SPECIALIST PALLIATIVE CARE OPIOID DRUG CONVERSION …

1 SPECIALIST PALLIATIVE CARE. OPIOID DRUG CONVERSION CHART. NOTE: When using this chart, calculate the total daily dose of morphine. Once CONVERSION is calculated, ensure OPIOID dose is prescribed in divided doses as appropriate. subcutaneous . MORPHINE. mg/day subcutaneous . OXYCODONE ORAL OXYCODONE. X4 2 x2. mg/day mg/day x2. 4. 2. TRANSDERMAL. X3 subcutaneous . fentanyl PATCH 3. (microgram/hour DIAMORPHINE. mg/day 3 3. 10. ORAL TRANSDERMAL. BUPRENORPHINE PATCH. ORAL MORPHINE (microgram/hour strength). TRAMADOL mg / day mg/day x 10. 10. ORAL CODEINE* OR 30. subcutaneous . DIHYDROCODEINE. x10 ALFENTANIL. mg/day 30 mg/day * The conversions given are comparable doses but there is wide patient intervariability relating to OPIOID CONVERSION . Using the chart In renal impairment (GFR <30ml/min) morphine and In renal impairment (GFR <15ml/min) subcutaneous diamorphine in particular can accumulate.)

2 Alfentanil may be considered - seek SPECIALIST advice. The arrow outward shows how to convert from Alternative opioids of choice are oxycodone po/sc, morphine to the alternative drug fentanyl and buprenorphine patches. If using other The arrow inward shows how to get options use low doses and increase the dose interval, the equivalent dose of oral morphine and regularly monitor and review. See the GUIDANCE NOTES overleaf Approved by HERPC: Sept 17 Updated: Jan 20 Review: Jan 2023. OPIOID Drug Conversions Example calculations from total daily dose of General Guidelines 80mg oral morphine This chart is designed for guidance only. The conversions Daily dose Calculation to Suggested given are comparable doses but there is wide patient of morphine alternative drug prescribed dose of intervariability relating to OPIOID CONVERSION .

3 For individual (mg) alternative drug patients, response to previous opioids, clinical condition and severity of pain must be taken into consideration. 80 fentanyl patch fentanyl patch The chart is intended to be used as a guide by working 80 3 = 25microgram/hour through the oral daily dose equivalent of morphine microgram/hour This chart is intended as a guide to a safe starting dose 80 subcutaneous subcutaneous and for all patients the required dose should be carefully oxycodone oxycodone titrated according to response. 80 4 = 20mg/ 20 mg per 24 hours BE AWARE: patients tend to respond better to the new day OPIOID if no/mild pain, consider a reduction when 80 Oral oxycodone Oral oxycodone S/R. converting. 80 2 = 40 mg/ 20 mg BD. Take particular care if switching from oral to parenteral day opioids if clinical concerns regarding oral absorption.

4 80 subcutaneous subcutaneous For patients on higher doses of opioids (morphine diamorphine diamorphine >300mg/day), SPECIALIST PALLIATIVE care assessment and 80 3 = 25mg per 24 hours advice should be sought. 80 subcutaneous subcutaneous It is good practice to document your rationale for OPIOID Alfentanil alfentanil switching and clinical reasoning. 80 30 = per 24 hours When calculating doses always double check your calculation, with someone else if possible. 80 Buprenorphine Buprenorphine patch Round doses up or down to a sensible number patch 35 microgram per dependent upon the drug and formulations available. 80 = hour microgram/hour Remember to prescribe breakthrough doses for PRN use (1/6 of total daily dose). Example calculations from weak opioids to To convert to/from METHADONE seek SPECIALIST oral morphine advice.

5 Dose of weak Calculation to Suggested Note: Prescribe by brands to avoid confusion. OPIOID oral morphine prescribed total Please be aware that there are several different daily dose of oral buprenorphine patches available. morphine (mg). Some are changed weekly Butec and BuTrans, others Codeine 60mg Codeine 240 10 20. are changed twice weekly Transtec and Bupeaze (96 qds = 24mg/day hrs) or Hapoctasin (72 hrs). Please see the BNF or Summary of Product Dihydrocodeine Dihydrocodeine 20. Characteristics (available at ) for full 60mg qds 240 10 = 24mg/. details of all available products. day For SPECIALIST PALLIATIVE care advice contact your local Tramadol Tramadol 400 40. SPECIALIST services. 100mg qds 10. For information on medicines: = 40mg / day or References: Twycross, R.

6 And Wilcock, A. (2014) PALLIATIVE Care Formulary (PCF5). Nottingham: Ltd. Approved by HERPC: Sept 17 Updated: Jan 20 Review: Jan 2023.