Equianalgesic Tables

EQUIANALGESIC TABLE FOR CHRONIC OPIOID DOSING

DRUG	ORAL (PO)	PARENTERAL (SC, IV)
Morphine	10 mg	5 mg1
Codeine	100 mg	65 mg
Hydromorphone	2 mg	1 mg2
Oxycodone	5.0-7.5 mg	-
Methadone	1 mg but highly variable ratio & complex3	Not readily available
Fentanyl transdermal patch	25 ug patch ≅ 60-134 mg oral morphine daily dose MEDD4

NOTE: Due to incomplete cross-tolerance between opioids, it is often necessary to reduce equivalent dose of new drug by 25% to 50%, and then titrate

RECOMMENDED INITIAL DOSE FOR OPIOID CONVERSION TO DURAGESIC® (FENTANYL) PATCH

Oral 24-hour morphine equivalent daily dose (MEDD mg/day)	(ug/hour) Duragesic® dose equivalent (ug/hour)
60-134	25
135-224	50
225-314	75
315-404	100
405-494	125
495-584	150
585-674	175
675-764	200
785-854	225
855-944	250
945-1034	275

SOURCES/REFERENCES

1. Janssen-Ortho 2006
2. Downing GM, Wainwright W, editors. Medical care of the dying. 4th ed. Victoria (BC): Victoria Hospice Society; 2006. p. 195,201.

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Footnotes

1. Common ratio PO:SC is 2:1, but may be 3:1

2. Common ratio PO:SC is 2:1, but may be 3:1

3. Rotation is complex, with delayed accumulation. Ratio varies from MOR:METH 5:1 at low doses to 10:1 or up to 20:1. Must be individualized

4. A range of fentanyl doses - see Table 2