Opioid - Narcotic - Converter

Opioid (Narcotic) analgesic converter

Converting From:

Step 1:
Step 2: (Enter total daily dose in mg)

Incomplete cross-tolerance correction

Step 3: Reduction for incomplete cross tolerance: %
(Usual range: 25 - 75% reduction)

Converting To:

Step 4:

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Conversion Data

The narcotic analgesic converter is based on the following table:
Note: levorphanol, oxymorphone, and propoxyphene have been eliminated from the calculator.

Drug

Duration

Half-life

Route

Equianalgesic
Dosage

Codeine

4–6 h

3 h

IM/IV/SC

120 mg

200 mg

Fentanyl

1–2 h

1.5–6 h

IM/IV

0.1 - 0.2 mg

Hydrocodone

4–8 h

3.3–4.5 h

20-30 mg

Hydromorphone

4–5 h

2–3 h

IM/IV/SC

1.3–1.5 mg

7.5 mg

Levorphanol

6–8 h

12–16 h

IM/IV/SC

2 mg

4 mg

Meperidine^æ

2–4 h

3–4 h

IM/IV/SC

75 mg

300 mg

Methadone

4–6 h

15–30 h

IM/IV/SC

1-10 mg^§Medline
Short term: 5-10mg
Chronic use: 1-4 mg
(2 mg)

2 - 20 mg^§ Medline
Short term use: 20 mg
Chronic dosing: 2-4 mg
(3mg)

Morphine

3–6 h

1.5–3 h

IM/IV/SC

10 mg

30–60 mg^#

Oxycodone

4–6 h

15-30 mg (20 mg)

Oxymorphone

3–6 h

IM/IV/SC

1 mg

Important Update: Opana™ and Opana ER™ (oxymorphone immediate release and oxymorphone extended release tablets) have been approved by the FDA.

10 mg

Propoxyphene

4–6 h

6–12 h

130-200 mg *

^*	Propoxyphene HCL: 130mg; Napsylate: 200mg. Not recommended for chronic pain management and therefore not available in program above.
^#	^{Acute dosing (opiate naive): 60mg. Chronic dosing: 30 mg.}
§:	Many equianalgesic tables underestimate methadone potency - more studies are needed. Parenteral: Program utilizes 10mg for short-term dosing and 2 mg for chronic dosing. Oral: Program utilizes 20mg for short-term dosing and 3 mg for chronic dosing.
æ	Meperidine should be used for acute dosing only and not used for chronic pain management (meperidine has a short half-life and a toxic metabolite: normeperidine). Its use should also be avoided in patients with renal insufficiency, CHF, hepatic insufficiency, and the elderly because of the potential for toxicity due to accumulation of the metabolite normeperidine. Seizures, confusion, tremors, or mood alterations may be seen.

References

Completed Medline Search
1.	Agency for Health Care Policy and Research. Acute Pain Management: Operative for Medical Procedures and Trauma. U.S. Department of Health and Human Services. February 1992:1-27..
2.	American Pain Society. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4th ed. Glenview, Ill. 1999.
3.	Anderson R, Saiers JH, Abram S, Schlicht C.Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage 2001 May;21(5):397-406
4.	Bruera E, Sweeney C.Methadone use in cancer patients with pain: a review.J Palliat Med 2002 Feb;5(1):127-38
5.	Cleeland, C.S. et al. "Pain and Its Treatment in Outpatients with Metastatic Cancer," N Engl J Med 330 (1994): 592-6.
6.	Coyle et al., "Character of the Terminal Illness in the Advanced Cancer Patient: Pain and Other Symptoms During the Last Four Weeks of Life," J Pain Sympt Mang 5 (1990): 84.
7.	Gagnon B, Bruera E. Differences in the ratios of morphine to methadone in patients with neuropathic pain versus non-neuropathic pain. J Pain Symptom Mgmt, 1999;18:120-125.
8.	Jacox, A., et al. Management of Cancer Pain. Clinical Practice Guideline No. 9, AHCPR Publication No. 94-0592, Rockville, Md. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service. 1994.
9.	Joranson, DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA, 2000;283:1710-1714.
10.	McCaffery, M., & Pasero, C. Pain: Clinical Manual, 2nd ed. St. Louis: Mosby. 1999.
11.	Mercadante S, Casuccio A, Fulfaro F, Groff L, Boffi R, Villari P, Gebbia V, Ripamonti C.Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study.J Clin Oncol 2001 Jun 1;19(11):2898-904
12.	Mercadante S, Casuccio A, Calderone L. Rapid switching from morphine to methadone in cancer patients with poor response to morphine. J Clin Oncol 1999 Oct;17(10):3307-12.
13.	Morley, JS, Makin, MK,: The use of methadone in cancer pain poorly responsive to other opioids. Pain Reviews. 1998, 5: 51-58.
14.	Moryl N, Santiago-Palma J, Kornick C, Derby S, Fischberg D, Payne R, Manfredi PL.Pitfalls of opioid rotation: substituting another opioid for methadone in patients with cancer pain.Pain 2002 Apr;96(3):325-8
15.	Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E.Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage 2001 Aug;22(2):672-87
16.	Ripamonti C, Zecca E, Bruera E. An update on the clinical use of methadone for cancer pain. Pain 1997; 70: 109-15.
17.	Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio? J Clin Oncol 1998 Oct;16(10):3216-21. Comment in: J Clin Oncol. 1998 Oct;16(10):3213-5.
18.	Rowlingson JC. Classification and Assessment of Chronic Pain. In Current Review of Pain 1994: Edited by Raj PP. Philadelphia, PA: Current Medicine; 1994:37-46.

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Disclaimer

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. Read the disclaimer