OPIOID ANALGESIA – DRUG CONVERSIONS AT KIRKWOOD …
OPIOID ANALGESIA – DRUG CONVERSIONS AT KIRKWOOD HOSPICE GUIDE 2012
Based on PCF2 and 3 & Oxberry & Simpson, Pharmacotherapy for cancer pain, BJACEPD, 2005
All conversions are approximate and conversions at higher doses should be discussed with a consultant
Examples of dose conversion:
NOTE: All drug conversions are approximate and care should be taken in conversion factors, especially at higher opioid doses.
Zomorph PO to Diamorphine SC:
30mg Zomorph PO BD = 60mg Zomorph PO over 24 hours ÷ 3 = 20mg Diamorphine SC over 24 hours
Zomorph PO to Oxycodone PO:
30mg Zomorph PO BD = 60mg Zomorph PO over 24 hours ÷ 2 = 30mg Oxycodone PO over 24 hours = 15mg BD Oxycontin M/R
Oxycodone PO to Oxycodone SC:
20mg Oxycontin M/R PO BD = 40mg Oxycodone PO over 24 hours ÷ 2 = 20mg Oxycodone SC over 24 hours
Zomorph PO to Fentanyl TD:
45mg Zomorph PO BD = 90mg Zomorph PO over 24 hours ÷ 3.6 = 25 microgram per hour Fentanyl TD patch (change every 72 hrs)
Breakthrough doses of opioids tend to be calculated by combining the total daily dose of opioid, then dividing by 6 (six).
Hence, the breakthrough PRN dose of Oramorph for 60mg Zomorph over 24 hours = 60mg ÷ 6 = 10mg Oramorph PO PRN
which in turn equals 10 ÷ 3 = 3.3mg Diamorphine SC PRN (in practice 2.5-5mg Diamorphine SC PRN)
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TRANSDERMAL BUPRENORPHINE PATCH micrograms/hour
ORAL OXYCODONE PO mg/day
OXYCODONE S/C mg/day
DIAMORPHINE S/C mg/day
ORAL MORPHINE PO mg/day
TRAMADOL PO mg/day
÷3.6
×3.6
TRANSDERMAL FENTANYL PATCH micrograms/hr
÷10
×10
CODEINE PO mg/day
÷2
÷2
×1.7
÷1.7
×5 or 8
÷5 or 8
×2
×2
×3
÷3
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