What is the oral oxycodone dose equivalent to 1.5 mg of hydromorphone (Dilaudid)?

Oral Oxycodone Equivalent to 1.5 mg Hydromorphone

1.5 mg of hydromorphone (Dilaudid) is equivalent to approximately 7.5-11 mg of oral oxycodone.

Calculation Using CDC Conversion Factors

The most straightforward approach uses the CDC's standardized morphine milligram equivalent (MME) conversion factors 1:

• Hydromorphone conversion factor: 5.0 1
• Oxycodone conversion factor: 1.5 1

Step-by-Step Conversion:

1. Convert hydromorphone to MME:

   • 1.5 mg × 5.0 = 7.5 MME 1

2. Convert MME to oxycodone:

   • 7.5 MME ÷ 1.5 = 5 mg oral oxycodone 1

Important Clinical Considerations

Route of Administration Matters

The calculation above assumes oral hydromorphone to oral oxycodone conversion. If the 1.5 mg hydromorphone dose is intravenous, the conversion differs significantly:

• IV hydromorphone is approximately 5 times more potent than oral hydromorphone 2
• 1.5 mg IV hydromorphone = approximately 7.5 mg oral hydromorphone 3
• 7.5 mg oral hydromorphone would then convert to approximately 11-15 mg oral oxycodone 4, 3

Critical Safety Warning

When converting between opioids, reduce the calculated equianalgesic dose by 25-50% to account for incomplete cross-tolerance and individual variability 1. This means:

• If converting from 1.5 mg oral hydromorphone, start with 2.5-4 mg oral oxycodone (50-75% of the 5 mg calculated dose) 1
• If converting from 1.5 mg IV hydromorphone, start with 5.5-8 mg oral oxycodone (50-75% of the 11 mg calculated dose) 1, 3

Potency Relationships

• Oral hydromorphone is 5-7 times more potent than oral morphine 1, 4, 2
• Oral oxycodone is 1.5-2 times more potent than oral morphine 1
• This creates an approximate 3.3-4.7:1 ratio between oral hydromorphone and oral oxycodone 1

Common Pitfalls to Avoid

Do not use MME calculations to determine actual conversion doses in clinical practice 1. The CDC explicitly warns that equianalgesic conversions are estimates only and cannot account for individual genetics and pharmacokinetics 1. Always start lower than the calculated dose when switching opioids 1.

Do not assume IV and oral routes are interchangeable 3, 2. The bioavailability difference is substantial and failing to account for this can lead to underdosing or dangerous overdosing 3.