Equivalent Dose of Dilaudid for Teva-Oxycocet 5-325 mg
For a 66-year-old male currently taking Teva-Oxycocet 5-325 mg 1 tablet orally every 6 hours PRN for pain (maximum 2 tablets/day), the equivalent dose of oral hydromorphone (Dilaudid) is 1-1.5 mg orally every 6 hours PRN (maximum 2-3 mg/day).
Dose Conversion Calculation
To determine the appropriate equivalent dose, I'll follow a systematic approach:
Calculate the total daily oxycodone dose:
- Teva-Oxycocet contains 5 mg oxycodone per tablet
- Maximum daily intake: 2 tablets = 10 mg oxycodone/day
Convert oxycodone to oral hydromorphone:
- According to the NCCN cancer pain guidelines, the equianalgesic ratio between oral oxycodone and oral hydromorphone is 5:1 1
- 10 mg oxycodone ÷ 5 = 2 mg oral hydromorphone per day
Divide for dosing schedule:
- For q6h dosing: 2 mg ÷ 4 = 0.5 mg per dose
- However, since hydromorphone tablets typically come in 1 mg, 2 mg, 4 mg, and 8 mg strengths, a practical starting dose would be 1 mg q6h PRN
Dosing Considerations
Incomplete cross-tolerance: When converting between opioids, a dose reduction of 25-50% is often recommended to account for incomplete cross-tolerance 1. Since the patient is on a relatively low dose of oxycodone, this reduction may not be necessary, but clinical judgment should be used.
Potency differences: Hydromorphone is significantly more potent than oxycodone. The guidelines indicate that oral hydromorphone is approximately 5 times more potent than oral oxycodone 1.
Formulation availability: Dilaudid (hydromorphone) is available in 1 mg, 2 mg, 4 mg, and 8 mg tablets. The 1 mg tablet would be most appropriate for this conversion.
Monitoring and Safety
Hydromorphone has a quicker onset of action compared to morphine and potentially oxycodone 1.
Due to its higher potency, there is a risk of respiratory depression. In one study, oxygen desaturation below 95% occurred in about one-third of patients receiving 2 mg IV hydromorphone 2, suggesting caution with dosing.
The patient should be monitored for side effects including nausea, constipation, somnolence, and dizziness, which are common with hydromorphone 3.
Important Caveats
The acetaminophen component in Teva-Oxycocet (325 mg per tablet) is not being replaced in this conversion. If the patient requires additional analgesia, a separate acetaminophen prescription could be considered.
If pain control is inadequate with 1 mg q6h, the dose could be cautiously increased to 1.5 mg or 2 mg q6h, not exceeding the calculated equivalent daily dose.
For elderly patients (66 years old), starting at the lower end of the dosing range (1 mg) is prudent to minimize adverse effects.