What is the conversion ratio for Dilaudid (hydromorphone) from intravenous (IV) to oral (PO) administration?

From the Guidelines

The conversion ratio for Dilaudid (hydromorphone) from intravenous (IV) to oral (PO) administration 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. This significant difference in potency occurs because of the first-pass metabolism that oral medications undergo in the liver before reaching systemic circulation, resulting in lower bioavailability compared to IV administration. Oral hydromorphone has a bioavailability of only about 20-25%, which explains the need for higher oral doses to achieve the same analgesic effect as IV dosing 1. When making this conversion in clinical practice, it's essential to reassess the patient's pain control and adjust dosing as needed, since individual patient factors such as hepatic function, age, and concurrent medications may affect metabolism and response to the medication. Some key points to consider when converting IV to oral hydromorphone include:

• The potency difference between IV and oral routes
• The impact of first-pass metabolism on oral bioavailability
• The need for individualized dosing based on patient factors
• The importance of monitoring and adjusting doses to achieve optimal pain control while minimizing adverse effects. Given the information provided in the study 1, it is crucial to prioritize the patient's safety and adjust the dosage accordingly to avoid any potential harm. In clinical practice, the conversion ratio of 1:5 for IV to oral hydromorphone is a general guideline, and the actual conversion may vary depending on the specific patient and clinical scenario. Therefore, it is vital to carefully evaluate each patient's response to the medication and adjust the dosage as needed to ensure effective pain management while minimizing the risk of adverse effects.

From the Research

Dilaudid IV to PO Conversion

The conversion ratio for Dilaudid (hydromorphone) from intravenous (IV) to oral (PO) administration is a crucial aspect of pain management. According to the studies, the following points can be noted:

• The median conversion ratio from IV to PO hydromorphone is 2.5, with a correlation of 0.95 (P < 0.0001) 2.
• This means that 1 mg of IV hydromorphone is equivalent to 2.5 mg of oral hydromorphone.
• The conversion ratio may vary depending on the dose of IV hydromorphone, with higher doses potentially requiring a lower conversion ratio 2.
• Another study found that a conversion ratio of 5:1 (morphine equivalent to hydromorphone) can be used for converting prior oral or transdermal opioid therapy to single daily doses of extended-release hydromorphone 3.
• However, it's essential to note that the conversion ratio may vary depending on the specific patient population and the clinical context.

Key Considerations

When converting Dilaudid from IV to PO, the following key considerations should be taken into account:

• The conversion ratio should be individualized based on the patient's response to the medication and their specific pain management needs.
• Close monitoring of the patient's pain and side effects is necessary to ensure that the conversion is successful and that the patient is receiving adequate pain relief.
• The conversion ratio may need to be adjusted over time as the patient's pain management needs change.

Comparison to Other Opioids

In comparison to other opioids, the conversion ratio for Dilaudid is unique and should not be extrapolated from other medications. For example:

• Morphine has a different conversion ratio, with a commonly cited ratio of 1:3 for IV to PO conversion 4.
• Fentanyl and other opioids may also have different conversion ratios, and these should be considered on a case-by-case basis 5.