Page 43 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
The suggested conversion ratio is shown in 7DEOH .

7DEOH 6XJJHVWHG 'RVH &RQYHUVLRQ 5DWLR LQ
7KH 'LUHFWLRQ 6SHFL¿HG
TO Oral morphine SC morphine Oral oxycodone SC oxycodone TD fentanyl
FROM mg/day mg/day mg/day mg/day mcg/h
Oral morphine
mg/day 2 1.5 3 3
SC morphine 2 0.7 1.5 1.5
mg/day
Oral oxycodone
mg/day 1.5 0.7 2 2
SC oxycodone 3 1.5 2 1
mg/day
TD fentanyl 3 1.5 2 1
mcg/h
MULTIPLY DIVIDE
$GDSWHG 0LQLVWU\ RI +HDOWK 0DOD\VLD &3* 0DQDJHPHQW RI &DQFHU 3DLQ 3XWUDMD\D
MoH; 2010.

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1. This conversion chart should only be used as a guide and
treatment must be individually tailored for patients based on clinical
assessment.
2. When changing from one opioid to another, consider a dose
reduction of 25 - 50% due to incomplete cross-tolerance.
3. Consider reduced doses in the elderly and in patients with renal or
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4. Calculate the total 24-hour opioid dose in mg (for fentanyl, note
that the hourly rate is in mcg).
5. Begin at the left-hand column and identify the opioid currently used.
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,GHQWLI\ WKH ER[ ZKHUH WKH FROXPQ DQG URZ LQWHUVHFW DQG GHWHUPLQH
the conversion factor to divide or multiply in order to obtain the 24-
hour dose of the alternative opioid.
8. Divide 24-hour dose according to the dosing frequency required
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dosing).
9. Calculate the rescue dose for breakthrough pain for each opioid as
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10. $GGLWLRQDO FRQYHUVLRQV
• PO dihydrocodeine 90 mg/day = PO morphine 10 - 12 mg/day
• PO tramadol 150 mg/day = PO morphine 15 - 30 mg/day
‡ 7' IHQWDQ\O PFJ KRXU FRQWLQXRXV 6& ,9 LQIXVLRQ IHQWDQ\O
25 mcg/hour
‡ 6& PRUSKLQH ,9 PRUSKLQH

25

e-cpg inside text-Cancer pain-25/5/24.indd 25 09/08/2024 12:09 AM