Palliative Care Matters

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Converting opioid doses

Converting to Transdermal Buprenorphine

Buprenorphine patches are approximately equivalent to the following 24-hour doses of oral morphine

Morphine salt Daily dose		Patch	Change
12mg	≡	BuTrans® ‘5’ patch	7-day
24mg	≡	BuTrans® ‘10’ patch	7-day
48mg	≡	BuTrans® ‘20’ patch	7-day
84mg	≡	Transtec® ‘35’ patch	4-day
126mg	≡	Transtec® ‘52.5’ patch	4-day
168mg	≡	Transtec® ‘70’ patch	4-day

Converting from oral morphine solution

Continue oral morphine for 12 – 24 hrs after start of buprenorphine patch until therapeutic levels are reached
Evaluate analgesic dose after 24 – 72hrs
Provide PRN doses of either oral morphine or sublingual buprenorphine for breakthrough pain
It may take approx 30 hrs for the plasma concentration to decrease by 50% after patch is removed

Licence: Licensed for use in children over the age of 6 years. Cutting the patches is not recommended by manufacturers. Sublingual tablets no licensed under 6 yrs.

OPIOID POTENCY RATIOS

	Route	Relative potency to oral morphine
Codeine	Oral	0.1
Dihydrocodeine	Oral	0.1
Buprenorphine	Sublingual	60
Pethidine	Oral	0.125
Pethidine	IM	0.375
Tramadol	Oral	0.1-0.2
Morphine	SC infusion	2
Diamorphine	SC infusion	3
Oxycodone	Oral	2
Oxycodone	SC infusion	3-4
Fentanyl	Patch	150
Fentanyl	SC infusion	150
Alfentanil	SC infusion	30
Hydromorphone	Oral	5-10