From the Guidelines
Dilaudid (hydromorphone) 0.5mg is equivalent to 2.5mg of morphine. This is based on the conversion factor of 5.0 for hydromorphone, as indicated in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. To calculate the morphine milligram equivalent (MME) dose, we multiply the dose of hydromorphone (0.5mg) by the conversion factor (5.0), resulting in 2.5 MME. It's essential to note that equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics 1. When converting between opioids, it's crucial to start with a substantially lower dose than the calculated MME dose to avoid overdose due to incomplete cross-tolerance and individual variability in opioid pharmacokinetics 1. Key considerations for conversion include:
- The conversion factor for hydromorphone is 5.0, as per the CDC guideline 1
- Individual patient responses to opioids can vary significantly
- Starting with a lower dose (about 25-50% less) than the calculated equivalent and titrating as needed is recommended to minimize the risk of adverse effects.
From the Research
Morphine Equivalent of Dilaudid (Hydromorphone)
To determine the morphine equivalent of Dilaudid (hydromorphone) 0.5mg, we need to consider the available evidence on the potency and efficacy of hydromorphone compared to morphine.
- The provided studies do not directly report a morphine equivalent dose for hydromorphone 0.5mg 2, 3, 4, 5, 6.
- However, it is known that hydromorphone is a potent opioid analgesic, and its efficacy is compared to morphine in various studies 3, 6.
- A study on the pharmacology of hydromorphone mentions its potency and efficacy but does not provide a direct conversion to morphine equivalent dose 3.
- Another study discusses the use of hydromorphone for neuropathic pain and its comparison with other opioids, including morphine, but does not provide a specific conversion factor 4.
- The World Health Organization recommends morphine as the drug of choice for moderate to severe cancer pain, and hydromorphone is considered an alternative for patients with significant adverse effects from morphine or severe renal dysfunction 2, 5.
- A systematic review of hydromorphone in acute and chronic pain suggests that hydromorphone is a potent analgesic with little difference in analgesic efficacy, adverse effect profile, and patient preference compared to other opioids, including morphine 6.
Limitations
- The available studies do not provide a direct conversion factor for hydromorphone 0.5mg to morphine equivalent dose.
- The potency and efficacy of hydromorphone can vary depending on the individual patient, pain condition, and route of administration.
- Further research is needed to establish a reliable conversion factor for hydromorphone to morphine equivalent dose.