sedating Opioid e.g. Fentanyl to Morphine or Diamorphine (as the sedative effects may be much greater for an ‘equianalgesic’ dose)
olh.ie DownloadA ratio of 100:1 is used in OLH&CS when converting transdermal buprenorphine or transdermal fenta-nyl to an equivalent dose of oral morphine. The conversion ratios are approximate and are intended as a guide only.