Also, I made a mistake in my current intake. I am currently taking 30mg BID
Thank you so much for your help, as it was very informative. However, I think I am going to consult my pain management provider/specialist before making any changes to my current regimen.
I am not sure what you mean when you stated "I am going to replace that for a short time with fentanyl patch". Are you under the care of a prescribing provider/pain specialist?
It is extremely important for you to work closely with your provider in optimizing your pain management. Opioid treatment regimens are very complicated, especially with dosing conversion and extended release formulations.
Opioid therapy conversion needs to be very conservative, because opioid overdose can lead to respiratory depression and may be fatal. Please follow-up with your provider in working out the best possible pain management for you.
First of all:
1. What is the dose of the fentanyl patch that you are applying? Is it the equivalent dose of what you are currently on? If not, you may not get equivalent pain relieve from the fentanyl patch.
If you are taking "Opana ER 30mg/2 TID":
30 mg x 2 tablets/dose = 60 mg per dose of oxymorphone
60 mg x 3 times daily = 180 mg per day of oxymorphone
When converting oxymorphone to morphine, it is about 1:3 ratio:
180 mg oxymorphone x 3 = 540 mg of morphine
However, because there is the factor of opioid cross-tolerance, usually a 50% reduction in the calculated dose is recommended.
540 mg of morphine x 0.5 = 270 mg of morphine
Per manufacture dosing guideline:
Oral 24-hour Morphine (mg/day) Fentanyl Patch (mcg/hr)
225 to 314 mg/day 75 mcg/hr
However, this is just a calculation based on the limited medical information I was presented. Since I do not have your liver and kidney status, it will be difficult for me to recommend the exact dosing regimen. Please consult your provider using this as a guideline.
2. If you are on Opana ER 30mg, why are you still taking Dilaudid? Is the Dilaudid dose taken into consideration in the conversion?
3. Opana ER is recommended to dose every 12 hours. Not sure if the three times daily (or TID) dosing is better for you pain regimen. Consult with your provider to consider Opana ER 30 mg three tablets every 12 hours if you both agree that it is a better option for you.
4. Why are you converting to fentanyl patch? Is your pain not well controlled? What is you pain rating, based on the scale of 1-10 (with 10 being the worst pain you have)? Pain meds can help reduce the pain to be tolerable but may not be possible to lower it to zero pain, especially with your spinal condition. It is a good idea for you to keep a pain diary and note any triggers and what helps pain reduction.
5. There may be additive central nervous system adverse effect when you take escitalopram (Lexapro) and aripiprazole (Abilify) concurrently with oxymorphone (Opana) and hydromorphone (Dilaudid). Please monitor closely.
Based on the information presented, I do not recommend for you to try the proposed treatment plan. Unlike Opana, fentanyl patch does not work immediately after applying it. It may take 1 to 3 days to see full effect. Fentanyl patch is not for short-term switch like how you are proposing. Please consult your pain specialist and pharmacist to optimize your medical therapy without causing more harm to your body.
For more detail information, please go to:
1. Opana ER - Daily Med
2. Fentanyl Transdermal System (fentanyl) patch - Daily Med