What are the steps for converting or rotating between opioids?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

See the list below:

  1. Calculate total mg dose taken in past 24-hours.

  2. Determine equi-analgesic dose (Table 1).

  3. If pain is controlled on current opioid, reduce the new opioid daily dose by 25-50% to account for cross-tolerance, dosing ratio variation, and interpatient variability.

  4. If pain is uncontrolled on the current opioid, increase opioid daily dose by up to 100-125%.

  5. Titrate liberally and rapidly to analgesic effect during first 24 hours.

  6. Monitor for adverse events and effectiveness.

  7. Reassess the analgesic effect every 2-3 days.

Table 1. Opioid Equi-analgesic Doses

Table. (Open Table in a new window)

Opioid Agonist

Parenteral Dose,

IV, SC, IM

Oral Dose

PO:IV

Duration of Action, h

Morphine

10 mg

30 mg

3:1

3-4

Morphine, long-acting

(Avinza, Kadian)

-

30 mg

-

12

HYDROmorphone

(Dilaudid)

1.5 mg

7.5 mg

5:1

2-3

OXYcodone (Oxecta)

-

15-20 mg

-

3-5

OXYcodone, long-acting (OxyContin)

-

20 mg

-

12

HYDROcodone

(Vicodin, Lortab)

-

30-45 mg

-

3-5

OXYmorphone

(Opana)

1 mg

10 mg

10:1

3-6

OXYmorphone, long-acting (Opana ER)

-

10 mg

-

12

Codeine

-

180-200 mg

-

4

Fentanyl*

0.2 mg (200 mcg)

-

-

2

Methadone**

-

-

-

-

*See Table 2 for transdermal fentanyl conversion

**Methadone dosing: always consult pain or palliative care specialist


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