From the Research
The conversion ratio from IV (intravenous) Dilaudid (hydromorphone) to PO (oral) Dilaudid (hydromorphone) is approximately 1:2.5, meaning that 1 mg of IV hydromorphone is equivalent to about 2.5 mg of oral hydromorphone. This conversion ratio is based on the study by 1, which found a median conversion ratio of 2.5 (2.14-2.75) with a high correlation of 0.95 (P < 0.0001).
When converting a patient from IV to oral hydromorphone, it is essential to consider individual patient factors such as age, renal function, and previous opioid exposure, as these may necessitate modifications to this standard conversion ratio. For example, if a patient is receiving 2 mg of IV hydromorphone, the equivalent oral dose would be approximately 5 mg.
It is crucial to monitor the patient closely for adequate pain control and potential side effects, and adjust the dose as needed. The difference in bioavailability between IV and oral administration, with oral hydromorphone having a lower bioavailability (approximately 20-30%) compared to IV administration (100% bioavailability) due to first-pass metabolism in the liver, should also be taken into account.
Some studies, such as 2, have reported variations in conversion ratios, but the study by 1 provides the most recent and highest quality evidence for the conversion ratio from IV to oral hydromorphone. Other studies, such as 3, 4, and 5, provide additional information on the pharmacology and safety of hydromorphone, but do not directly address the conversion ratio.
Key points to consider when converting from IV to oral hydromorphone include:
- The conversion ratio of 1:2.5
- Individual patient factors that may affect the conversion ratio
- Close monitoring of the patient for adequate pain control and potential side effects
- Adjustment of the dose as needed
- The difference in bioavailability between IV and oral administration.