Compact Clinical Guide to Acute Pain Management by D'Arcy Yvonne;D'Arcy Yvonne MS APN-C CNS FAANP;

Author:D'Arcy, Yvonne;D'Arcy, Yvonne, MS, APN-C, CNS, FAANP; [D'Arcy, Yvonne]
Language: eng
Format: epub
Publisher: Springer Publishing Company, Incorporated
Published: 2011-03-22T00:00:00+00:00

Opioid Rotation Conversion Example

Original medication: MS-Contin

MS-Contin 120 mg twice per day with morphine sulfate immediate release (MSIR) 30 mg every 4 hours as needed for pain

New medication: Oxycontin

MS-Contin 120 mg twice per day (240 mg/day) is equal to Oxycontin 80 mg twice per day (160 mg/day)

MSIR 30 mg is equal to oxycodone 20 mg every 4 hours

Decrease the new dose by 25% to 50%

25% = Oxycontin 60 mg twice per day with 15 mg oxycodone every 4 hours for breakthrough

50% = Oxycontin 40 mg twice per day with 10 mg of oxycodone every 4 hours for breakthrough

There is no hard and fast rule about using morphine for breakthrough with extended-release morphine or oxycodone with Oxycontin, but the illustration helps to show an additional conversion by also including the breakthrough option. As a prescriber, you can choose to mix and match morphine with other drugs and vice versa. The key here is to choose medications that the patient has not seen in awhile and to monitor the effect closely, so that you can see if the change has made any difference. If you choose to go with the conservative option, 50%, you can always increase the new medication up to the 25% reduction to improve pain relief if the patient starts to have increased pain. If the patient is someone who can tolerate a bigger dose, considering previous medication history, age, and comorbidities, the 25% option may work best. Always offer adequate breakthrough medication so the patient can more easily convert to the new medication regimen and retain pain control.

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