conversion methadone to morphine

[onechance]

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What would be a reasonable conversion ratio from methadone to morphine ( 1:3 or 4), and fentanyl to morphine ( do you follow the same table we use for morphine to fent, how abt levy's rule?).
Also, while converting morphine to fentanyl, do you guys do the usual 25 - 30% reduction in dose, as some folks say it is inbuilt and is not rqd?
Thanks.

 

[drf]

Chronic methadone can be 1:12. Single dose methadone is 1:1.

I always undershoot by 25-30% at least and liberalize prns.

I mostly rotate in cancer patients.

 

[epidural man]

What would be a reasonable conversion ratio from methadone to morphine ( 1:3 or 4), and fentanyl to morphine ( do you follow the same table we use for morphine to fent, how abt levy's rule?).
Also, while converting morphine to fentanyl, do you guys do the usual 25 - 30% reduction in dose, as some folks say it is inbuilt and is not rqd?
Thanks.

it is non-linear - so the conversion ratio depends on the starting morphine equivalents.

 

[epidural man]

What would be a reasonable conversion ratio from methadone to morphine ( 1:3 or 4), and fentanyl to morphine ( do you follow the same table we use for morphine to fent, how abt levy's rule?).
Also, while converting morphine to fentanyl, do you guys do the usual 25 - 30% reduction in dose, as some folks say it is inbuilt and is not rqd?
Thanks.

here is the chart I use.

http://www.compassionandsupport.org...hadone_Dose_Conversion_Guidelines.051810_.pdf

 

[onechance]

So if some one is on 20 mg tid of methadone: what would be your morphine conversion?

 

[lobelsteve]

So if some one is on 20 mg tid of methadone: what would be your morphine conversion?

20 bid Kadian (now generic and they can use the coupon for the name brand).
Can start 15mg bid if frail/elderly.

 

[ghost dog]

What would be a reasonable conversion ratio from methadone to morphine ( 1:3 or 4), and fentanyl to morphine ( do you follow the same table we use for morphine to fent, how abt levy's rule?).
Also, while converting morphine to fentanyl, do you guys do the usual 25 - 30% reduction in dose, as some folks say it is inbuilt and is not rqd?
Thanks.

Eopioid is a nice little app for this kind of issue. It's great ( especially for about $5).

However, methadone is a beast all unto itself. I don't prescribe it ( and don't treat cancer pain).

To hijack this thread a bit, I just love it when nurses try to convert the different opioids. They are terrible at it ( especially when it comes to fentanyl patches).

Example: I reviewed a worker's comp case where a worker was taking 125 mcg of Fentanyl, and the nurse / case manager calculated that this was equivalent to something like 500 mg of morphine equivalent dose. I indicated that this was not correct, and was an incorrect application of the MED tables.

Much confusion ensued.

 

[Ducttape]

i would have done a bit more morphine than 20 bid kadian, more in lines of ms contin 30 tid.

one of the few decent things about methadone is when you rotate over, since methadone lasts so long, the patient may not have a lot of withdrawal symptoms.

 

[epidural man]

So if some one is on 20 mg tid of methadone: what would be your morphine conversion?

No one knows the other way around.

1:1 is a good starting place.

 

[Tenesma]

best conversion? methadone wean by 20% per week - then no more narcotics...