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18mg to 28mg 24mg 10 micrograms/hour 27mg to 41mg 36mg 15 micrograms/hour 36mg to 65mg 48mg 20 micrograms/hour Transdermal buprenorphine changed every three or four days (twice weekly) 24-hour dose oral morphine (mg/day) Buprenorphine patch strength three or four days (twice weekly) patch*** (micrograms/hour) Bristol and Weston Palliative
Morphine. Conversions are complex. 1.3mg oral hydromorphone is equivalent to 10mg oral morphine. Please seek advice. Depending on age, comorbidities and prior side effects, consider reducing the dose of the new opioid by up to 33-50% when converting between strong opioids.
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20 mg x 6 doses = 120 mg daily 120 mg divided by 2 = 60 mg = 60 mg twice daily. Ensure also that an appropriate dose of immediate release opioid is prescribed “as required (prn)” for breakthrough pain. This should be the 4 hourly equivalent of the total daily dose. To calculate a prn dose, divide the total daily dosage of opioid by six.
Prescribe 4 hourly prn doses of subcutaneous (sc) morphine unless contraindicated. If 2 or more rescue/ prn doses are needed in 24 hours, start a syringe driver with appropriate opioid and continue patch(es). The opioid dose in the SD should equal the total prn doses given in the previous 24 hours up to a maximum of 50% of the existing regular ...
Tapentadol 0.4 50mg x 0.4 = 20mg morphine equivalent 12.5 micrograms / hour 30mg / day Tramadol 0.1 50mg x 0.1 = 5mg morphine equivalent 25 micrograms / hour 60mg / day 37.5 micrograms/ hour 90mg / day Injections Approximate equivalent potency conversion ratio Multiply total daily dose of prescribed drug by
75 mcg, 150 mcg, 300 mcg, 450 mcg, 600 mcg, 750 mcg, 900 mcg ; 0.03
ntanil* rather than the 30:1 conversion in the table above. *Seek specialist advice when doses are greater than the equivalent of 180mg PO morphine in 24 hours Consider reducing the equianalgesic dose by 25-33% if converting from a less sedating opioid, e.g. fentanyl to morphine, oxycodone or diamorphine, a.
