From the Guidelines
When converting from Dilaudid (hydromorphone) to oxycodone, use a ratio of approximately 1:3.75, considering the conversion factor of hydromorphone as 4 and oxycodone as 1.5, as indicated in the morphine milligram equivalent (MME) doses table 1. This means 1 mg of Dilaudid is roughly equivalent to 3.75 mg of oxycodone, but due to individual variability and incomplete cross-tolerance, it is recommended to start with a lower dose, around 75-80% of the calculated equivalent. Some key points to consider when making this conversion include:
- The conversion factor for hydromorphone is 4, and for oxycodone is 1.5, as shown in the table 1.
- Equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics 1.
- It is crucial to monitor the patient closely after conversion for signs of either inadequate pain control or excessive sedation.
- Individual patient factors, including age, renal function, hepatic function, and concomitant medications, can affect opioid metabolism and may necessitate further dose adjustments.
- The conversion is based on the different potencies of these opioids - hydromorphone is significantly more potent than oxycodone on a milligram-per-milligram basis due to differences in receptor binding affinity and bioavailability. For example, a patient taking 2 mg of Dilaudid would need approximately 7.5 mg of oxycodone for equivalent pain control, but the actual dose should be adjusted based on the patient's response and medical history.
From the FDA Drug Label
Conversion from Other Opioids to Oxycodone Hydrochloride Tablets There is inter-patient variability in the potency of opioid drugs and opioid formulations Therefore, a conservative approach is advised when determining the total daily dosage of oxycodone hydrochloride tablets. It is safer to underestimate a patient’s 24-hour oxycodone hydrochloride tablets dosage than to overestimate the 24-hour oxycodone hydrochloride tablets dosage and manage an adverse reaction due to overdose If a patient has been receiving opioid-containing medications prior to taking oxycodone hydrochloride tablets, the potency of the prior opioid relative to oxycodone should be factored into the selection of the total daily dose (TDD) of oxycodone
The FDA drug label does not provide a direct conversion ratio from Dilaudid to oxycodone.
- A conservative approach is advised when converting patients from other opioids to oxycodone hydrochloride tablets.
- The potency of the prior opioid relative to oxycodone should be factored into the selection of the total daily dose (TDD) of oxycodone.
- Close observation and adjustment of dosage based upon the patient’s response to oxycodone hydrochloride tablets is imperative 2.
From the Research
Opioid Conversion
- The process of converting from one opioid to another, such as from Dilaudid to oxycodone, requires careful consideration of individual patient characteristics, including age, renal function, side effects, and pain syndrome 3.
- Nurses play a crucial role in assessing patients receiving opioids for pain management and recommending changes to the treatment plan, including opioid conversion or rotation 3.
Equianalgesic Conversion
- Equianalgesic conversion involves converting from one opioid to another with the goal of achieving equivalent analgesic effects 3.
- The conversion must take into account individual patient characteristics and the patient's pain syndrome, and liberal titration and adjustment of doses may be necessary to ensure a smooth transition 3.
Interaction with Other Medications
- Pregabalin, a medication often used in combination with opioids, has been shown to enhance the antinociceptive effect of oxycodone and morphine in animal models without affecting their pharmacokinetics 4.
- Gabapentinoids, including pregabalin, have been associated with an increased risk of abuse and misuse, particularly in individuals with opioid use disorder 5, 6.