Table 6a.12 Open in new tab Equivalent...

Table 6a.12

Equivalent subcutaneous opioid doses for steps two and three of the analgesic ladder

Subcutaneous medication
Opioid	Step 2: mild-to-moderate pain			Step 3: moderate-to-severe pain
Alfentanil CSCI (24h)	1mg 24h	2mg 24h	4mg 24h	6mg 24h	8mg 24h	12mg 24h
Diamorphine SC (4h p.r.n.)	2.5mg 4h	2.5–5mg 4h	5–7.5mg 4h	10mg 4h	15mg 4h	20mg 4h
Diamorphine CSCI (24h)	10mg 24h	20mg 24h	40mg 24h	60mg 24h	80mg 24h	120mg 24h
Morphine SC (4h p.r.n.)	2.5–5mg 4h	5mg 4h	10mg 4h	15mg 4h	20mg 4h	30mg 4h
Morphine CSCI (24h)	15mg 24h	30mg 24h	60mg 24h	90mg 24h	120mg 24h	180mg 24h
Oxycodone SC (4h p.r.n.)	2.5mg 4h	2.5mg 4h	5mg 4h	7.5mg 4h	10mg 4h	15mg 4h
^* Oxycodone CSCI (24h)	7.5mg 24h	15mg 24h	30mg 24h	50mg 24h	60mg 24h	90mg 24h
Approximate 24 horal morphine	30mg	60mg	120mg	180mg	240mg	360mg

Subcutaneous medication
Opioid	Step 2: mild-to-moderate pain			Step 3: moderate-to-severe pain
Alfentanil CSCI (24h)	1mg 24h	2mg 24h	4mg 24h	6mg 24h	8mg 24h	12mg 24h
Diamorphine SC (4h p.r.n.)	2.5mg 4h	2.5–5mg 4h	5–7.5mg 4h	10mg 4h	15mg 4h	20mg 4h
Diamorphine CSCI (24h)	10mg 24h	20mg 24h	40mg 24h	60mg 24h	80mg 24h	120mg 24h
Morphine SC (4h p.r.n.)	2.5–5mg 4h	5mg 4h	10mg 4h	15mg 4h	20mg 4h	30mg 4h
Morphine CSCI (24h)	15mg 24h	30mg 24h	60mg 24h	90mg 24h	120mg 24h	180mg 24h
Oxycodone SC (4h p.r.n.)	2.5mg 4h	2.5mg 4h	5mg 4h	7.5mg 4h	10mg 4h	15mg 4h
^* Oxycodone CSCI (24h)	7.5mg 24h	15mg 24h	30mg 24h	50mg 24h	60mg 24h	90mg 24h
Approximate 24 horal morphine	30mg	60mg	120mg	180mg	240mg	360mg

Nb. In all opioid conversions there is uncertainty. It is safer to err on the side of underestimating analgesic requirement when converting between opioids but ensure that the patient has ready access to appropriate breakthrough analgesia. If in doubt about a conversion always seek specialist advice if you are unfamiliar with the particular opioid.

The manufacturer of oxycodone states clearly that the conversion factor between oxycodone sc and diamorphine sc is 1:1. While most clinicians are comfortable with this ratio when converting from oxycodone sc to diamorphine sc, when converting from diamorphine sc to oxycodone sc some would advocate a 2:1 ratio with provision for breakthrough medication. As in every dose conversion the clinician must assess each individual patient and clinical situation.

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