I stumbled across this and I am going to reference it under my resource tab. When I first looked at the Equianalgesic dosage table it seemed rather vague and confusing, but in looking at it, I noticed that Morphine oral chronic pain was 30, so making a educated guess that everything else in the chart is referencing what is presumed to be a 30 MME dose. Please reference the first sentence I highlighted in RED. All of these MME equianalgesic values have no science nor double blind clinic studies behind their conclusions/values, they are considered CRUDE ESTIMATES AT BEST Within these tables there is many warnings about the lack of a black/white conversion from one opioid to another. There is no lab values or test to determine the intensity of a pt’s pain. Only the pt knows how intensive their pain is. There are a few lab tests that would SUGGEST that the pt has been dealing with under/untreated pain for some time. In my professional opinion, most people can generally tolerate <5 level of pain for an extended period of time, but that is not acceptable if their pain can be lowered without unacceptable side effects to get their pain to a lower level. Expecting a pt to live/exist is a >5 level of pain long term, I consider a torturous level of pain, and is not acceptable if their pain can be lowered without unacceptable side effects.
OPIOIDS – EQUIANALGESIC DOSAGES
D. McAuley: “Incomplete cross-tolerance relates to tolerance to a currently administered opiate that does not extend completely to other opioids. This will tend to lower the required dose of the second opioid. This incomplete cross-tolerance exists between all of the opioids and the estimated difference between any two opiates could vary widely. This points out the inherent dangers of using an equianalgesic table and the importance of viewing the tabulated data as approximations. Many experts recommend – depending on age and prior side effects – reducing the dose of the new opiate by 33 to 50 percent to account for this incomplete cross-tolerance. (Example: a patient is receiving 200mg of oral morphine daily (chronic dosing), however, because of side effects a switch is made to oral hydromorphone 25 – 35mg daily – (this represents a 33 to 50 percent reduction in dose compared to the calculated 50mg conversion dose produced via the equianalgesic calculator). This new regimen can then be re-titrated to patient response. In all cases, repeated comprehensive assessments of pain are necessary in order to successfully control the pain while minimizing side-effects.”
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| Equianalgesic dosage table | |||||||||||||||||||||||||||||||||||
| Buprenorphine (IM/IV): 0.4 Butorphanol (IM/IV): 2.0 Codeine (IM/IV): 120 Codeine (PO): 200 Fentanyl (IM/IV): 0.1 Fentanyl (Transdermal): 0.2 Hydrocodone (PO): 30 Hydromorphone (IV/IM/SC): 1.5 Hydromorphone (PO): 7.5 Levorphanol (acute PO): 4.0 Levorphanol (chronic PO): 1.0 Meperidine (IV/IM/SC): 75 Meperidine (PO): 300 Methadone (acute IV): 5.0 Methadone (acute PO): 10 |
Morphine (IV/IM/SC): 10 Morphine (acute PO): 60 Morphine (chronic PO): 30 Nalbuphine (IV/IM/SC): 10 Oxycodone (PO): 20 Oxymorphone (IV/IM/SC): 1.0 Oxymorphone (PO): 10 Tapentadol (PO): 75-100Methadone Chronic dosing: 0-99 mg: 4:1 100-299 mg: 8:1 300-499 mg: 12:1 500-999 mg: 15:1 >1000 mg: 20:1 |
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| Fentanyl Patch Conversions – Package Insert Recommendations | |||||||||||||||||||||||||||||||||||
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Filed under: General Problems
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