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
•
•
•
•
•
Unresponsiveness
Unmanageable adverse effects
Route of administration
Potency
Cost
Equianalgesic Chart
Drug
Morphine
Hydromorphone
Parenteral
(mg)
10
Oral (mg)
30
1.5
7.5
24
20
24
Oxycodone
Fentanyl
Duration
(hours)
0.1
24
24
Methadone
5
10
68
Meperidine
75100
300
24
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
•
•
•
•
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
4/8/2015
17
Final Output Screen
4/8/2015
18