Opioid Pharmacology and Opioid Conversion 
 • Opioid-tolerant ...

Opioid Pharmacology and Opioid Conversion 

 • Opioid-tolerant defined as total daily dose (TDD) x7 days: morphine 60 mg/oxycodone 30 mg/hydromorphone 8 mg/fentanyl 25 mcg/h

 • Patients on suboxone or methadone for OUD → consult ACT for assistance with pain management

 • No max dose. Goal is to find minimum dose needed to control sx w/ minimal SE

 • Avoid use combo pills (limits titration flexibility)

 • Treat constipation prophylactically

 • Rotate opioids if side effects, dose reduce by 25-50%

Converting opioids

Step 1) Calculate total daily opioid requirement

Step 2) Convert TDD to equivalent dose of new opioid

Step 3) Divide TDD by number of doses per day - If initiating or converting to long-acting opioid, divide TDD into ER doses and add breakthrough dose (10-20% of TDD of ER opioid)

#Opioid #Pharmacology #Conversion #Opiate #table #pain #management 
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MGH White Book Manual
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf

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