Opioid Conversion Tips Changing To Another Oral Opioid printable pdf download

Chronic Pain Management Charts

Opioid conversion tips

C C a a l l c c u u l l a a t t i i n n g g t t h h e e r r e e s s c c u u e e d d o o s s e e

native opioid into appropriate inter-

calculate the equivalent total daily

1. Calculate 10% of the provided total

mittent doses based upon the spe-

morphine dose.

daily opioid dose as an immediate-

cific opioid dosing intervals found

3. Use the “Morphine to Fentanyl

release formulation.

in the “Dosing and Conversion

Equivalents” chart to determine the

O O p p i i o o i i d d a a d d j j u u s s t t m m e e n n t t s s

Chart for Opioid Analgesics.”

equianalgesic dose of transdermal

1. Calculate the total oral 24-hour

4. Modify by reducing dose by

fentanyl.

opioid taken by adding the amount

25%-50% for incomplete cross-

C C h h a a n n g g i i n n g g a a n n o o p p i i o o i i d d a a g g e e n n t t a a n n d d r r o o u u t t e e

of the sustained-release and imme-

tolerance

( ( o o r r a a l l t t o o I I V V ) )

diate-release rescue doses.

C C h h a a n n g g i i n n g g a a n n o o r r a a l l o o p p i i o o i i d d t t o o i i t t s s I I V V / / S S Q Q

1. Calculate the total daily dose of the

2. Divide total daily dose into appro-

r r o o u u t t e e

original opioid (add long-acting and

priate intermittent doses based

1. Calculate the total amount of oral

rescue doses).

upon the specific opioid dosing

opioid taken per 24 hours (add

2. Use the “Dosing and Conversion

intervals found in the “Dosing and

long-acting and rescue doses).

Chart for Opioid Analgesics” to

Conversion Chart for Opioid

2. Use the “Dosing and Conversion

convert from an oral to IV dose.

Analgesics.”

Chart for Opioid Analgesics” to cal-

3. Use the “Dosing and Conversion

C C h h a a n n g g i i n n g g t t o o a a n n o o t t h h e e r r o o r r a a l l o o p p i i o o i i d d

culate the equivalent total daily par-

Chart for Opioid Analgesics” to

1. Calculate the total daily dose of

enteral dose.

convert original opioid to an alter-

current opioid (add the long-acting

3. Divide the dose by 24 to get the

native, equivalent IV dose.

and rescue doses).

hourly drip rate.

4. Adjust the dose for incomplete

C C h h a a n n g g i i n n g g a a n n o o r r a a l l o o r r I I V V o o p p i i o o i i d d t t o o t t r r a a n n s s - -

2. Use the “Dosing and Conversion

cross tolerance by reducing dose by

Chart for Opioid Analgesics” to cal-

d d e e r r m m a a l l f f e e n n t t a a n n y y l l

25%-50%.

culate the equivalent total daily oral

1. Calculate the total opioid dose.

5. Divide adjusted dose by 24 to

dose of the alternative opioid.

2. Use the “Dosing and Conversion

obtain hourly opioid infusion rate.

3. Divide total daily dose of the alter-

Chart for Opioid Analgesics” to

C C h h a a n n g g i i n n g g t t o o a a n n o o t t h h e e r r o o r r a a l l o o p p i i o o i i d d

Question:

A patient is taking sustained-release oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. She

would like to try an immediate-release opioid agent, hydromorphone. What is the equivalent dose of hydromorphone?

Answer:

the new opioid, and then reduce the

oxycodone to hydromorphone is

dose by 25%-50%.

20:7.5, or 2.6:1):

The “Dosing and Conversion

The single exception to this rule

200 mg oxycodone / 2.6 = 77 mg

Chart for Opioid Analgesics” will help

is when prescribing fentanyl. The

oral hydromorphone (round off

you calculate the equivalent dose of

equianalgesic tables for fentanyl have

to 75 mg)

the new opioid, but you must allow

been adjusted, so you can use the

Adjust the total 24-hour oral hydro-

for the incomplete nature of cross tol-

doses given in the “Conversion to

morphone dose downward by 25%-

erance to opioid side effects.

Transdermal Fentanyl (Duragesic)”

50%:

After patients take the same opi-

fentanyl/morphine conversion tables

75 mg x 2/3 = 50 mg

oid dose for a week or two, they

without further adjustment.

Divide the total daily dose of hydro-

become tolerant of the opioid’s seda-

Calculate the total daily dose of oxy-

morphone into appropriate intermit-

tive and respiratory depressive effects.

codone:

tent doses based upon the “Dosing

When another opioid is substituted

and Conversion Chart for Opioid

100 mg x 2 = 200 mg

for the original opioid, patients will

Use the “Dosing and Conversion

Analgesics”:

not be completely tolerant to the new

Chart for Opioid Analgesics” to calcu-

50 mg / 6 doses per day = 8 mg

opioid’s side effects, which can lead to

late the equivalent oral hydromor-

every 4 hours

over-sedation or confusion. You must

phone dose (the conversion ratio of

calculate the equianalgesic dose of

Opioid Conversion Tips Changing To Another Oral Opioid

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