What is the equivalent dose of long-acting hydromorphone (hydromorphone) for a patient taking 4 mg of short-acting hydromorphone (hydromorphone) daily?

From the Guidelines

The equivalent dose of long-acting hydromorphone for a patient taking 4 mg of short-acting hydromorphone daily is 4 mg of long-acting hydromorphone daily. When converting between short-acting and long-acting formulations of the same opioid, the total daily dose remains the same, only the frequency of administration changes 1. For implementation, the patient should take the 4 mg long-acting hydromorphone once daily, typically as a single dose. This conversion maintains the same total daily dose while providing more consistent pain control throughout the day with fewer peaks and troughs in blood concentration.

The long-acting formulation is designed to release the medication gradually over 24 hours, which can improve patient compliance, provide more stable analgesia, and reduce the risk of breakthrough pain. It's essential to note that the conversion factor for hydromorphone is 5.0, as indicated in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. However, this conversion factor is used to determine the morphine milligram equivalent dose, not for converting between short-acting and long-acting formulations of the same opioid.

Key points to consider when switching from short-acting to long-acting hydromorphone include:

• Monitoring the patient after switching formulations to ensure adequate pain control
• Assessing for any side effects
• Adjusting the dose as needed to achieve optimal pain management
• Educating the patient on the proper use of the long-acting formulation and the importance of taking it as directed.

It's crucial to prioritize the patient's safety and well-being during this transition, and the recommended dose of 4 mg long-acting hydromorphone daily should be individualized based on the patient's response and medical history 1.

From the FDA Drug Label

Conversion from Hydromorphone Hydrochloride Tablets to Extended-Release Hydromorphone Hydrochloride The relative bioavailability of hydromorphone hydrochloride tablets compared to extended-release hydromorphone hydrochloride is unknown, so conversion to extended-release tablets must be accompanied by close observation for signs of excessive sedation and respiratory depression.

The FDA drug label does not answer the question.

From the Research

Equivalent Dose of Long-Acting Hydromorphone

To determine the equivalent dose of long-acting hydromorphone for a patient taking 4 mg of short-acting hydromorphone daily, we need to consider the conversion ratios provided in the studies.

• The study 2 found that 1 mg of IV hydromorphone is equivalent to 2.5 mg of oral hydromorphone.
• The study 3 used a conversion ratio of 8:1 mg of oral morphine to oral ER hydromorphone HCl.
• The study 4 suggested that the same total daily dose of immediate-release hydromorphone and once-daily osmotic-controlled extended-release hydromorphone had comparable effects.
• The study 5 used a ratio of 5:1 (morphine sulphate equivalent to hydromorphone hydrochloride) for conversion to extended-release OROS hydromorphone.

Conversion Ratios

Based on the studies, the conversion ratios are:

• 1 mg of IV hydromorphone to 2.5 mg of oral hydromorphone 2
• 8:1 mg of oral morphine to oral ER hydromorphone HCl 3
• 1:1 total daily dose of immediate-release hydromorphone to once-daily osmotic-controlled extended-release hydromorphone 4
• 5:1 (morphine sulphate equivalent to hydromorphone hydrochloride) for conversion to extended-release OROS hydromorphone 5

Calculation of Equivalent Dose

Using the 1:1 total daily dose conversion ratio from study 4, the equivalent dose of long-acting hydromorphone for a patient taking 4 mg of short-acting hydromorphone daily would be 4 mg of long-acting hydromorphone.

Key Points

• The conversion ratio may vary depending on the specific study and population.
• The equivalent dose of long-acting hydromorphone may need to be adjusted based on individual patient response and titration.
• The studies suggest that a 1:1 conversion ratio may be used for switching from short-acting to long-acting hydromorphone, but this should be done under close medical supervision. 6, 2, 3, 4, 5