Converting from Hydromorphone to Oxycodone

Conversion Process

The National Comprehensive Cancer Network recommends calculating the total daily hydromorphone dose and then reducing the calculated equianalgesic oxycodone dose by 25-50% to account for incomplete cross-tolerance, for example, 4 mg oral hydromorphone is equivalent to 20 mg oral oxycodone, which is then reduced to 10-15 mg oxycodone daily 1
The daily oxycodone dose can be divided by the number of doses per day, for instance, 10-15 mg daily divided by 4 doses equals 2.5-3.75 mg per dose 1

The National Comprehensive Cancer Network suggests that no washout period is needed when converting from hydromorphone to oxycodone, as both are pure opioid agonists 1, 2
Breakthrough pain management can be achieved by providing short-acting opioid rescue doses, typically 10-15% of the total daily dose, during the transition from hydromorphone to oxycodone 1, 3

The National Comprehensive Cancer Network advises against using fixed conversion ratios without clinical judgment, as patient variability means suggested doses are approximate 3
To avoid underdosing or overdosing, consider patient-specific factors, such as age, renal or hepatic function, and comorbidities, and adjust the dose accordingly, for example, using 100% of the equianalgesic dose or increasing by 25% if pain was poorly controlled on hydromorphone, or using the lower end of the dose reduction range if transitioning due to side effects 1, 2