From the Guidelines
When converting Dilaudid (hydromorphone) from oral to intravenous administration, a conversion ratio of approximately 5:1 should be used, where 5 mg of oral hydromorphone is equivalent to about 1 mg of IV hydromorphone, but the most accurate conversion can be determined by using equianalgesic dose calculations as shown in the example of converting IV morphine to IV hydromorphone 1. To determine the equianalgesic dose of IV hydromorphone from oral hydromorphone, first calculate the total daily dose of oral hydromorphone the patient is taking.
- Then, use an equianalgesic dose table or calculation to find the equivalent dose of IV morphine, knowing that 10 mg IV morphine is equivalent to 5 mg IV hydromorphone, as seen in the case example 1.
- It's crucial to consider the patient's current level of pain control and adjust the dose accordingly, reducing the calculated equianalgesic dose by 25%-50% if the patient's pain is well-controlled, or using the full calculated dose if pain control is inadequate 1.
- Factors such as age, renal function, and prior opioid exposure should be taken into account when making this conversion, and patients should be monitored closely for signs of opioid toxicity, including respiratory depression and sedation, especially during the initial 24 hours after conversion 1.
- The conversion should prioritize minimizing morbidity, mortality, and maximizing quality of life, thus a careful and individualized approach is necessary.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dilaudid PO to IV Conversion
- The conversion ratio from intravenous (IV) hydromorphone to oral hydromorphone is approximately 1:2.5, meaning 1 mg of IV hydromorphone is equivalent to 2.5 mg of oral hydromorphone 2.
- The opioid rotation ratio (ORR) from IV hydromorphone to oral morphine equivalent daily dose (MEDD) is approximately 1:11.46, meaning 1 mg of IV hydromorphone is equivalent to 11.46 mg of MEDD 2.
- However, the ORR may vary depending on the dose of IV hydromorphone, with higher doses (≥30 mg/day) potentially requiring a lower ORR to other opioids 2.
- Other studies have compared the effectiveness of different analgesics, including hydromorphone, in various clinical settings, but do not provide specific conversion ratios for Dilaudid PO to IV conversion 3, 4, 5, 6.