UMEM Educational Pearls

Title: Opioid Conversion Updates

Category: Pharmacology & Therapeutics

Posted: 12/5/2020 by Ashley Martinelli (Updated: 11/21/2024)
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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.