What dose of Dilaudid (hydromorphone) is equivalent to 10mg of morphine sulfate?

From the Guidelines

A dose of 2 mg of Dilaudid (hydromorphone) is approximately equivalent to 10 mg of morphine sulfate. When converting between these opioids, it's essential to consider the potency ratio, which is about 5:1 to 7:1, as indicated in the study by 1. This means that a smaller dose of hydromorphone is needed to achieve the same analgesic effect as morphine.

• The exact conversion may need to be adjusted based on individual patient factors such as age, renal function, prior opioid exposure, and pain severity.
• According to the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, the conversion factor for hydromorphone is 5.0, which supports the calculation that 2 mg of hydromorphone is equivalent to 10 mg of morphine sulfate.
• When switching from one opioid to another, it's generally recommended to start with a slightly lower equivalent dose (about 25-50% reduction) to account for incomplete cross-tolerance and then titrate as needed based on pain control and side effects, as suggested by 1.
• Patients should be monitored closely after conversion, especially during the first 24-48 hours, for signs of over-sedation or inadequate pain control as individual responses to opioids can vary considerably.

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 equivalent dose of Dilaudid (hydromorphone) for 10 mg of morphine sulfate, we can use the ratio of hydromorphone to morphine sulfate from the study.

• 5 mg of hydromorphone is comparable to 30 mg of morphine sulfate
• 10 mg of hydromorphone is comparable to 60 mg of morphine sulfate Since 10 mg of morphine sulfate is one-third of 30 mg of morphine sulfate, we can estimate the equivalent dose of hydromorphone as one-third of 5 mg of hydromorphone for 10 mg of morphine sulfate, but a more direct comparison is not available from the provided information, however, 1.67 mg of hydromorphone (5 mg / 3) would be the calculated equivalent to 10 mg of morphine sulfate based on the ratio of 5 mg hydromorphone to 30 mg morphine sulfate, but this is an extrapolation. 2

From the Research

Equivalent Dose of Dilaudid to Morphine Sulfate

To determine the equivalent dose of Dilaudid (hydromorphone) to 10mg of morphine sulfate, we need to consider the dose ratios between these two opioids.

• The study 3 mentions a ratio of 5:1 between morphine sulphate equivalent to hydromorphone hydrochloride.
• Another study 4 also proposes a dose ratio of 5:1 between morphine and hydromorphone.

Calculation of Equivalent Dose

Based on the 5:1 ratio, we can calculate the equivalent dose of Dilaudid as follows:

• 10mg of morphine sulfate is equivalent to 10mg / 5 = 2mg of hydromorphone (Dilaudid).

Important Considerations

It's essential to note that these ratios are general guidelines and may vary depending on individual patient factors, such as previous opioid exposure and tolerance.

• The study 4 highlights that the dose ratios may not be consistent across different patient populations and opioid regimens.
• Other studies, such as 5, 6, and 7, discuss the efficacy and safety of hydromorphone compared to morphine, but do not provide specific dose ratios for conversion.

Summary of Findings

In summary, based on the available evidence, 2mg of Dilaudid (hydromorphone) is equivalent to 10mg of morphine sulfate, assuming a 5:1 dose ratio. However, it's crucial to consider individual patient factors and consult with a healthcare professional for personalized guidance on opioid conversion and dosing.