Fillable Printable Opioid Conversion Chart Sample
Fillable Printable Opioid Conversion Chart Sample
Opioid Conversion Chart Sample
Opioid Conversion Chart
Morphine
4hrly (o)
Morphine MR
BD (o)
Total 24h
Morphine (o)
(adding 4hrly
doses)
Oxycodone
4hrly (o)
Oxycodone
MR BD (o)
Oxycodone
4hrly (sc)
Total 24h
(sc)
Oxycodone
Diamorphine
4hrly (sc)
Total 24 h
(sc)
Diamorphine
Fentanyl patch
72hrly
5mg 20mg
1
30mg 2.5mg 10mg 15mg
1.25-2.5mg
10mg 25mcg
10mg 30mg 60mg 5mg 20mg 5mg 30mg 2.5-5mg 20mg 25mcg
15mg 50mg
1
90mg 10mg 30mg 7.5mg 45mg 5mg 30mg 25mcg
20mg 60mg 120mg 12.5mg 40mg 10mg 60mg 5-7.5mg 40mg 25-50mcg
30mg 90mg 180mg 20mg 60mg 15mg 90mg 10mg 60mg 50mcg
40mg 120mg 240mg 25mg 80mg 20mg 120mg 15mg 80mg 50-75mcg
50mg 150mg 300mg 35mg 100mg 25mg 150mg 15-20mg 100mg 75mcg
60mg 180mg 360mg 40mg 120mg 30mg 180mg 20mg 120mg 100mcg
70mg 200mg
2
420mg 45mg 130mg 35mg 210mg 20-25mg 140mg 125mcg
80mg 240mg 480mg 50mg 160mg 40mg 240mg 25mg 160mg 125-150mcg
90mg 260mg² 540mg 60mg 170mg 45mg 270mg 30mg 180mg 150mcg
100mg 300mg 600mg 65mg 200mg 50mg 300mg 30-35mg 200mg 150-175mcg
110mg 330mg 660mg 70mg 220mg 55mg 330mg 35mg 220mg 175mcg
120mg 360mg 720mg 80mg 240mg 60mg 360mg 40mg 240mg 200mcg
140mg 420mg 840mg 90mg 280mg 70mg 420mg 45mg 280mg 225-250mcg
160mg 480mg 960mg 105mg 320mg 80mg 480mg 55mg 320mg 275mcg
180mg 540mg 1080mg 120mg 360mg 90mg 540mg 60mg 360mg 300mcg
200mg 600mg 1200mg 130mg 400mg 100mg 600mg 70mg 400mg 350mcg
300mg 900mg 1800mg 200mg 600mg 150mg 900mg 100mg 600mg 500mcg
Notes
• Potency of oral Oxycodone reviewed by palliativedrugs.com recently and now thought to be morphine 1.5mg: oxycodone 1mg
• Oxycodone subcutaneous conversions are constantly being reviewed as this is a new product. Latest advice is oral oxycodone 1.5mg: parenteral
oxycodone 1mg and parenteral oxycodone 1.5mg: parenteral diamorphine 1mg.
(The manufacturers conversion rates differ from the recommendations of palliativedrugs.com. Individual variance in response to opioids is always to be
expected and careful titration according to individual response will be required)
• Alfentanil can be used as an alternative opioid parenterally and the total dose is one tenth of the diamorphine dose
• Morphine can be used parenterally and the dose conversion is one half of the oral dose (the same as the oxycodone parenteral dose)
• Methadone conversion more complex and not dealt with here.
1
Rounded up to take into account specific tablet sizes available
2
Rounded down to take into account specific tablet sizes available
• More precise equivalencies of Morphine to Fentanyl given in separate table below
• Hydromorphone only used infrequently: approximately 7.5 times as potent as Morphine orally.
• Patients on weak opioids are not opioid naïve – equivalent doses to morphine need to be taken into account – see separate table below.
• When converting from a HIGH dose of any opioid to another (say, over the equivalent of 500mg/day of morphine) it is usual to halve the calculated
conversion dose initially to avoid opioid toxicity (Ref: PCF and other sources)
• Double check all conversions – take time and refer to PCF or Handbook of Palliative Medicine (Ian Back)
• When a patient is in terminal stage of illness and diamorphine is to be given by syringe driver as additional (“top up”) analgesia, the Fentanyl patch
should stay on. Stat doses of diamorphine can be calculated by dividing the patch strength in mcg by 5 (i.e. a 100mcg patch requires 20mg
diamorphine as breakthrough analgesia). For the initial syringe driver 24-hour dose, the addition of all the previous 24hour stat doses given can be
used, or, if difficult to estimate, the equivalent of 2 or 3 stat doses can be used on the first day.
24 hour oral morphine
(mg)
Fentanyl patch strength
(mcg)
Breakthrough 4 hourly
morphine (mg)
<135 25 <20
135-224 50 25-35
225-314 75 40-50
315-404 100 55-65
405-494 125 70-80
495-594 150 85-95
595-674 175 100-110
675-764 200 115-125
765-854 225 130-140
855-944 250 145-155
945-1034 275 160-170
1035-1124 300 175-185
(there is no upper limit)
Analgesic and dose (oral) Relative oral morphine equivalent (mg)
Dihydrocodeine 240mg in 24 hours 24
Codeine phosphate 240mg in 24 hours 24
Buprenorphine 600mcg in 24 hours 36
Tramadol 200mg in 24 hours 20
Oxycodone MR tablets are available in 5mg, 10mg, 20mg, 40mg and 80mg strengths
Zomorph capsules are available in 10mg, 30mg, 60mg, 100mg and 200mg strengths
*These charts were modified 23/5/08 and will be constantly reviewed and updated: Dr Joy Waldock*
