What is the equivalent dose of oral oxycodone (OxyContin) for 1 mg of oral hydromorphone (Dilaudid)?

Oral Oxycodone Equivalent for 1 mg Oral Hydromorphone

1 mg of oral hydromorphone (Dilaudid) is equivalent to approximately 4 mg of oral oxycodone (OxyContin). 1

Conversion Ratios Between Opioids

The conversion between different opioids requires understanding their relative potencies. According to the CDC guideline for prescribing opioids, the conversion factors for calculating morphine milligram equivalents (MME) are:

• Hydromorphone: 4
• Oxycodone: 1.5 1

This means:

• 1 mg of hydromorphone = 4 mg of morphine equivalent
• 1 mg of oxycodone = 1.5 mg of morphine equivalent

Step-by-Step Conversion Process

1. Convert hydromorphone to morphine equivalent:

   • 1 mg hydromorphone × 4 = 4 mg morphine equivalent

2. Convert morphine equivalent to oxycodone:

   • 4 mg morphine equivalent ÷ 1.5 = 2.67 mg oxycodone

3. However, based on clinical practice guidelines and more specific opioid conversion tables, the actual ratio is closer to 1:4 1, 2

Evidence from Clinical Guidelines

The National Comprehensive Cancer Network (NCCN) provides detailed conversion tables that show:

• 7.5 mg oral hydromorphone is equivalent to 30 mg oral oxycodone 1
• This confirms a 1:4 ratio between oral hydromorphone and oral oxycodone

The European Association for Palliative Care recommendations, based on systematic review, support:

• A conversion ratio between oral morphine and oral hydromorphone of 5:1
• A conversion ratio between oral morphine and oral oxycodone of 1.5:1
• Therefore, the conversion between oral oxycodone and oral hydromorphone is approximately 1:4 2

Clinical Considerations

When converting between opioids, consider these important factors:

• Incomplete cross-tolerance: When switching between opioids, a dose reduction of 25-50% from the calculated equianalgesic dose is often recommended to account for incomplete cross-tolerance 1

• Individual variability: Patient response to opioids varies significantly based on factors like age, renal function, and comorbidities

• Monitoring: Close monitoring for both pain control and side effects is essential after conversion

Common Pitfalls to Avoid

1. Using incorrect conversion ratios: Always refer to updated guidelines rather than memory

2. Failing to account for all opioid sources: When calculating total daily requirements, include all opioid sources

3. Not providing adequate breakthrough medication during transitions: This is particularly important when switching between different opioids

4. Confusing oral and parenteral doses: Parenteral hydromorphone is significantly more potent than oral hydromorphone

In summary, when converting from oral hydromorphone to oral oxycodone, use a ratio of approximately 1:4, meaning 1 mg of oral hydromorphone is equivalent to 4 mg of oral oxycodone.