Opioid Conversion Guidelines

Fentanyl Transdermal Patch Conversion

When converting from continuous IV fentanyl infusion to transdermal fentanyl, use a straight 1:1 ratio (mcg of parenteral fentanyl = mcg/hour of transdermal fentanyl), as recommended by the National Comprehensive Cancer Network 1, 2
Some patients may require patch replacement every 48 hours instead of the standard 72 hours, according to the National Comprehensive Cancer Network 1
Always reduce the calculated equianalgesic dose by 25-50% when switching between opioids to account for incomplete cross-tolerance, as suggested by the National Comprehensive Cancer Network and Praxis Medical Insights 1, 3
Heat sources (heating pads, electric blankets) accelerate fentanyl absorption and are contraindicated, as warned by the National Comprehensive Cancer Network 1

Always reduce the calculated equianalgesic dose by 25-50% when rotating between different opioids, as recommended by the National Comprehensive Cancer Network and Praxis Medical Insights 1, 3
Prescribe additional doses of approximately 10-20% of the 24-hour dose for breakthrough pain, as suggested by Praxis Medical Insights 3
More frequent assessment and titration are needed for actively dying patients, according to Praxis Medical Insights 3