Related Article: Oral Opioid Medications.
Related Article:  How to Write Patient Controlled Analgesia (PCA) Orders.
Related Article: Opioid Conversion, Expanded Table.

Opioid Conversions and Opioid Equivalents

Morphine is used as the reference standard.

Opioid Agonist Parenteral Dose
(IV, SC, IM)
Oral Dose PO:IV Duration of Action, in hrs
Morphine 10 mg 30 mg 3:1 3-4
Morphine, long-acting 30 mg 12
HYDROmorphone 1.5 mg 7.5 mg 5:1 2-3
OXYcodone 15-20 mg 3-5
OXYcodone, long-acting 20 mg 12
HYDROcodone 30-45 mg 3-5
OXYmorphone 1 mg 10 mg 10:1 3-6
OXYmorphone, long-acting 10 mg 12
Codeine 180-200 mg 4
Fentanyl 0.1 mg (100 mcg) 2
Methadone

Tips

  • Parenteral morphine is 3 times as potent as oral morphine.

It’s best to consult pain management for Methadone dosing.

When switching from one opioid to another, “dosing must be titrated to individual response. There is often incomplete cross-tolerance among these drugs. It is, therefore, recommended to begin with a 50% lower dose than the equianalgesic dose when changing drugs and then titrate to a safe/effective response”

Use cautious dosing for elderly or debilitated patients, and patients with renal or hepatic impairment.

Immediate-release opioids are recommended for breakthrough pain.

 

References

Mark A. Schumacher, Ph.D., MD, et al. Opioid Analgesics and Antagonists. Chapter 31. Bertram G. Katzung BG: Basic & Clinical Pharmacology, 9e.

palliative.stanford.edu/opioid-conversion/equivalency-table

palliative.stanford.edu/opioid-conversion/equianalgesic-doses

https://emedicine.medscape.com/article/2138678-overview

Click to access Opioid-Comparison-Chart-Prescriber-Letter-2012.pdf

 

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