April 19, 2023
Equianalgesia Opioid Calculator: JHH ApplicationsSuzanne A Nesbit, PharmD, CPEClinical Pharmacy Specialist, Pain Management
Department of Pharmacy
The Johns Hopkins Hospital
Patient Case
• 35 yo comes into the clinic complaining of persistent back pain. He has been taking Percocet (7.5mg oxycodone /324mg APAP) 2 tablets every 2-4 hours for his pain. He currently rates his pain 7/10.– Would you recommend any changes to his
regimen?• Long acting opioid + short acting for breakthrough
pain
Equianalgesia
• Different dose of two opioids that approximately provide the same pain relief
• convert route and drug
• morphine 10mg parenterally standard
• decrease dose by up to 50% in tolerant patient
Equianalgesic Conversion
• usually convert to morphine equivalents
• patient taking 18 Percocet (7.5mg/325mg) per day
• 18 X 7.5mg = 135 mg oxycodone
•
• 135 = 20 X = 202.5 mg oral morphine
• decrease dose for incomplete cross tolerance
30X
Opioid Rotation
• Unresponsiveness
• Unmanageable adverse effects
• Route of administration
• Potency
• Cost
Equianalgesic Chart
DrugParenteral
(mg) Oral (mg)Duration (hours)
Morphine 10 30 24
Hydromorphone 1.5 7.5 24
Oxycodone 20 24
Fentanyl 0.1 24
Methadone 5 10 68
Meperidine 75100 300 24
Oxymorphone 1 10 7-9
Current Equianalgesia Tables
• Single dose studies
• Broad guidelines
• Calculated dose reduced due to incomplete cross tolerance
• Clinical status of the patient considered
• Titrate and reassess
Equianalgesia Studies
• Single Dose– Usually acute pain ; opioid naïve patients
• Retrospective– Chart review of patients with opioid rotation
• Cross-over– Stable patients on an opioid; switched to
another to determine dose and analgesic effect
Dose Reduction
• Large interpatient variability in potencies to opioids
• Clinical status of patient: age, organ function, comorbidities, pain control
• Relative potencies for chronic dosing unknown• Cross-tolerance: incomplete
– start with 50%–75% of published equianalgesic dose– more if pain, less if adverse effects
• Methadone– start with 10%–25% of published equianalgesic dose
Johns Hopkins Opioid Conversion Software and Applications
• Floppy disc 1989• PDAs 2002
– Tungsten Palm Version– Windows CE Version
• Hopkins Opioid Program– Web-based version 2005
• www.hopweb.org• www.hopontheweb.org
04/19/23 12
Top Related