Opioid patches: safe conversion from oral therapy. Buprenorphine patches are available as BuTrans and Transtec patches. The Scottish Medicines Consortium concluded that buprenorphine patches were not cost-effective in the treatment of severe opioid responsive pain conditions and did not recommend their use.
Both cases involved patients above the age of 80 suffering from chronic pain. Two near misses have been reported by a community pharmacist involving the conversion of tramadol to buprenorphine patches. Both patients were reporting that their pain was poorly controlled.
See the NHSGGC Chronic Non Malignant Pain Opioid Guidelines for more information.
In one case, the GP was unaware that the patient had been experiencing nausea with the prescribed dose of tramadol so was in fact taking less than half the prescribed dose. In each case, the GP had converted the prescribed dose of tramadol to buprenorphine and rounded up to the next available patch since the pain was not well controlled.
When undertaking conversion from one opioid to another, the guidelines recommend decreasing the original equivalent morphine dose by 25-50% to prevent adverse effects. In both cases, the prescription issued was for a dose double that which would be recommended by the conversion tool approved within NHSGGC.
In order to prevent this type of issue, prescribers should consider the following:
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Oral morphine remains the first-line choice of strong analgesic for cancer and non-cancer pain. The Scottish Medicines Consortium concluded that buprenorphine patches were not cost-effective in the treatment of severe opioid responsive pain conditions and did not recommend their use. Buprenorphine patches are available as BuTrans and Transtec patches. These patches are non-Formulary in NHSGGC.
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Opioid Conversion Chart. (please note all conversions are approximate and doses need to be chosen cautiously and individualised to the patient). Oral Morphine. Oral Oxycodone. SC Morphine. SC Diamorphine. SC Oxycodone. Fentanyl patch. 4 hourly dose. (mg). 12 hourly dose. (mg). 24 hour equivalent. (mg). 4 hourly.
Oxycodone dose by 2. Calculated by dividing 24 hour oral morphine dose by 30. Prn dose is one sixth (1/6th) of 24 hour subcutaneous (sc) syringe driver dose plus opioid patches if in situ. NB Alfentanil injection is short acting. Maximum 6 prn doses in 24 hours. If require more seek help. Conversions use UK SPC. 20. 10. 5.
However, if switching because of possible opioid-induced hyperalgesia, the calculated equivalent dose should be reduced by 25-50% (2,14). Comparative doses of oral morphine to transdermal fentanyl are given in Tables 1 and 2. The dose conversion used in Table 1 of oral morphine: transdermal.