From the Guidelines
Approximately 0.2-0.3 mg of IV Dilaudid (hydromorphone) is equivalent to 25 mcg of IV Fentanyl, considering the conversion factors and relative potencies of opioids. This conversion is based on the relative potency of opioids, where fentanyl is approximately 50-100 times more potent than morphine, and hydromorphone is about 5-7 times more potent than morphine 1. When converting between opioids, it's essential to consider that these are approximate equivalencies and individual patient responses may vary.
Key Considerations for Opioid Conversion
- Patients should be monitored closely after conversion for both efficacy and side effects.
- Factors such as prior opioid exposure, age, renal function, and concurrent medications can affect how a patient responds to the medication.
- When switching between opioids, it's generally recommended to start with a slightly lower dose than the calculated equivalent (about 25-50% reduction) to account for incomplete cross-tolerance and then titrate to effect while monitoring for respiratory depression, sedation, and other opioid-related side effects 1.
Opioid Conversion Table
The provided table from the study 1 recommends dose conversions from other opioids to transdermal fentanyl, but for IV fentanyl, the conversion would be different. However, using the conversion factors from 1, we can estimate the equivalent dose of hydromorphone for 25 mcg of IV fentanyl.
Clinical Judgment and Patient Monitoring
It's crucial to use clinical judgment when converting between opioids and to monitor patients closely for signs of overdose or underdose. The conversion factors provided in the studies 1 are estimates and may not account for individual variability in genetics and pharmacokinetics. Therefore, starting with a lower dose and titrating to effect is recommended to ensure patient safety and optimal pain management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Equivalent Dosing of IV Dilaudid and IV Fentanyl
- The provided studies do not directly address the equivalent dosing of IV Dilaudid (hydromorphone) and IV Fentanyl.
- However, study 2 discusses opioid rotation from transdermal fentanyl to continuous subcutaneous hydromorphone, but does not provide a direct conversion ratio between IV Dilaudid and IV Fentanyl.
- Study 3 mentions that nalbuphine and buprenorphine can be substituted for hydromorphone, fentanyl, and morphine, but does not provide specific dosing strategies for IV Dilaudid and IV Fentanyl.
- Studies 4 and 5 do not provide relevant information for determining the equivalent dosing of IV Dilaudid and IV Fentanyl.
- Therefore, based on the provided evidence, there is no direct answer to the question of how much IV Dilaudid is equivalent to 25 mcg IV Fentanyl 6, 2, 3, 4, 5.