From the Guidelines
The IV to oral (PO) conversion ratio for dilaudid (hydromorphone) is approximately 1:5, meaning that 1 mg of IV hydromorphone is equivalent to about 5 mg of oral hydromorphone. When converting a patient from IV to oral hydromorphone, multiply the IV dose by 5 to determine the appropriate oral dose. For example, if a patient is receiving 2 mg of IV hydromorphone, the equivalent oral dose would be approximately 10 mg. This conversion is based on the relative analgesic ratios for opioid switching, as outlined in the ESMO clinical practice guidelines for the management of cancer pain in adult patients 1. The guidelines provide a range of conversion ratios for different opioids, including oral morphine to oral hydromorphone, which is listed as 1:5 to 1:7.5 1. However, the most relevant and specific conversion ratio for IV to oral hydromorphone is approximately 1:5. Some key points to consider when making this conversion include:
- Monitoring the patient closely for adequate pain control and potential side effects such as respiratory depression, sedation, or constipation
- Dose adjustments may be needed based on individual patient response, renal function, age, and other factors
- Implementing a bowel regimen when starting oral opioids to prevent constipation It's essential to note that the oral bioavailability of hydromorphone is approximately 20-25%, which explains the 1:5 conversion ratio. By following this conversion ratio and taking into account individual patient factors, healthcare providers can ensure safe and effective pain management for patients transitioning from IV to oral hydromorphone.
From the Research
IV to PO Conversion of Dilaudid
- The conversion ratio from intravenous (IV) hydromorphone to oral hydromorphone is approximately 1:2.5, meaning that 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 that 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.
- It's essential to note that the pharmacokinetics of hydromorphone can be affected in patients with hepatic or renal impairment, which may impact the conversion ratio and increase the risk of adverse effects 3, 4, 5, 6.