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The size of the breakthrough dose should be 5-15% of the patient's 24-hour baseline dose. In an inpatient setting, rescue doses can be provided IV every 15-30 minutes. Oral rescue doses can be offered as needed over the normal dosing interval of the drug (typically every 4 hours).
Table 1: Pharmacokinetic Data for Oral Opioids . Starting Dose Onset Peak Duration Half life Codeine 30 - 60 mg q 4 hr 30 min 1.5 hr 6 hours 2-4 hr Morphine SA 10 - 15 mg q 3 - 4 hr 15 min 1.5-2 hr 4 hr 1.5-2 hr Hydrocodone 5-10 mg q 4-6 hr 60 min 2 hr 4-6 hr 4 hr Oxycodone 5-10 mg q 4-6 hr 15-30 min 1-2 hr 4-6 hr 4 hr
When morphine at lower doses (e.g., 30–60 mg/d orally) is switched to methadone, the potency may be 3 to 5 times; when switched from high doses (e.g., >300 mg/d orally), the potency may be 12 times or even higher.
Consider the need to adjust dose for conditions that increase opiate risk (eg elderly, co-morbidities, renal or hepatic impairment). Where dose equivalence is expressed as a range, use the value that produces the lowest equivalent dose and titrate as necessary.
Use Oxycodone HCl equivalent for MME calculation. 8. Converts mcg to mg when computing MME. 9. Divide by number of days (dosage interval) for MME per day. 10. Reference value not listed due to risk of interpretation error. 11.
For example, if your reduced IV morphine dose was 50mg, the equivalent IV hydromorphone dose is 10mg. Divide this number by the bioavailability of the new drug to get a bigger number, that being the oral 24 hour dose of the new drug. Some rounding of numbers is fine.
Opioid Conversion Table. This table serves as a general guide to opioid conversion. Utilization of a direct conversion without a detailed patient and medication assessment is not recommended and may result in over- or underdosing.
