From the Guidelines
To convert 95mg of hydromorphone to morphine equivalents, you would multiply by a conversion factor of 5.0, resulting in 475mg of morphine equivalents, as indicated in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. This conversion is crucial for clinicians when assessing a patient's total opioid burden or rotating between different opioids.
- The conversion factor for hydromorphone is 5.0, as shown in the table of morphine milligram equivalent doses for commonly prescribed opioids for pain management 1.
- Hydromorphone is approximately 5 times stronger than morphine, meaning smaller doses of hydromorphone provide pain relief equivalent to larger doses of morphine.
- A dose of 95mg of hydromorphone represents a very high dose that would typically only be used in opioid-tolerant patients with severe pain, such as those with advanced cancer.
- This dose would be considered well above the recommended starting doses for opioid-naive patients and would carry significant risks of respiratory depression and other opioid-related adverse effects.
- When prescribing or administering opioids at this level, close monitoring for side effects and appropriate precautions (including naloxone availability) would be essential, as emphasized in the guideline 1.
From the FDA Drug Label
In another trial, 5 mg and 10 mg of hydromorphone hydrochloride oral solution were compared to 30 mg and 60 mg of morphine sulfate oral liquid. The pain relief provided by 5 mg and 10 mg hydromorphone hydrochloride oral solution was comparable to 30 mg and 60 mg oral morphine sulfate, respectively. To determine the morphine equivalent of 95mg of hydromorphone, we can use the ratio of hydromorphone to morphine from the study:
- 5 mg hydromorphone is comparable to 30 mg morphine
- 10 mg hydromorphone is comparable to 60 mg morphine We can calculate the ratio of hydromorphone to morphine as follows:
- 5 mg hydromorphone / 30 mg morphine = 1 mg hydromorphone / 6 mg morphine
- 10 mg hydromorphone / 60 mg morphine = 1 mg hydromorphone / 6 mg morphine Using this ratio, we can calculate the morphine equivalent of 95mg of hydromorphone:
- 95 mg hydromorphone x (6 mg morphine / 1 mg hydromorphone) = 570 mg morphine Therefore, 95mg of hydromorphone is equivalent to 570 mg of morphine 2
From the Research
Hydromorphone to Morphine Equivalents
To determine the morphine equivalent of 95mg of hydromorphone, we need to consider the conversion ratios provided in the studies.
- The study 3 found that 1mg of IV hydromorphone is equivalent to 11.46mg of morphine equivalent daily dose (MEDD).
- Another study 4 suggested a morphine to hydromorphone equivalence ratio of 3:1 for PCA (patient-controlled analgesia) use.
Calculating Morphine Equivalents
Using the conversion ratio from 3, we can calculate the morphine equivalent of 95mg of hydromorphone as follows:
- 95mg of hydromorphone x (11.46mg of MEDD / 1mg of hydromorphone) = 1088.7mg of MEDD However, this calculation is based on IV hydromorphone, and the study does not provide a direct conversion for oral hydromorphone to morphine equivalents.
Oral Hydromorphone to Morphine Equivalents
The study 3 also found that 1mg of IV hydromorphone is equivalent to 2.5mg of oral hydromorphone.
- To calculate the oral hydromorphone equivalent of 95mg of hydromorphone, we can use this ratio: 95mg of hydromorphone x (2.5mg of oral hydromorphone / 1mg of IV hydromorphone) = 237.5mg of oral hydromorphone Then, using the morphine to hydromorphone equivalence ratio of 3:1 from 4, we can estimate the morphine equivalent:
- 237.5mg of oral hydromorphone x (1mg of morphine / 3mg of hydromorphone) = 79.17mg of morphine
Note that these calculations involve some assumptions and may not be directly applicable to all clinical situations. The actual conversion ratio may vary depending on individual patient factors and the specific context of use.