What is the oral oxycodone (OxyContin) equivalent dose for a patient requiring conversion from 1.5 mg of intravenous hydromorphone (Dilaudid)?

Oral Oxycodone Equivalent to 1.5 mg IV Hydromorphone

For 1.5 mg IV hydromorphone, the equivalent oral oxycodone dose is approximately 30 mg.

Conversion Calculation

The conversion requires two steps using established equianalgesic ratios from NCCN guidelines:

Step 1: Convert IV hydromorphone to oral morphine equivalent

• Using the NCCN conversion table, 1.5 mg/day IV hydromorphone equals 60 mg/day oral morphine 1
• This represents a 1:40 ratio for this specific dose range 1

Step 2: Convert oral morphine to oral oxycodone

• The established conversion ratio between oral morphine and oral oxycodone is approximately 1.5:1 to 2:1 2
• Using the more conservative 2:1 ratio: 60 mg oral morphine ÷ 2 = 30 mg oral oxycodone 1, 2

Clinical Context and Dose Adjustment

Apply incomplete cross-tolerance reduction:

• If the patient's pain was well-controlled on IV hydromorphone, reduce the calculated oral oxycodone dose by 25-50% to account for incomplete cross-tolerance 1
• This would result in 15-22.5 mg oral oxycodone as the starting dose 1
• If pain was poorly controlled, you may use 100% of the calculated dose (30 mg) or increase by 25% 3

Provide breakthrough medication:

• Prescribe immediate-release oxycodone at 10-20% of the total 24-hour dose (3-6 mg) every 1-2 hours as needed for breakthrough pain 4, 5
• If more than 3-4 breakthrough doses are required daily, increase the scheduled baseline dose rather than shortening the interval 4, 5

Important Clinical Considerations

Monitoring requirements:

• Reassess pain control and adverse effects within 24 hours after conversion, as steady state is reached within this timeframe 4
• Institute prophylactic bowel regimen with stimulant laxatives, as constipation is universal with opioid therapy 4

Common pitfall to avoid:

• Do not use analgesic potency ratios (which suggest hydromorphone is 5-7 times more potent than morphine) for these conversions, as they do not accurately reflect clinical conversion ratios 6, 2
• The NCCN table-based conversions are derived from clinical experience and should take precedence over theoretical potency calculations 1

Special populations:

• In renal impairment, start with one-fourth to one-half the calculated dose 4
• In hepatic impairment, similarly reduce the initial dose by 25-50% 4