Hydrocodone to Oxycodone Conversion
30 mg of hydrocodone is equivalent to approximately 20 mg of oxycodone, but you should reduce this by 25-50% when switching opioids, resulting in a starting dose of 10-15 mg of oxycodone daily. 1
Conversion Calculation
The conversion is based on morphine milligram equivalent (MME) calculations using CDC conversion factors:
- Hydrocodone 30 mg daily = 30 MME (conversion factor 1.0) 2
- Oxycodone conversion factor = 1.5 2
- Calculated equivalent: 30 MME ÷ 1.5 = 20 mg oxycodone daily 1
This can be verified using standard equianalgesic tables showing that 60 mg oral morphine equals 30 mg oral oxycodone, maintaining the same 2:1 ratio. 1
Critical Safety Reduction
You must reduce the calculated equianalgesic dose by 25-50% when rotating between opioids. 2, 1 This reduction accounts for:
- Incomplete cross-tolerance between different opioid molecules 2, 1
- Individual pharmacokinetic variability 2
- Patient-specific factors such as renal or hepatic insufficiency 2
Therefore, start with 10-15 mg oxycodone daily (50-75% of the calculated 20 mg dose). 1
Implementation Strategy
- Provide breakthrough medication at 10-20% of the total daily dose every 4-6 hours as needed 1
- Reassess within 24-48 hours after initiating oxycodone to evaluate pain control and side effects 1
- Titrate cautiously based on response, using the smallest practical dose increases 2
Common Pitfalls to Avoid
The research literature demonstrates significant variability in opioid conversion practices among clinicians, with large standard deviations in calculated doses. 3, 4 Never use the calculated MME dose directly without the 25-50% reduction, as this creates substantial overdose risk due to incomplete cross-tolerance. 2, 1 The conversion factors are estimates and cannot account for individual genetic and pharmacokinetic variability. 2