101 Converting Opioids: Point A to Point B
- M=morphine,
- H=hydromorphone,
- X=oxycodone,
- F=fentanyl,
- MET=methadone
- O=oral,
- V=intravenous,
- T=transdermal
- 1 = all doses in mg unless otherwise noted
- 2 = note 100 mcg = 0.1 mg
- 3 = dose in mcg/hr
| B:
→Desired1→ |
MO (“OME”) | MV | HO | HV | XO | FV2 | FT3 (MCG/HR) | METO | METV |
| A: ↓Current1↓ | |||||||||
| MO (“OME”) | — | 1/3 | 1/4 | 1/20 | 2/3 | 1/300 | 1/2 |
|
|
|---|---|---|---|---|---|---|---|---|---|
| MV | 3/1 | — | 3/4 | 1/7 | 2/1 | 1/100 | 3/2 | ||
| HO | 4/1 | 4/3 | — | 1/5 | 3/1 | 1/75 | 2/1 | ||
| HV | 20/1 | 7/1 | 5/1 | — | 14/1 | 1/15 | 10/1 | ||
| XO | 3/2 | 1/2 | 1/3 | 1/14 | — | 1/200 | 3/4 | ||
| FV2 | 300/1 | 100/1 | 75/1 | 15/1 | 200/1 | — | 150/1 | ||
| FT3 (MCG/HR) | 2/1 | 2/3 | 1/2 | 1/10 | 4/3 | 1/150 | — | ||
| METO | 5/1 | — | 1/2 | ||||||
| METV | 13.5/1 | 1.3/1 | — |
- A: Find current drug (Point A) in far left column
- B: Find desired drug (Point B) in top row
- Intersection of A and B in table defines conversion ratio
- Dose desired drug (B) = Dose current drug (A) x conversion ratio
Calculated dose represents an estimated equianalgesic dose. Significant individual patient variation should be expected. The actual dose of the desired drug to administer should be adjusted for a variety of factors including but not limited to: age, pain intensity, cross-tolerance, and renal/hepatic dysfunction.
Consider the following when adjusting the calculated (estimated) equianalgesic dose:
- 0% reduction:
- moderate to severe pain, no side effects (sedation, respiratory depression, neurotoxicity) on current medication
- 25% reduction:
- mild to moderate pain, no side effects
- 50% reduction:
- mild or controlled pain, presence of side effects
