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
  • ¼
    • OME/24°< 90
  • 1/8
    • OME/24°90- 300
  • 1/12
    • OME/24°>300
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

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Reference Notes for Palliative Care Consultation Copyright © 2018 by Robert F. Johnson MD, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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