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AI-Generated response:

My patient, who was taking 120 mg of oral Morphine at home, is admitted to the hospital with acute renal failure. How do I convert her Morphine into Hydromorphone?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

To convert oral Morphine to oral Hydromorphone in a patient with acute renal failure, use a conversion factor of 0.2.

For a patient taking 120 mg of oral Morphine, the equivalent dose of oral Hydromorphone would be approximately 24 mg per day.

Start with 50% of this converted dose to account for individual variability and potential incomplete cross-tolerance, which would be about 12 mg per day, and adjust based on patient response and renal function.

  • Calculate the total daily dose of Morphine (120 mg) and multiply by the conversion factor (0.2) to get the equivalent dose of Hydromorphone (24 mg).[1-2]

  • Initiate Hydromorphone at 50% of the calculated equivalent dose, which is 12 mg per day, to minimize the risk of overdose due to potential incomplete cross-tolerance.[2]

  • Monitor the patient closely for signs of opioid toxicity and adjust the dose based on clinical response and renal function.

  • Consider the pharmacokinetics of Hydromorphone in patients with renal impairment, as opioid accumulation may occur.

  • Titrate the dose carefully, increasing or decreasing based on pain control and side effects, with frequent reassessments.

Additional info

When converting opioids, especially in a patient with renal failure, it is crucial to start at a lower dose and titrate up as needed. This approach helps manage the risk of adverse effects due to the accumulation of the drug and its metabolites, which can be pronounced in patients with impaired renal function. Hydromorphone is preferred over Morphine in renal impairment due to its lesser propensity to accumulate neurotoxic metabolites. However, even Hydromorphone must be used cautiously, with adjustments made based on the patient's ongoing response to therapy and any changes in their renal function. Regular monitoring and dose adjustments are essential to avoid opioid toxicity while providing adequate pain control.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 2, 2024.

Indications And Dosage NOTE: Do not use this table to convert from Exalgo to other opioid agonist therapy. Doing so will result in an overestimation of the new opioid dose and may result in fatal overdose. * Hydromorphone: 1 * Codeine: 0.06 * Hydrocodone: 0.4 * Methadone: 0.6 * Morphine: 0.2 * Oxycodone: 0.4 * Oxymorphone: 0.6

Reference 2

2.

Food and Drug Administration (DailyMed).

Publish date: January 1, 2024.

Dosage And Administration Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose. Table 1. Conversion Factors to Hydromorphone Hydrochloride Extended-Release Tablets Prior Oral Opioid Approximate Oral Conversion Factor Hydromorphone 1 Codeine 0.06 Hydrocodone 0.4 Methadone 0.6 Morphine 0.2 Oxycodone 0.4 Oxymorphone 0.6 To calculate the estimated hydromorphone hydrochloride extended-release tablets dose using Table 1 : • For patients on a single opioid, sum the current total daily dose of the opioid and then multiply the total daily dose by the conversion factor to calculate the approximate oral hydromorphone daily dose. • For patients on a regimen of more than one opioid, calculate the approximate oral hydromorphone dose for each opioid and sum the totals to obtain the approximate total hydromorphone daily dose. • For patients on a regimen of fixed-ratio opioid/non-opioid analgesic products, use only the opioid component of these products in the conversion. Always round the dose down, if necessary, to the appropriate hydromorphone hydrochloride extended-release tablet strength(s) available. Example conversion from a single opioid to hydromorphone hydrochloride extended-release tablets: Step 1: Sum the total daily dose of the opioid • 30 mg of oxycodone 2 times daily = 60 mg total daily dose of oxycodone Step 2: Calculate the approximate equivalent dose of oral hydromorphone based on the total daily dose of the current opioid using Table 1 • 60 mg total daily dose of oxycodone x Conversion Factor of 0.4 = 24 mg of oral hydromorphone daily Step 3: Calculate the approximate starting dose of hydromorphone hydrochloride extended-release tablets to be given every 24 hours, which is 50% of the calculated oral hydromorphone dose. Round down, if necessary, to the appropriate hydromorphone hydrochloride extended-release tablet strengths available.

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