Oxycodone 5 mg PO = Approximately 1 mg PO Dilaudid (Hydromorphone)
Using the CDC 2022 conversion factors, 5 mg oral oxycodone converts to approximately 1 mg oral hydromorphone (Dilaudid). 1
Calculation Method
The CDC 2022 Clinical Practice Guideline provides standardized conversion factors to morphine milligram equivalents (MME):
- Oxycodone conversion factor: 1.5
- Hydromorphone conversion factor: 5.0 1
Step-by-step conversion:
- Convert oxycodone to MME: 5 mg × 1.5 = 7.5 MME
- Convert MME to hydromorphone: 7.5 MME ÷ 5.0 = 1.5 mg hydromorphone
However, the 2008 ESMO guideline suggests hydromorphone is 7.5 times more potent than oral morphine 2, which would yield approximately 1 mg hydromorphone for 5 mg oxycodone.
Critical Safety Considerations
When converting between opioids, always reduce the calculated equianalgesic dose by 25-50% to account for incomplete cross-tolerance and individual variability. 1 This is essential to prevent overdose.
- If using the CDC conversion (1.5 mg calculated dose), reduce to 0.75-1.1 mg hydromorphone
- Start conservatively at 1 mg hydromorphone for 5 mg oxycodone
- Titrate upward based on response
The CDC explicitly warns: "Do not use the calculated dose in MMEs to determine the doses to use when converting one opioid to another; when converting opioids, the new opioid is typically dosed at a substantially lower dose than the calculated MME dose to avoid overdose." 1
Clinical Context
Research supports this conversion ratio. Studies comparing hydromorphone to oxycodone in cancer pain found equivalent efficacy when hydromorphone was dosed at approximately 1/5 to 1/4 the oxycodone dose 3, 4, 5. The conversion ratio from IV hydromorphone to oral morphine equivalent daily dose (which includes oxycodone) was found to be approximately 11.46:1 6, supporting the relative potency difference.
Practical dosing: For a patient on oxycodone 5 mg, initiate hydromorphone at 1 mg and provide immediate-release breakthrough doses of 0.2-0.5 mg (20-30% of scheduled dose) every 1-2 hours as needed, adjusting the total daily dose based on breakthrough requirements.