Conversion Chart for Strong Opioids in Palliative Care

Conversion Chart for Strong Opioids in Palliative Care This is advice on conversion factors and dose equivalents. It is not a guideline on using opioids. For further advice see www. palliativecareguidelines. scot. nhs. uk If converting in the opposite direction multiply rather than divide. *When changing to a different opioid it is usual to reduce the final opioid dose by one third: vigilance for opioid toxicity and provision for breakthrough pain is advised at this time. Contact Palliative care team for advice. ORAL MORPHINE mg/24 hrs Contact palliative care team Divide by 2 SUBCUTANEOUS MORPHINE mg/24 hrs Divide by 3 SUBCUTANEOUS DIAMORPHINE mg/24 hrs Equivalent* FENTANYL PATCH microgram/hr Divide by 2* ORAL OXYCODONE mg/24 hrs Divide by 2 SUBCUTANEOUS OXYCODONE mg/24 hrs Divide by 7. 5* ORAL HYDROMORPHONE mg/24 hrs Divide by 2 SUBCUTANEOUS HYDROMORPHONE mg/24 hrs Contact palliative care team Divide by 10* SUBCUTANEOUS ALFENTANIL mg/24 hrs Breakthrough pain: • For same opioid & route divide 24 hour opioid dose by 6 • For Fentanyl: divide patch strength (microgram) by 5 to get breakthrough SC diamorphine dose (mg) Incident pain: For Abstral® , fentanyl sublingual tablet, start at lowest dose, 100 micrograms, and titrate up. Adapted for use in NHS Ayrshire and Arran by Karen Menzies, with kind permission from NHS GG&C March 2018