Equianalgesia Opioid Calculator
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Transcript Equianalgesia Opioid Calculator
Equianalgesia Opioid Calculator:
JHH Applications
Suzanne A Nesbit, PharmD, CPE
Clinical Pharmacy Specialist, Pain Management
Department of Pharmacy
The Johns Hopkins Hospital
April 8, 2015
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
• X
30
• 135 = 20 X = 202.5 mg oral morphine
• decrease dose for incomplete cross
tolerance
Opioid Rotation
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Unresponsiveness
Unmanageable adverse effects
Route of administration
Potency
Cost
Equianalgesic Chart
Drug
Morphine
Hydromorphone
Parenteral
(mg)
10
Oral (mg)
30
1.5
7.5
24
20
24
Oxycodone
Fentanyl
Duration
(hours)
0.1
24
24
Methadone
5
10
68
Meperidine
75100
300
24
1
10
7-9
Oxymorphone
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
Challenging Conversions
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Fentanyl
Methadone
Oxycodone
Hydromorphone
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
4/8/2015
12
iPhone Application 2012
4/8/2015
15
Main Conversion Screen
4/8/2015
16
Drug and Dose Entry
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Final Output Screen
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