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Opioid Conversion Updates
Updated in 2018, some clinicians are unaware of the changes to the opioid conversion tables.
|
| 2010 Recommendations |
| 2018 Updates | ||
| Opioid | IV (mg) | PO (mg) |
| IV (mg) | PO (mg) |
| Morphine | 10 | 30 |
| 10 | 25 |
| Fentanyl | 0.1 | NA |
| 0.15 | NA |
| Hydromorphone | 1.5 | 7.5 |
| 2 | 5 |
| Oxycodone | NA | 20 |
| NA | 20 |
When converting between opioids, it is important to remember the following steps:
- Determine the patient’s level of pain and current response to therapy.
- Calculate current opioid requirement.
- Convert the opioid using table above.
- ASSESS! Combine Steps 1-3 to determine what is most appropriate clinically. If the patient is suffering from severe pain, using the calculated dose may be appropriate. If the patient is requesting a switch but is otherwise pain controlled, consider a general dose reduction of 25-50% in the new opioid.
- Monitor the patient for efficacy and side effects.
While online calculators can be helpful, opioid conversions should be done thoughtfully with a full patient assessment to determine the correct conversion for the individual patient.
References
References:
- McPherson, M. L. M. Demystifying opioid conversion calculations: a guide for effective dosing. American Society of Health-System Pharmacists. Bethesda, MD. 2018.
- McPherson MLM. Why equianalgesic tables are only part of the answer to equianalgesia. Ann Palliat Med. 2020; 9(2):537-541.