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Clinical Application of Opioid Equianalgesic Data

Gammaitoni, Arnold R. PharmD*; Fine, Perry MD; Alvarez, Nancy PharmD*; McPherson, Mary Lynn PharmD; Bergmark, Suzette§


Physicians and other healthcare professionals may often be faced with the need to change opioids during the course of a patient's opioid analgesic care due to a number of clinical reasons. The act of converting opioid analgesics, for many physicians, nurses, and pharmacists, who do not receive adequate training, remains a challenging and often uncomfortable aspect of pain treatment. Part of the challenge clinicians face is secondary to the relatively weak literature evidence base that exists to support the equianalgesic ratios provided in textbooks, journals, and other medical resources. Another aspect involves the lack of a widely recognized treatment algorithm or guideline to assist clinicians with opioid conversion. The final decision on which opioid dose to prescribe must involve a thorough clinical assessment to minimize the risk of prescribing inappropriate opioid doses over or under the patient's actual need. The purpose of this paper is to provide the clinician with an approach for dealing with the conversion between opioid analgesics that is standardized, yet allows for individualized results to meet unique patient needs. We present a 5-step process as a guide for clinicians faced with the need to change a patient's opioid regimen. This approach may help to build a comfort level when dealing with the clinical challenges of converting from one opioid to another.

*Endo Pharmaceuticals, Inc., Chadds Ford, Pennsylvania; †University of Utah, Pain Management Center, Salt Lake City, Utah; ‡University of Maryland, School of Pharmacy, Baltimore, Maryland; and §University of the Sciences in Philadelphia, Aldan, Pennsylvania

Received July 23, 2002; accepted October 5, 2002.

Corresponding author: Arnold R. Gammaitoni, PharmD, Endo Pharmaceuticals, Inc., 100 Painters Drive, Chadds Ford, PA 19317. E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.