___________________________________________ Palliative Care and Pain Management at the End of Life
PROCESS FOR OPIOID SWITCHING
Calculate the total dose of the current opioid(s) taken in a 24-hour period.
Calculate the equianalgesic dose of the new drug.
If pain was effectively controlled with current drug, reduce the dose of the new drug by 25% to 50% (to allow for incomplete cross-tolerance). a
If pain was not effectively controlled with current drug, may begin with 100% or 125% of the equianalgesic dose.
Divide the 24-hour dose of the new opioid by the number of doses to be given over 24 hours.
Titrate liberally during first 24 hours, taking into account both pain relief and side effects.
Give 50% to 100% of the 4-hourly dose for breakthrough pain.
a Reduce by a greater percentage if the patient is older, frail, or has significant organ dysfunction. If changing to methadone, reduce the dose by 75%. If changing to transdermal fentanyl, do not reduce the dose and continue the current opioid for 12 to 48 hours. Source: [187; 206; 223] Figure 8
OPIOID EQUIVALENT DOSES
Drug
Oral Dose
Parenteral Dose
Morphine Codeine
30 mg
10 mg
200 mg 7.5 mg
NA
Hydromorphone Hydrocodone Oxycodone Oxymorphone
1.5 mg
30–45 mg
NA NA
20 mg 10 mg 20 mg
1 mg
Methadone
10 mg
Buprenorphine transdermal patch
5–10 mcg/hour
NA
Source: [187; 206; 223]
Table 9
31
MDCA1525
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