From the Guidelines
The conversion from OxyContin (oral oxycodone) to IV hydromorphone (Dilaudid) should be based on a ratio of approximately 1:4, as indicated by the oral oxycodone to oral hydromorphone analgesic ratio, and considering the increased potency of IV administration, a more appropriate conversion would be around 3-4 mg oral oxycodone to 0.2-0.4 mg IV hydromorphone. When converting, it's crucial to consider the different potencies of these opioids, as well as individual patient factors such as age, renal and hepatic function, prior opioid exposure, and pain severity 1. For example, 30 mg of OxyContin would roughly convert to 1.5-4 mg of IV hydromorphone, depending on these factors.
- Key considerations in this conversion include:
- Incomplete cross-tolerance between opioids, necessitating initial dose reductions of 25-50%
- Close monitoring for respiratory depression, sedation, and other opioid side effects during the transition
- The significantly higher potency and increased bioavailability of hydromorphone when given intravenously compared to oral oxycodone
- Patient-specific factors, such as prior opioid exposure and pain severity, must be taken into account to ensure a safe and effective conversion, as outlined in guidelines for the management of cancer pain in adult patients 1.
- This conversion should only be performed by healthcare providers experienced in pain management and opioid conversions, due to the potential risks and complexities involved.
From the FDA Drug Label
Conversion from Other Opioids to Hydromorphone Hydrochloride Injection There is inter-patient variability in the potency of opioid drugs and opioid formulations. Therefore, a conservative approach is advised when determining the total daily dosage of Hydromorphone Hydrochloride Injection It is safer to underestimate a patient's 24-hour Hydromorphone Hydrochloride Injection dosage than to overestimate the 24-hour Hydromorphone Hydrochloride Injection dosage and manage an adverse reaction due to overdose If the decision is made to convert to Hydromorphone Hydrochloride Injection from another opioid analgesic using publicly available data, convert the current total daily amount(s) of opioid(s) received to an equivalent total daily dose of Hydromorphone Hydrochloride Injection and reduce by one-half due to the possibility of incomplete cross tolerance.
The FDA drug label does not provide a direct conversion from OxyContin to IV dilaudid. However, it advises to convert the current total daily amount(s) of opioid(s) received to an equivalent total daily dose of Hydromorphone Hydrochloride Injection and reduce by one-half due to the possibility of incomplete cross tolerance 2. Key points to consider when converting:
- Inter-patient variability in opioid potency
- Conservative approach to determine total daily dosage
- Reduce by one-half due to incomplete cross tolerance
- Titrate the dose according to the patient's response Note that OxyContin is not explicitly mentioned in the label, and dilaudid is another name for hydromorphone, which is the active ingredient in the drug label.
From the Research
OxyContin to IV Dilaudid Conversion
- The conversion ratio from OxyContin (oxycodone) to IV dilaudid (hydromorphone) is not directly stated in the provided studies.
- However, study 3 suggests a conversion ratio between oral morphine and oral hydromorphone of 5:1, and a conversion ratio between oral morphine and oral oxycodone of 1.5:1.
- Using these ratios, we can estimate the conversion ratio from OxyContin to IV dilaudid as follows:
- Therefore, the estimated conversion ratio from OxyContin to IV dilaudid is approximately 1:0.625 (or 1.6:1), assuming a 1:1 conversion between oral and IV oxycodone.
- However, it is essential to note that these conversions are estimates and may vary depending on individual patient factors, such as opioid tolerance and medical history.
- Study 5 provides information on the relative potency of oxymorphone compared to other opioids, but it does not directly address the conversion ratio from OxyContin to IV dilaudid.
- Study 6 discusses the conversion from IV opioid analgesic to oral controlled-release oxycodone, but it does not provide information on the conversion ratio from OxyContin to IV dilaudid.
- Study 7 discusses the conversion of high-dose IV opioids to epidural or intrathecal doses, but it does not provide information on the conversion ratio from OxyContin to IV dilaudid.