From the Guidelines
To convert 2mg of morphine to hydromorphone (Dilaudid), the equivalent dose would be approximately 0.4mg of hydromorphone. This is based on the standard equianalgesic conversion ratio where hydromorphone is about 5 times more potent than morphine, as indicated in the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1. According to the guideline, the conversion factor for hydromorphone is 5.0, meaning 2mg of morphine is equivalent to 0.4mg of hydromorphone.
When making this conversion in clinical practice, it's essential to consider several factors, including:
- The patient's age and renal function, as these can affect the metabolism and excretion of the medication
- Previous opioid exposure, as this can impact the patient's tolerance and sensitivity to the new medication
- The patient's medical history, including any history of respiratory depression, sedation, or constipation
It's also crucial to start with a conservative dose and titrate as needed based on the patient's response, especially if the patient is opioid-naive. Hydromorphone has a faster onset of action (15-30 minutes) and shorter duration (3-4 hours) compared to morphine, which may influence dosing frequency. Always monitor for side effects such as respiratory depression, sedation, and constipation when administering any opioid medication. As noted in the guideline, equianalgesic dose conversions are only estimates and cannot account for individual variability in genetics and pharmacokinetics 1.
From the Research
Opioid Conversion
- The conversion of 2mg morphine to Dilaudid (hydromorphone) is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, it is known that hydromorphone is a more potent opioid than morphine, with a typical conversion ratio of 1.5-2mg of hydromorphone being equivalent to 10mg of morphine 5.
- The studies provided focus on the safety and efficacy of hydromorphone and other opioids in the treatment of opioid use disorder and pain management, but do not provide a direct conversion guide for 2mg morphine to Dilaudid.
Key Findings
- A study on the safety profile of injectable hydromorphone and diacetylmorphine found that related adverse events, including somnolence and opioid overdoses, were distributed throughout the treatment period 6.
- Another study examined the impact of high-dose opioid analgesics on overdose mortality and found that dose-dependent opioid overdose risk increased gradually across the range of average daily milligrams of morphine equivalents 4.
- The use of naloxone to counteract opioid overdose is a safe and effective treatment option 2, 5, 6.