TABLE OF OPIOID EQUIVALENTS FOR

DIFFERENT ROUTES OF ADMINISTRATION

NAME IV DOSE PO DOSE RATIO IV:PO

Morphine 2 mg 6 mg 1:3
Hydromorphone (Dilaudid) 0.3 mg 1.5 mg 1:5
Oxycodone 4 mg
Fentanyl 20 mcg

ADDITIONAL CONVERSIONS:
Hydrocodone PO: morphine PO = 1:1
Dilaudid IV: morphine IV = 1: 7 (ie 1 mg IV Dilaudid = 7 mg IV morphine)
Morphine IV: Dilaudid IV = 1: 0.14 (ie 1 mg IV morphine = 0.14 mg IV Dilaudid)
Dilaudid PO: morphine PO = 1: 4 (ie 1 mg PO Dilaudid = 4 mg PO morphine)
Morphine PO: Dilaudid PO = 1: 0.25 (ie 1 mg PO morphine = 0.25 mg PO Dilaudid)

COMMON MED USE AT RUSH:

Norco 5 (hydrocodone/acetaminophen) = Morphine PO 5 mg = Morphine IV 1.67 mg
Norco 10 (hydrocodone/acetaminophen) = Morphine PO 10 mg = Morphine IV 3.33 mg
MSIR 15 mg (15 mg PO morphine) = Morphine IV 5 mg = 3 doses of Norco 5/325 mg PO at once
ADDITIONAL TIPS Constipation Patients with scheduled opioids
should have stimulant laxitive
Illinois Prescription Monitoring Program: (e.g. senna, bisacodyl) + stool
https://www.ilpmp.org/ softener (e.g. docusate)
Naloxone (Narcan) Nausea/ Add antiemetics
Indications: Vomiting (e.g. ondansetron, prochlorpera-
Most important role: reversal of respiratory zine, metoclopramide). Decrease
depression opioid dose & increase frequency;
If RR less than 8, hypoxemic, or cyanotic: add non-opioid to reduce opioid
dilute a 0.4mg vial in 9 ml NS and administer load; change opioid
1 ml every 10 to 30 seconds over 3 minutes
Pruritus Diphenhydramine 12.5-25 mg
Adverse Effects:
PO/IV. Decrease opioid dose
Opioid withdrawal & pain
& increase frequency; add
Nausea, vomiting
non-opioid to reduce opioid
Abrupt i in LES sphincter tone: aspiration
load; change opioid
pneumonia
Cardiac arrhythmias including VT & VF Sedation Monitor. Decrease opioid dose
Unopposed seizure activity of normeperidine & increase frequency; add
Risk Factors for Respiratory Depression non-opioid to reduce opioid
BMI >30 load; change opioid.
CrCl <30 mL/min
Respiratory Monitor. Stop opioid, if necessary
Concomitant benzodiazepine use
Depression titrate naloxone to avoid with-
Prevention and Management of opioid drawal, seizures, and severe pain.
side effects (see right)