Opioid conversion ratios used in palliative care: is there an Australian consensus?. Issue 5 (May 2014)

• Record Type: Journal Article
• Authors: Syrmis, W.; Good, P.; Wootton, J.; Spurling, G.
• Is Part Of: Internal medicine journal. Volume 44:Issue 5(2014)
• Page Start: 483
• Page End: 489
• Publication Date: 2014-05
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12401
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12401-sec-0001" sec-type="section"> <title>Background</title> <p>Opioid switching or rotation is reported to be a common practice in palliative care. Published tables of opioid conversion ratios have been found to vary in their recommendations, potentially leading to significant differences in clinical practice.</p> </sec> <sec id="imj12401-sec-0002" sec-type="section"> <title>Aims</title> <p>To identify common practices in the calculation of opioid equianalgesia by specialist palliative medicine practitioners and trainees.</p> </sec> <sec id="imj12401-sec-0003" sec-type="section"> <title>Method</title> <p>An anonymous, cross‐sectional, online survey completed by 85 Australian palliative care specialists or advanced trainees. Questions focused on conversion ratios used in switching between oral and parenteral opioid doses; conversion ratios used when switching from other opioids to oral morphine; and practice of commencing methadone.</p> </sec> <sec id="imj12401-sec-0004" sec-type="section"> <title>Results</title> <p>The majority of respondents calculated equianalgesic doses for morphine, oxycodone and hydromorphone using the same conversion ratios. Methadone was used almost equally as either the sole opioid or as a 'co‐opioid'. The majority surveyed converted slow‐release hydromorphone differently to the manufacturer's recommendations.</p> </sec> <sec id="imj12401-sec-0005" sec-type="section"> <title>Conclusion</title> <p>Further discussion among Australian palliative care specialist organisations is recommended in order to produce uniform conversion guidelines to improve consistency and safety in the prescribing of opioids.</p> </sec> </abstract>