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LAST UPDATED: 25 May, 2022 
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route of current opioid = route of new opioid 24hr dose and route 24hr dose and route of current opioid of new opioid Ex: Pt is taking Morphine SR 90mg po Q12h; you want to switch to IV morphine. Your equation would look like this based on conversion table. 15mg PO morphine = 5mg IV morphine = 60mg IV
http://champ.bsd.uchicago.edu/palliativeCare/documents/Pallpaincard2009update.pdfDemystifying opioiD conversion calculations 87 n “In patients who are not opioid -tolerant [NOTE: Prescribing information does not exclude the 12 mcg/h TDF patch from this contraindication) n In the management of acute pain or in patients who require opioid analgesia for a short period of time n In the management of post-operative pain, including use after out ...
https://www.ashp.org/-/media/store-files/p1985-sample-chapter-5.ashxThere is considerable variations in other factors of opioid prescribing including dosage thresholds based on morphine milligram equivalents daily, who should be prescribing, the use of evidence and conflict of interest. There are several tools in the resources to help with opioid dosing, conversion and pain assessment:
https://cdn.ymaws.com/www.ascp.com/resource/resmgr/docs/toolkits/mstoc/mstoc_2.5.pdf4 hour equianalgesic dose = 90mg of morphine sulfate. Convert the calculated 24 hour equianalgesic dose of oral morphine to the 24 hour equianalgesic dose of the new opioid . Oxycodone is the preferred drug in this case as it is renally safer than morphine. Oxycodone is thought to be 1.5 times er than morphine.
https://palliative.stanford.edu/opioid-conversion/equianalgesic-doses/E. Online Opioid Calculators 1. Webster L, Fine P. Review and Critique of Opioid Rotation. Pain Medicine 2012; 13: 562‐570. Available Online Opioid Conversion Calculators • WA State Agency • Med Calc • Pain Research • Pain Physicians • Hopkins • Palliative Care • Global RPh • Practical Pain Management (PPM)
http://paindr.com/wp-content/uploads/2014/05/Fudin_Handout-Objectives-and-slides-Annual-Assembly.pdfOPIOID CONVERSION TABLE Parenteral (mg) Oral (mg) Morphine 1 3 Hydromorphone 1 0.2 1 Fentanyl 0.01 N/A Codeine 1 N/A 20-30 Methadone Consult APS Consult APS 1 Hydromorphone and codeine should not be used in patients with a true allergic reaction to morphine. Opioid Administration Guidelines 3.
http://www.pedmed.org/DrugApp/Supplementary/OPIOID%20ADMIN%20GUIDELINES.pdfOpioid Conversion Calculators •Med Calc •WA State Agency •Pain Research •Pain Physicians ›Hopkins ›Palliative Care › Global RPh ›Practical Pain Management Ref. Shaw K, Fudin J. Evaluation and Comparison of Online Equianalgesic Opioid Dose Conversion Calculators. Practical Pain Management. 2013 August; 13(7):61-66.
https://nyschp.memberclicks.net/assets/docs/2018AAPresentations/Fudin%20J.%20-%20Demystifying%20Opioid%20Conversion%20Calculations.pdfObjectives: The aim of this exploratory study was to assess the conversion ratios between tapentadol and other opioids in patients requiring an opioid switching. Methods: A prospective study was carried out in a convenience sample of consecutive patients admitted to an acute palliative care unit and a home care unit for a period of 1 year.
https://pubmed.ncbi.nlm.nih.gov/23540512/GlobalRPh Narcotic Converter – GlobalRPh ’s Narcotic Converter is free for 14 days, after which it is $27.95 to purchase We have deemed it worthy of a single free download, but not worth the $27.95 There are enough free, reliable conversion charts and calculators available on the web and the local library.
Opiate Equianalgesic Dosing Chart Committee 1nn s of age. 2nue to dimi i conti 3ncombtions must al g ht. 4nioid-t te-na#239;ve patie ue to cumulative effects . 09. urs) 4-11 12 8-22 25 23-37 50 38-52 75 53-67 100 68-82 125 83-97 150 98-112 175 113-127 200 cut patch.
https://www.med.unc.edu/aging/wp-content/uploads/sites/753/2018/06/Analgesic-Equivalent-Chart.pdfPublished equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid . Dosage titration of the new opioid should be completed slowly and with frequent monitoring. Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of ...
https://globalrph.com/medcalcs/morphine-equivalent-dose-med-opioid-conversions/Global RPh - has an automated narcotic conversion calculator. The only tricky part is the quot;Reduction for incomplete cross tolerancequot; field. This is a calculation that takes into consideration the concept of starting with a less than equianalgesic dose to avoid overdosing the patient. Many clinicians start with a 25-50% dose reduction.
https://pharmdexternship.blogspot.com/OBJECTIVES •Compare and contrast unique pharmacotherapy options for the treatment of chronic pain including: methadone, buprenoprhine, tapentadol, and tramadol •Select methadone, buprenorphine, tapentadol, or tramadol based on patient specific factors •Apply appropriate opioid conversion strategies to unique opioids •Understand opioid overdose risk ...
https://nyschp.memberclicks.net/assets/docs/EventsEducation/webinar/A%20Review%20of%20Unique%20Opioids%20and%20Their%20Conversions%20Handout.pdfOpioid Conversion Tables . Ernest Dole , Pharm.D., BCPS , PhC, FASHP . Clinical Pharmacist , University of New Mexico Hospitals . Chronic Pain C onsultation amp; Treatment Center . Table 1: Pharmacokinetic Data for Oral Opioids . Starting Dose Onset Peak Duration Half life Codeine 30 - 60 mg q 4 hr 30 min 1.5 hr 6 hours 2-4 hr Morphine SA
https://www.ashp.org/-/media/B76A200F75864442AC044C3B87E0ACD6.ashx› Global RPh › Practical Pain Management Ref. Shaw K, Fudin J. Evaluation and Comparison of Online Equianalgesic Opioid Dose Conversion Calculators. Practical Pain ...
https://www.fda.gov/media/150393/download4 hour equianalgesic dose = 90mg of morphine sulfate. Convert the calculated 24 hour equianalgesic dose of oral morphine to the 24 hour equianalgesic dose of the new opioid . Oxycodone is the preferred drug in this case as it is renally safer than morphine. Oxycodone is thought to be 1.5 times er than morphine.
https://palliative.stanford.edu/opioid-conversion/equianalgesic-doses/Percocet is Oxycodone, and Oxycodone is 2x stronger than Morphine. So a 7.5 Percocet is equal to 15mgs of Morphine. Hope that helped! Still looking for answers?
While they are both opioids, the primary difference between the two is that morphine is a naturally occurring, plant-based substance, whereas fentanyl is entirely synthetic. Fentanyl is also significantly more potent, roughly 100 times stronger than morphine.
In patients whose daily morphine requirements are expected to be less than or equal to 120 mg per day, the 30 mg tablet strength is recommended for the initial titration period. Once a stable dose regimen is reached, the patient can be converted to the 60 mg or 100 mg tablet strength, as appropriate.
Higher Dosage, Higher Risk. Higher dosages of opioids are associated with higher risk of overdose and death—even relatively low dosages (20-50 morphine milligram equivalents (MME) per day) increase risk. Higher dosages haven’t been shown to reduce pain over the long term.
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