Opioid Dose Conversions

• The guidelines are applicable to chronic pain for palliative care patients
• Calculate the equianalgesic starting dose of the new opioid using the guidelines
• Apply a dose reduction of 25% to 50% to the equianalgesic starting dose to allow for cross-tolerance
• A dose reduction closer to 50% is appropriate if the patient is elderly or medically frail
• Also consider
•  dose and duration of previous opioid treatment
• current pain severity
• renal and hepatic function
• occurrence of adverse effects
• direction of switch of opioid
• Provide supplemental opioid analgesia (breakthrough medication) during the titration process of 1/10th to 1/6th of the total daily opioid dose
• Frequently monitor for patient response and individual dose titration

References:

1. Opioid Conversion Ratios - Guide to Practice 2013. Eastern Metropolitan Region Palliative Care Consortium
2. http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20041106080808159860
3. Opioid Conversion Guidelines February 2011 Gippsland Region Palliative Care Consortium Clinical Practice Group