What is a suitable regimen for converting 203 Morphine Milligram Equivalents (MME) to OxyContin (oxycodone) twice a day with oxycodone for breakthrough pain?

Converting 203 MME to OxyContin and Immediate-Release Oxycodone Regimen

For a 203 MME daily dose, an appropriate conversion would be OxyContin 60 mg twice daily (120 mg total) with immediate-release oxycodone 15 mg every 4-6 hours as needed for breakthrough pain. 1, 2

Conversion Calculation

• According to CDC guidelines, oxycodone has a conversion factor of 1.5, meaning 203 MME equals approximately 135 mg of oxycodone daily 1
• When converting between opioids, a conservative approach is recommended - starting with a lower dose (approximately 75-80% of the calculated equivalent) to account for incomplete cross-tolerance 1, 2
• This yields a total daily oxycodone dose of approximately 100-110 mg, which can be divided between long-acting and breakthrough medications 2

OxyContin (Extended-Release) Dosing

• OxyContin should be administered twice daily (every 12 hours) for most patients to maintain consistent pain control 1
• For a 203 MME conversion, OxyContin 60 mg twice daily (120 mg total) provides the foundation for around-the-clock pain control 1
• While some patients may require dosing every 8 hours, twice-daily dosing is preferred for simplicity and compliance 1

Breakthrough Pain Management

• Immediate-release oxycodone should be available for breakthrough pain 1
• The appropriate breakthrough dose is typically 10-15% of the total daily extended-release dose 1
• For this regimen, immediate-release oxycodone 15 mg every 4-6 hours as needed would be appropriate 1, 2

Monitoring and Adjustments

• Reassess pain control within 24-48 hours after initiating therapy 1, 2
• If breakthrough pain occurs consistently before the next scheduled OxyContin dose, consider increasing the regular dose rather than increasing dosing frequency 1
• The drug regimen should be kept as simple as possible to improve compliance 1

Important Cautions

• When converting between opioids, there is significant inter-patient variability in response; close monitoring is essential during the first 24-72 hours 2
• It is safer to underestimate the initial 24-hour oxycodone requirement and provide adequate breakthrough medication than to overestimate and risk overdose 2
• Some patients may require three-times-daily dosing of extended-release oxycodone if they consistently experience end-of-dose failure with twice-daily dosing 3

Titration Strategy

• If pain control is inadequate, increase the OxyContin dose by 25-50% at 48-hour intervals 1, 2
• Monitor the frequency of breakthrough medication use - if consistently using more than 3-4 doses daily, increase the OxyContin dose accordingly 1
• The goal is to achieve a balance between pain control and minimizing adverse effects 2