Wednesday, September 23, 2015

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

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