What is the oral Dilaudid (hydromorphone) equivalent in Morphine Milligram Equivalents (MME) for a patient taking 5 mg of oxycodone orally?

Oxycodone 5 mg PO to Oral Dilaudid (Hydromorphone) Conversion

For 5 mg oral oxycodone: the equivalent oral hydromorphone dose is approximately 1 mg, and this represents 7.5 MME (Morphine Milligram Equivalents).

Step-by-Step Conversion Calculation

First: Calculate the MME from Oxycodone

• 5 mg oral oxycodone = 7.5 MME 1
• The CDC establishes a conversion factor of 1.5 between oxycodone and morphine equivalents 1
• This means oxycodone is 1.5 times more potent than morphine 1

Second: Convert to Oral Hydromorphone

• Oral hydromorphone is approximately 5 times more potent than oral morphine on a milligram basis 2
• Using the established conversion ratio of 5:1 (morphine:hydromorphone) 3, 2
• 7.5 mg morphine equivalent ÷ 5 = 1.5 mg oral hydromorphone
• However, clinical practice typically rounds to 1-1.5 mg oral hydromorphone as the practical equivalent 4

Critical Safety Considerations When Converting

Reduce the Calculated Dose by 25-50%

• Always reduce the calculated equianalgesic dose by 25-50% when switching opioids to account for incomplete cross-tolerance and individual pharmacokinetic variability 3, 1, 5
• This means the starting dose should be 0.75-1 mg oral hydromorphone rather than the full calculated 1.5 mg 1
• Individual patient factors such as prior opioid exposure, renal function, and concomitant medications significantly affect the appropriate conversion 5

Monitor and Titrate Carefully

• Assess efficacy and side effects every 60 minutes for orally administered opioids 3
• Provide breakthrough doses of 10-20% of the total 24-hour opioid dose for transient pain exacerbations 4
• If more than 3-4 breakthrough doses per day are required, increase the scheduled baseline dose 4

Common Pitfalls to Avoid

Don't Use Conversion Tables as Absolute Values

• Equianalgesic dose ratios are approximate guides only; clinical judgment must be used to titrate to the desired response 3
• Conversion factors cannot account for individual variability in genetics and pharmacokinetics 1

Special Population Considerations

• In renal impairment: Start with one-fourth to one-half the usual dose, as hydromorphone metabolites may accumulate 4, 5
• Hydromorphone appears safer than morphine in renal insufficiency, but caution is still required 4
• In hepatic impairment: Similarly reduce the dose by one-fourth to one-half 4

Route-Specific Cautions

• If converting to IV hydromorphone instead of oral, the ratio changes dramatically
• 1 mg IV hydromorphone = 2.5 mg oral hydromorphone 6
• This would make 5 mg oral oxycodone equivalent to approximately 0.4-0.6 mg IV hydromorphone (after applying the 25-50% reduction for safety)

Practical Clinical Application

For an opioid-tolerant patient taking 5 mg oral oxycodone who needs conversion to oral hydromorphone:

• Start with 0.75-1 mg oral hydromorphone every 4 hours (conservative approach with 25-50% reduction) 1, 4
• Provide 0.2 mg oral hydromorphone as breakthrough dosing (approximately 20% of single dose) 4
• Reassess within 24 hours and titrate based on pain control and side effects 4
• Institute prophylactic stimulant laxative immediately, as constipation is universal with opioid therapy 3, 4