Aspirus Wausau Hospital
PHARM-033 mmk 12/04
Opioid Equianalgesic Conversion chart
Aspirus Wausau Hospital 11/2003
USUAL ORAL STARTING DOSE FOR MODERATE TO
Medication listed are oral dosages
SEVERE PAIN IN ADULTS (ELDERLY MAY REQUIRE
forms available at Aspirus Wausau Hospital
Morphine sulfate oral solution
2 & 4 mg/ml10 mg immediate release tabs (IR) 20 mg/ml concentrated soln
Morphine sulfate controlled release
15, 30, 60,100 mg tablets
2 & 4 & 8 mg tablets
Meperidine (Demerol®) Methadone (Dolophine®)
10 mg tablets
Roxycodone, Percolone®, OxyIR® 5 mg immediate release tablets
5 mg/325 mg (Percocet®)5 mg/325 mg per 5 ml liquid
5 mg/325 mg tablet (Percodan®)
Oxycodone controlled release
10 , 20, 40, and 80 mg tabletsPropoxyphene/APAP
100 mg/650 mg
(various- Vicodin, Lortab, Lorcet, Norco)
5 mg/500 mg7.5 mg/500 mg 10 mg/325 mg2.5 mg/167 mg per 5 ml liquid
7.5 mg/200 mg
15, 30, and 60 mg tabs 15 mg/5 ml oral soln.
(Tylenol # 2, 3, or 4)
Duragesic® Transdermal patch
25, 50, 75, 100 mcg/hr
Need to provide PRN medication while
starting and adjusting transdermal dosing.
After patch is removed the serum levels
drop 50% in 17 hours.
5-10 mg PO q 3-4h15-30 PO q 12h
(Not for PRN dosing)
2-4 mg PO q 3-4 hours
PO conversion dose may be less. The ratio can vary
considerably and may be as little as 30 mg Morphine =
5 mg Methadone with repetitive dosing.
5-10 mg PO q 3-4 hours 10-20 mg PO q 12 h
(Not for PRN dosing)
NOT Recommended - Accumulation of toxic metabolite with repetitive dosing in patients with renal dysfunction.
Inappropriate in the elderly. Do not exceed 6 tablets
(600 mg) in any 24 hour period.
5-10 mg PO q 3-4 hours
Watch APAP content: Maximum recommended
amount is 4000 mg per 24 hours
Watch for ibuprofen content: Maximum
recommended dose is 3200 mg per 24 hours
30-60 mg PO q 3-4 hours
Initial transdermal dose depends upon daily
Opioid (PO doses) 24 hr analgesic require-
ment (oral doses)
Fentanyl patch 25 ug/hr 50 ug/hr
Oxycodone 30-90 mg 90-150 mg
Hydromorphine 11-33 mg 33-56 mg
Morphine (IR. CR) 45-134 mg 135-224 mg
This list is not inclusive of all oral agents but limited to what is available at Aspirus Wausau Hospital Pharmacy.
Quick conversion: Percocet 2 tabs q4h = 2 – Hydrocodone/APAP 7.5/500 tablets q4h = 15 mg Morphine IR tablets q4h = 45 mg MS Contin q12 = 1.25
mg/hr IV Morphine infusion = Fentanyl 25 mcg/hr transdermal patch q72hrs.
Meperidine is NOT an option for oral dosing. Meperidine is not recommended for multiple dosing or chronic use. Meperidine should be avoided in patients with
renal dysfunction, history of seizures, or the elderly.
INSTRUCTION FOR USE OF EQUIANALGESIC CONVERSION CHART* Download full-text
DON’T PANIC - YOU CAN DO THIS!!
2. Set up ratio using values from the table for new medication or change in route of administration.
Note: all boxes are equal on chart (vertically and horizontally).
X = total mg of desired medication/24 hours = mg of new medication from equivalency chart
Total mg of present medication in 24 hours mg of present medication from equivalency chart
3. Solve for X**.
4. Calculate new medication dosage into appropriate frequency for a 24-hour period.
Example: divide by 6 for q 4 hours, divide by 4 for q 6 hours and so on.
5. Figure breakthrough dose by 5 to 15% of the total daily dose.
6. Remember stimulant laxative (e.g. Senokot, Senna).
Calculate the total amount of narcotic used by the patient in the last 24 hours.
Mrs. D, 45 years old. Breast cancer, metastatic to bone. Comfortable on MSO4 at 6 mg/hr IV.
Convert to PO medication before discharge.
1. Figure out total 24 hour daily dose of IV morphine.
6 mg/hr IV x 24 hours = 144 mg morphine IV
Set up ratio of IV to PO morphine from table
X mg/day PO MSO4
144 mg/day IV MSO4
Solve for X (144 x 30/10 = 442)
X = 442 mg/day PO morphine
Divide by 2 for BID formulation of extended release morphine or divide by 6 for immediate release
morphine administered every 4 hours.
Sig: 200 mg extended release morphine PO BID or 70 mg immediate release morphine PO q 4 hours.
Also prescribe breakthrough doses of 5% to 15% of total daily dose.
Sig: 20–60 mg immediate release morphine PO q 1 hour PRN.
Remember stimulant laxative.
10 mg IV MSO4
30 mg PO MSO4
Mr. B, 67 years old. Severe left hip osteoarthritis. POD #3, S/P total hip arthroplasty.
Comfortable on PCA MSO4 1mg q 6 minutes with 30 mg q 4 hours lockout..
Over past 24 hours, patient required 18 mg IV MSO4.
Convert to PO hydrocodone.
1. Figure out total 24 hour dose of IV morphine.
From PCA records patient received = 18 mg IV MSO4
2. Set up ratio of IV MSO4 to PO Hydrocodone using equianalgesic table.
18 mg IV MSO4x 30 mg PO Hydrocodone
10 mg IV MSO4 =
Divide by 6 for q 4 hour dosing.
54 mg PO hydrocodone divide by 6 = 9 mg hydrocodone q 4 hours
Consider hydrocodone/APAP options:
10 mg/325 mg PO q 4 hours = 60 mg/24 hours or 7.5 mg/500 PO q 4 hours = 45 mg/24 hours
Remember stimulant laxative.
54 mg PO Hydrocodone per 24 hours
*When converting to methadone, these instructions generally do not apply. Recommend consulting a pharmacist or
physician experienced in converting to methadone.
**When changing to a different opiate (not route) in patients requiring a narcotic analgesic chronically may need to
reduce the calculated dose by 25 to 50% (or more) due to the lack of cross tolerance between different opiates.