Convert oxycontin dose to kadian.










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Individually titrate KADIAN to a dose that provides adequate analgesia and minimizes adverse reactions. Continually reevaluate patients receiving KADIAN to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse [see WARNINGS AND PRECAUTIONS ]. Frequent communication is important among the prescriber, other members of the healthcare team, the patient, and the caregiver/family during periods of changing analgesic requirements, including initial titration. During chronic therapy, periodically reassess the continued need for the use of opioid analgesics. Gammaitoni AR, Fine P, Alvarez N, McPherson ML. Clinical application of opioid equianalgesic data. Clin J Pain. 2003; 19:286-297. Pereira J et al. Equianalgesic dose rations for opioids: a critical review and proposals for long-term dosing. J Pain Sym Manage. 2001; 22:672-687. Anderson R et al. Accuracy in equianalgesic dosing: conversion dilemmas. J Pain Sym Manage. 2001; 21:397-406. Lichtor JL, Sevarino FB, and Joshi GP. et al. The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain. Anesth Analg. 1999 89:732–738. [ PubMed ] [ Google Scholar ]. From the Departments of Psychiatry and Internal Medicine, Medical College of Virginia, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va Corresponding author and reprints: W. Victor R. Vieweg, M.D., 17 Runswick Drive, Richmond, VA 23238-5414 (e-mail: Example: Change 90 mg q12 Extended Release Morphine to Morphine by IV continuous infusion. CONVERSION TABLE We provide an opioid conversion table ( Appendix 1 ) 7–10. KADIAN is not indicated as an as-needed (prn) analgesic. Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published July 2005; 3rd Edition May 2015. Re-copy-edited March 2009; references updated. Revised December 2012; hydrocodone and oxycodone added to the equianalgesic table using standard values; copy-edited again May 2015. constipation, nausea, sleepiness, vomiting, tiredness, headache, dizziness, abdominal pain. Call your healthcare provider if you have any of these symptoms and they are severe. >/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group /Tabs/S/StructParents 0>> endobj 4 0 obj. >/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group /Tabs/S/StructParents 0>> endobj 4 0 obj. Drug names: amiodarone (Cordarone, Pacerone, and others), clarithromycin (Biaxin and others), diltiazem (Cardizem, Tiazac, and others), erythromycin (Eryc, PCE, and others), fluconazole (Diflucan and others), fluoxetine (Prozac and others), itraconazole (Sporanox and others), ketoconazole (Ketozole, Nizoral, and others), nelfinavir (Viracept), paroxetine (Paxil and others), ritonavir (Norvir), verapamil (Calan, Isoptin, and others). Close monitoring is of particular importance when converting from methadone to other opioid agonists. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure. Methadone has a long half-life and can accumulate in the plasma. Morphine 10 mg parenteral = Morphine 30 mg oral = Hydromorphone 1.5 mg parenteral = Hydromorphone 7.5 mg oral = Hydrocodone 30 mg oral = Oxycodone 20-30 mg oral (see Reference 1). Your browser does not support the NLM PubReader view. See Fast Fact #2 about conversions involving transdermal fentanyl; #75 and #86 about methadone; and #181 about oxymorphone. Instruct patients not to consume alcoholic beverages or use prescription or nonprescription products that contain alcohol while taking KADIAN. The co-ingestion of alcohol with KADIAN may result in increased plasma levels and a potentially fatal overdose of morphine [see WARNINGS AND PRECAUTIONS ]. Commonly Used Medications That May Inhibit Cytochrome P450 3A4 Metabolism and Increase Blood and Tissue Levels of Methadone a. Reassess benefits and harms when increasing dosage to≥50 mg MED/day and decrease dose if benefits do not outweigh harms. There are no established conversion ratios from other opioids to KADIAN defined by clinical trials. Initiate dosing using KADIAN 30 mg orally every 24 hours. There was no external funding for this project. Calculate the 24 hour current dose: 90 Q12 x 2 = 180 mg PO Morphine/24 hrs Use the equianalgesic ratio of PO to IV morphine: 30 mg po Morphine = 10 mg IV Morphine Calculate new dose using ratios: 180/30 x 10 = 60 mg IV Morphine/24 hours Use the equianalgesic ratio of IV Morphine to IV Hydromorphone: 10 mg Morphine = 1.5 mg Hydromorphone Calculate new dose using ratios: 60/10 x 1.5 = 9 mg IV Hydromorphone/24 hours Reduce dose 50% for cross-tolerance: 9 x 0.5 = 4.5 mg/24 hours = 0.2 mg IV continuous infusion Note: one would also get the same amount of hydromorphone if you directly converted from oral morphine to IV hydromorphone using the 30 mg:1.5 mg ratio. If unacceptable opioid-related adverse reactions are observed, consider reducing the dosage. Adjust the dosage to obtain an appropriate balance between management of pain and opioid-related adverse reactions. KADIAN 100 mg and 200 mg capsules, a single dose greater than 60 mg, or a total daily dose greater than 120 mg, are only for use in patients in whom tolerance to an opioid of comparable potency has been established. Patients considered opioid-tolerant are those taking, for one week or longer, at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl per hour, 30 mg oral oxycodone per day, 8 mg oral hydromorphone daily, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose of another opioid. B. Change drug, keep the same route (e.g. po morphine to po hydromorphone). Prim Care Companion J Clin Psychiatry. 2005; 7(3): 86–88. Fill in the mg per day for the patient's opioid medications. The daily morphine equivalent dose is calculated automatically. This article has been cited by other articles in PMC. Primary Care Companion to The Journal of Clinical Psychiatry. Considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present. Gunderson EW, Stimmel B. Treatment of pain in drug-addicted persons. In: Galanter M, Kleber HD, eds. Textbook of Substance Abuse Treatment. 3rd ed. Washington, DC: American Psychiatric Publishing, Inc. 2004 563–573. [ Google Scholar ]. Initiate the dosing regimen for each patient individually, taking into account the patient's severity of pain, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse [see WARNINGS AND PRECAUTIONS ]. Congestive Heart Failure: Treating Failure (FL INITIAL Autonomous Practice - Differential Diagnosis). Medical Record Documentation and Legal Aspects for CNAs and HHAs. Neonatal Infections (FL INITIAL Autonomous Practice - Differential Diagnosis). For the best experience, choose your profession & state. CDC Guidelines for Prescribing Opioids for Chronic Pain (FL INITIAL Autonomous Practice - Pharmacology). BPH and Prostate Cancer (FL INITIAL Autonomous Practice - Differential Diagnosis). Measles: How Soon Forgotten (FL INITIAL Autonomous Practice - Differential Diagnosis). Opioid Crisis: Feeling the Pain (FL INITIAL Autonomous Practice- Pharmacology). Congestive Heart Failure: The Essence of Heart Failure. LPN IV Series: Homeostasis and Regulatory Functions Relationship to IV Therapy. LPN IV Series: Legalities, Infection Control, Safe Injection and Documentation. Wound Series Part 1: Assessing and Diagnosing Chronic Wounds of the Lower Extremity. CDC Guidelines for Prescribing Opioids for Chronic Pain. Domestic Violence, Sexual Violence, Intimate Partner Violence (Kentucky). Cultural Competency for Nursing Assistants, Home Health Aides, and Medical Assistants. Suicide Prevention: Identify and Treat at Risk Patients. Pain Assessment and Management (FL INITIAL Autonomous Practice). Assistance with Self-Administration: Medication Savvy for Nursing Assistants. Drug Overdose and Antidotes (FL INITIAL Autonomous Practice - Pharmacology). Management of Diabetes during Pregnancy (FL INITIAL Autonomous Practice - Differential Diagnosis). LPN IV Series: Central Venous Catheters and Arterial Catheters. Suicide Prevention: Identify and Treat at Risk Patients (FL INITIAL Autonomous Practice - Differential Diagnosis). Prescribing Controlled Substances & Drug Diversion, 1hr (FL INITIAL Autonomous Practice - Pharmacology). Kawasaki Disease (FL INITIAL Autonomous Practice - Differential Diagnosis). Psychopharmacology: Medications for the Mind (FL INITIAL Autonomous Practice - Pharmacology). Cardiac Emergencies: Sudden Death (FL INITIAL Autonomous Practice - Differential Diagnosis). Suicide Prevention: Identify and Treat at Risk Patients. Adverse Reactions to Contrast Agents: Dispelling the Myths. Congestive Heart Failure: The Essence of Heart Failure. Suicide Screening and Referral. Protein Synthesis Inhibitors (FL INITIAL Autonomous Practice - Pharmacology). Wound Series Part 2: Introduction to Chronic Wound Treatments. Multisystem Inflammatory Syndrome in TEENren (MIS-C) Associated with COVID-19..  

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