Title: Opioid Conversion Updates<br/>Author: Ashley Martinelli<br/><a href='mailto:1912'>[Click to email author]</a><hr/><p style="color: rgb(0, 0, 0); font-size: 12pt; font-family: "Times New Roman", serif; margin: 0px;">
<strong><span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">Opioid Conversion Updates</span></strong></p>
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<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">Updated in 2018, some clinicians are unaware of the changes to the opioid conversion tables.</span></p>
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<span style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; color: white;">2010 Recommendations</span></p>
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<span style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; color: white;">2018 Updates</span></p>
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<span style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline; color: white;">Opioid</span></p>
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IV (mg)</p>
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PO (mg)</p>
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IV (mg)</p>
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PO (mg)</p>
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Morphine</p>
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10</p>
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30</p>
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10</p>
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<b><u>25</u></b></p>
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Fentanyl</p>
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0.1</p>
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NA</p>
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0.15</p>
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NA</p>
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Hydromorphone</p>
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1.5</p>
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7.5</p>
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<b><u>2</u></b></p>
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<b><u>5</u></b></p>
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Oxycodone</p>
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NA</p>
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20</p>
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NA</p>
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20</p>
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<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">When converting between opioids, it is important to remember the following steps:</span></p>
<ol start="1" style="color: rgb(0, 0, 0); font-family: "Segoe UI", "Segoe UI Web (West European)", "Segoe UI", -apple-system, system-ui, Roboto, "Helvetica Neue", sans-serif; font-size: 15px; margin-bottom: 0px;" type="1">
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<span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: Calibri, sans-serif; vertical-align: baseline; color: inherit;">Determine the patient’s level of pain and current response to therapy.</span></li>
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<span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: Calibri, sans-serif; vertical-align: baseline; color: inherit;">Calculate current opioid requirement.</span></li>
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<span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: Calibri, sans-serif; vertical-align: baseline; color: inherit;">Convert the opioid using table above.</span></li>
<li data-ogsc="black" style="font-size: 12pt; font-family: "Times New Roman", serif; margin: 0px;">
<span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: Calibri, sans-serif; vertical-align: baseline; color: inherit;">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.</span></li>
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<span style="margin: 0px; padding: 0px; border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; font-size: inherit; line-height: inherit; font-family: Calibri, sans-serif; vertical-align: baseline; color: inherit;">Monitor the patient for efficacy and side effects.</span></li>
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<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">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.</span></p>
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<fieldset><legend>References</legend>
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<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">References:</span></p>
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<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">McPherson, M. L. M. <i>Demystifying opioid conversion calculations: a guide for effective dosing</i>. American Society of Health-System Pharmacists. Bethesda, MD. 2018.</span></li>
<li style="color: rgb(0, 0, 0); font-size: 12pt; font-family: "Times New Roman", serif; margin: 0px;">
<span data-ogsc="black" style="margin: 0px; padding: 0px; border: 0px; font: inherit; vertical-align: baseline;">McPherson MLM. Why equianalgesic tables are only part of the answer to equianalgesia. Ann Palliat Med. 2020; 9(2):537-541.</span></li>
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