What is the equivalent dose of IV Dilaudid (hydromorphone) for 50 micrograms of IV fentanyl?

IV Fentanyl to IV Hydromorphone Conversion

The equivalent dose of IV hydromorphone (Dilaudid) for 50 micrograms of IV fentanyl is approximately 0.8-1 mg. This conversion is based on the equianalgesic ratio where fentanyl is approximately 60-100 times more potent than morphine, and morphine is approximately 5-7 times less potent than hydromorphone.

Conversion Calculation Method

When converting between opioids, follow these steps:

1. Determine the equianalgesic ratio between the opioids:

   • IV fentanyl to IV morphine ratio is approximately 100:1 1
   • IV morphine to IV hydromorphone ratio is approximately 5:1 1

2. Calculate the morphine equivalent dose:

   • 50 mcg IV fentanyl = 5 mg IV morphine 1

3. Convert to hydromorphone:

   • 5 mg IV morphine = 1 mg IV hydromorphone 1

4. Adjust for incomplete cross-tolerance:

   • When converting between opioids, consider reducing the calculated dose by 25-50% to account for incomplete cross-tolerance, especially if pain was previously well-controlled 1
   • This would suggest a range of 0.5-0.75 mg IV hydromorphone

Clinical Example

This conversion is similar to the case example provided in guidelines:

• For IV morphine to IV hydromorphone conversion, a 10 mg IV morphine dose is equivalent to approximately 1.5-2 mg IV hydromorphone 1
• Therefore, 5 mg IV morphine (equivalent to 50 mcg IV fentanyl) would convert to approximately 0.8-1 mg IV hydromorphone 1

Important Considerations

• Individual patient factors: Age, renal function, and prior opioid exposure may necessitate dose adjustments 1

• Titration: After conversion, careful titration based on patient response is essential 1

• Monitoring: Close monitoring for both pain control and side effects is required during the first 24 hours after conversion 1

• Rescue doses: Provide rescue doses of short-acting opioids (10-20% of 24-hour dose) for breakthrough pain 1

• Renal function: Avoid using morphine in patients with renal failure due to risk of accumulation of renally cleared metabolites; hydromorphone may be preferred in this population 1

Potential Pitfalls

• Overestimation of dose: Starting with too high a dose of hydromorphone can lead to respiratory depression 1

• Underestimation of dose: Starting with too low a dose may result in inadequate pain control 1

• Incomplete cross-tolerance: Different opioid receptors may have varying degrees of tolerance, necessitating dose adjustments 1

• Individual variability: Patient response to opioids can vary significantly, requiring individualized titration 1