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Opioid conversion tips - Denver, Colorado

Chronic Pain Management ChartsCCaallccuullaattiinngg tthhee rreessccuuee ddoossee 1. Calculate 10% of the provided totaldaily Opioid dose as an immediate-release aaddjjuussttmmeennttss1. Calculate the total oral 24-houropioid taken by adding the amountof the sustained-release and imme-diate-release rescue doses. 2. Divide total daily dose into appro-priate intermittent doses basedupon the specific Opioid dosingintervals found in the Dosing andConversion Chart for OpioidAnalgesics. CChhaannggiinngg ttoo aannootthheerr oorraall ooppiiooiidd1. Calculate the total daily dose ofcurrent Opioid (add the long-actingand rescue doses).2. Use the Dosing and ConversionChart for Opioid Analgesics to cal-culate the equivalent total daily oraldose of the alternative Opioid . 3. Divide total daily dose of the alter-native Opioid into appropriate inter-mittent doses based upon the spe-cific Opioid dosing intervals foundin the Dosing and ConversionChart for Opioid Analgesics.

Dosing and Conversion Chart for Opioid Analgesics Drug Route Equianalgesic Duration (h) Plasma Half-Life (h) Dose (mg) Morphine IM 10 4 2-3.5 Morphine PO 30 4 4

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Transcription of Opioid conversion tips - Denver, Colorado

1 Chronic Pain Management ChartsCCaallccuullaattiinngg tthhee rreessccuuee ddoossee 1. Calculate 10% of the provided totaldaily Opioid dose as an immediate-release aaddjjuussttmmeennttss1. Calculate the total oral 24-houropioid taken by adding the amountof the sustained-release and imme-diate-release rescue doses. 2. Divide total daily dose into appro-priate intermittent doses basedupon the specific Opioid dosingintervals found in the Dosing andConversion Chart for OpioidAnalgesics. CChhaannggiinngg ttoo aannootthheerr oorraall ooppiiooiidd1. Calculate the total daily dose ofcurrent Opioid (add the long-actingand rescue doses).2. Use the Dosing and ConversionChart for Opioid Analgesics to cal-culate the equivalent total daily oraldose of the alternative Opioid . 3. Divide total daily dose of the alter-native Opioid into appropriate inter-mittent doses based upon the spe-cific Opioid dosing intervals foundin the Dosing and ConversionChart for Opioid Analgesics.

2 4. Modify by reducing dose by 25%-50% for incomplete cross-toleranceCChhaannggiinngg aann oorraall ooppiiooiidd ttoo iittss IIVV//SSQQ rroouuttee1. Calculate the total amount of oralopioid taken per 24 hours (addlong-acting and rescue doses).2. Use the Dosing and ConversionChart for Opioid Analgesics to cal-culate the equivalent total daily par-enteral dose. 3. Divide the dose by 24 to get thehourly drip rate. CChhaannggiinngg aann oorraall oorr IIVV ooppiiooiidd ttoo ttrraannss--ddeerrmmaall ffeennttaannyyll1. Calculate the total Opioid dose. 2. Use the Dosing and ConversionChart for Opioid Analgesics tocalculate the equivalent total dailymorphine Use the Morphine to FentanylEquivalents chart to determine theequianalgesic dose of aann ooppiiooiidd aaggeenntt aanndd rroouuttee((oorraall ttoo IIVV))1.

3 Calculate the total daily dose of theoriginal Opioid (add long-acting andrescue doses).2. Use the Dosing and ConversionChart for Opioid Analgesics toconvert from an oral to IV Use the Dosing and ConversionChart for Opioid Analgesics toconvert original Opioid to an alter-native, equivalent IV dose. 4. Adjust the dose for incompletecross tolerance by reducing dose by25%-50%.5. Divide adjusted dose by 24 toobtain hourly Opioid infusion :The Dosing and ConversionChart for Opioid Analgesics will helpyou calculate the equivalent dose ofthe new Opioid , but you must allowfor the incomplete nature of cross tol-erance to Opioid side patients take the same opi-oid dose for a week or two, theybecome tolerant of the Opioid s seda-tive and respiratory depressive another Opioid is substitutedfor the original Opioid , patients willnot be completely tolerant to the newopioid s side effects, which can lead toover-sedation or confusion.

4 You mustcalculate the equianalgesic dose ofthe new Opioid , and then reduce thedose by 25%-50%. The single exception to this ruleis when prescribing fentanyl. Theequianalgesic tables for fentanyl havebeen adjusted, so you can use thedoses given in the conversion toTransdermal Fentanyl (Duragesic) fentanyl/morphine conversion tableswithout further the total daily dose of oxy-codone:100 mg x 2 = 200 mgUse the Dosing and ConversionChart for Opioid Analgesics to calcu-late the equivalent oral hydromor-phone dose (the conversion ratio ofoxycodone to hydromorphone is20 , or :1): 200 mg oxycodone / = 77 mgoral hydromorphone (round offto 75 mg)Adjust the total 24-hour oral hydro-morphone dose downward by 25%-50%:75 mg x 2/3 = 50 mg Divide the total daily dose of hydro-morphone into appropriate intermit-tent doses based upon the Dosingand conversion Chart for OpioidAnalgesics.

5 50 mg / 6 doses per day = 8 mgevery 4 hours Opioid conversion tipsCChhaannggiinngg ttoo aannootthheerr oorraall ooppiiooiiddQuestion:A patient is taking sustained-release oxycodone, 100 mg every 12 hours, but has developed intolerable sedation. Shewould like to try an immediate-release Opioid agent, hydromorphone. What is the equivalent dose of hydromorphone? OB7009 web charts 11/30/07 2:39 PM Page 1 Dosing and conversion Chart for Opioid Analgesics DrugRouteEquianalgesic Duration (h)Plasma Half-Life (h)Dose (mg) (Dilaudid) (Dilaudid) IM753-42 MeperidinePO3003-4 normeperidineMethadone IM10*6-8 12-24 MethadonePO20*6-8 20-200 Fentanyl IM-HydrocodonePO303-44 Adapted from Foley KM.

6 The treatment of cancer pain. N Engl J Med. 1985;313:84-95. (PMID: 2582259) *The equianalgesic dose of methadone compared to other opioids is extremely variable with chronic dosing. conversion from oralmorphine to oral methadone may range from 4 to 14:1. Risk of CNS depression with repeated use; accumulation in elderly or persons with impaired renal function with regular for patient variability in duration of is it addiction?How can you tell if your patient is truly addicted to opioids? The following definitions are jointly from The AmericanAcademy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine: Addiction:Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factorsinfluencing its development and manifestations.

7 It is characterized by behaviors that include one or more of the following:impaired control over drug use, compulsive use, continued use despite harm, and Dependence:Physical dependence is a state of adaptation that is manifested by a drug-class-specific withdrawalsyndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or adminis-tration of an :Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of oneor more of the drug s effects over extra: Chronic Pain Management OB7009 web charts 11/30/07 2:39 PM Page 2


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