Examples of approximate equivalent doses when changing from morphine to another opioid (Table 10.7)
Examples of approximate equivalent doses when changing from morphine to another opioid (Table 10.7)
 CHANGING TO  | morphine oral 30 mg 4-hourly | morphine oral CR or SR 60 mg/day | morphine SC 10 mg 4-hourly | morphine CSCI 100 mg/day |
| fentanyl transdermal | 50 micrograms/hour | 25 micrograms/hour | 50 micrograms/hour | 75 micrograms/hour |
| hydromorphone oral | 6 mg 4-hourly | 2 mg 4-hourly | 6 mg 4-hourly | 10 mg 4-hourly |
| hydromorphone SC | 1.5–2 mg 4-hourly | 0.5 mg 4-hourly | 1.5–2 mg 4-hourly | 3 mg 4-hourly |
| methadone oral | [NB2] [NB3] | [NB2] [NB3] | [NB2] [NB3] | [NB2] [NB3] |
| morphine SC | 10 mg 4-hourly | 3 mg 4-hourly | 10 mg 4-hourly | 16 mg 4-hourly |
| morphine CSCI | 60 mg/day | 20 mg/day | 60 mg/day | 100 mg/day |
| morphine intrathecal [NB3] | 600 micrograms/day | 200 micrograms/day | 600 micrograms/day | 1 mg/day |
| | 60 micrograms/day | 20 micrograms/day | 60 micrograms/day | 100 micrograms/day |
| oxycodone oral | 15 mg 4-hourly | 5 mg 4-hourly | 15 mg 4-hourly | 25 mg 4-hourly |
| oxycodone oral CR | 40 mg twice daily | 20 mg twice daily | 40 mg twice daily | 80 mg twice daily |
| CR = controlled-release preparation; CSCI = continuous subcutaneous infusion; SC = subcutaneous; SR = sustained-release preparation NB1: these are average equivalents because of pharmacokinetic variation between individuals; doses are approximate because of the strengths of preparations available NB2: care needs to be taken with methadone to avoid toxicity because the time to reach steady-state concentrations following a change in dosage may be up to 12 days. Dose conversion ratios from other opioids are not static, but are a function of previous opioid exposure. Published tables of equianalgesic doses of opioids, established in healthy opioid-naive individuals, indicate that methadone is 1 to 2 times as potent as morphine in single-dose studies, but in individuals on long-term morphine, methadone is closer to 10 times as potent as morphine NB3: consultation with a pain clinic or a palliative care service is advised | ||||
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