From the Guidelines
Intravenous hydromorphone 0.5 mg is approximately equivalent to oral oxycodone 10 mg in terms of analgesic effect, though the onset and duration differ significantly. IV hydromorphone works within 5 minutes with peak effect at 15-30 minutes and lasts 2-3 hours, while oral oxycodone takes 30-60 minutes to begin working with effects lasting 3-4 hours. The IV route provides faster pain relief but requires healthcare provider administration and monitoring for respiratory depression. Oral oxycodone is more convenient for outpatient use but has more variable absorption.
Key Considerations
- When converting between these medications, consider that hydromorphone is approximately 5-7 times more potent than morphine, while oxycodone is about 1.5 times more potent than morphine, as shown in 1.
- Patient-specific factors including age, renal function, opioid tolerance, and comorbidities may necessitate dose adjustments, as noted in 1.
- Always start with conservative dosing when switching between opioids and titrate based on patient response to minimize adverse effects while maintaining adequate pain control.
Comparison of Opioids
- Hydromorphone and oxycodone are both effective alternatives to oral morphine, as stated in 1.
- Transdermal fentanyl and transdermal buprenorphine are best reserved for patients whose opioid requirements are stable, as mentioned in 1.
- Methadone is a valid alternative but, because of marked interindividual differences in its plasma half-life and duration of action, it is still considered as a drug which should be initiated by physicians with experience and expertise in its use, as noted in 1.
From the Research
Comparison of Hydromorphone and Oxycodone
- The comparison between 0.5 mg IV hydromorphone and 10 mg PO oxycodone can be evaluated based on their efficacy and safety profiles in managing pain.
- A study by 2 demonstrated that hydromorphone immediate-release tablets were non-inferior to oxycodone hydrochloride immediate-release powder in terms of efficacy for cancer pain management.
- Another study by 3 showed that once-daily OROS hydromorphone was non-inferior to twice-daily sustained-release oxycodone for moderate to severe chronic noncancer pain.
- The equianalgesic doses of hydromorphone and oxycodone varied across studies, but a study by 3 reported median equianalgesic doses of 16 mg OROS hydromorphone and 40 mg SR oxycodone.
Safety and Tolerability
- Both hydromorphone and oxycodone had acceptable safety profiles, with similar adverse event rates reported in several studies 2, 3, 4.
- A study by 5 compared the efficacy and safety of nalbuphine and hydromorphone in painless colonoscopy techniques and found that nalbuphine had a better postoperative comfort profile, with reduced incidence of nausea, vomiting, dizziness, and headache.
- The safety and tolerability of hydromorphone and oxycodone were maintained over a 1-year period, as reported in a study by 4.
Efficacy in Pain Management
- Hydromorphone and oxycodone were both effective in managing moderate to severe chronic noncancer pain, as demonstrated in studies by 3 and 4.
- A study by 6 discussed the use of opioids, including hydromorphone and oxycodone, in the management of chronic severe pain in the elderly, highlighting the importance of considering individual patient factors, such as comorbidities and functional status, when selecting an opioid analgesic.