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<span data-path="/Clinical-resources/eviQ-calculators/3201-Opioid-Conversion-Calculator" class="hidden"></span>
<div class="page-header">
<h1>Opioid Conversion Calculator</h1>
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<strong>ID: 3201</strong> v.3
</li>
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<strong>Endorsed </strong>
</li>
<li class="item-hide">
<a href="/">
<img src="/WWW_eviQ/Assets/images/favicon-32x32.png" alt=""></a>
<strong>Opioid Conversion Calculator</strong>
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<a href="#history" data-original-title="View history" data-toggle="tooltip" data-title="History" class="scrolltoelement">
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<div id="warnings" class="alert alert-danger m-b-1">
<span class="alert-heading"><span class="fa fa-warning fa-fw"> </span>Opioid Conversion Calculator:</span>
<p>Version 3 has undergone significant updates. Consult the <a href="#history">history section</a> for comprehensive details.</p>
</div>
<div id="flags" class="alert alert-info m-b-1">
<p><span aria-hidden="true" class="fa eviq-icon-chalkboard-teacher" style="color: #54267e;"> </span> <strong>Related eLearning:</strong>
<a href="https://education.eviq.org.au/rapid-learning/principles-of-opioid-conversion" target="_blank" rel="noopener noreferrer">- Principles of opioid conversion<span class="sr-only"> opens in a new tab or window</span></a></p>
<div class="well">
<h5><strong>Intention of use</strong></h5>
<ul>
<li>Familiarity is important for safe prescribing of opioids and clinicians need to have a good understanding of pain management and equianalgesic conversions before using this calculator. Its use should not replace the need for education
in the area of equianalgesic dosing.</li>
<li>The calculator provides conversions from one opioid to another and/or from one route of administration to another, to be used as a guide only. It is not tailored to any specific pain syndrome or for utilisation by specific healthcare
professionals.</li>
<li>The calculator does not provide clinical guidance on therapeutic use of opioids e.g. initiating, tapering or stopping opioids; drug-drug interactions, side effects or dosing in renal/hepatic impairment or any other special
populations. Long-term opioid therapy for chronic non-cancer pain remains controversial. Refer
to <a href="https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/drugs-of-dependence/part-c2/a-summary-of-opioid-use-in-chronic-non-cancer-pain">guidance</a> for opioid
use in chronic non-cancer pain.</li>
<li>Clinical judgement should always be used while switching opioids. Medical and psychosocial factors and clinical care environment need to be assessed prior to opioid rotation.</li>
</ul>
</div>
</div>
<div id="related" class="alert alert-default m-b-2">
<p><strong>Related pages:</strong></p>
<ul>
<li>
<a href="/Additional-clinical-information/3344-Conversion-factors-used-in-eviQ-opioid-conver" target="_blank" rel="noopener noreferrer">Conversion factors used in eviQ opioid conversion calculator</a>
</li>
</ul>
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<!--
Embedded Calculator taken from file
eviQ\eviQ.Cms\CMS\WWW_eviQ\CmsWebparts\EmbeddedCalculator.ascx
-->
<div class="eviq-calculator">
<div class="spinner iframe-spinner" style="display: none;">
<div class="double-bounce1"></div>
<div class="double-bounce2"></div>
</div>
<oc-calculator id="oc-calculator">
<fieldset>
<h3>Opioid Conversion</h3>
<div class="form-group hidden-print">
<label for="patientName" class="col-xs-7 col-md-4 control-label">Patient Name:</label>
<div class="col-xs-5 col-md-8">
<input type="text" id="patientName" class="form-control" placeholder="Patient Name" data-bind="textInput: patientName"><span class="validationMessage" style="display: none;"></span>
</div>
</div>
<div class="form-group hidden-print">
<label for="medicalRecordNumber" class="col-xs-7 col-md-4 control-label">Medical Record Number:</label>
<div class="col-xs-5 col-md-8">
<input type="text" id="medicalRecordNumber" class="form-control" placeholder="Medical Record Number" data-bind="textInput: medicalRecordNumber"><span class="validationMessage" style="display: none;"></span>
</div>
</div>
<div class="form-group hidden-print">
<label for="gender" class="col-xs-7 col-md-4 control-label">Gender:</label>
<div class="col-xs-5 col-md-8" data-bind="validationElement: gender, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title="">
<span data-bind="foreach: cinsw.eviq.calculators.genders">
<label class="radio-inline">
<input type="radio" name="gender" data-bind="attr: { 'selected-value': value }, checked: $parent.gender, checkedValue: $data" selected-value="m" value="[object Object]"> <span data-bind="text: text">Male</span>
</label>
<label class="radio-inline">
<input type="radio" name="gender" data-bind="attr: { 'selected-value': value }, checked: $parent.gender, checkedValue: $data" selected-value="f" value="[object Object]"> <span data-bind="text: text">Female</span>
</label>
</span>
<div class="text-danger" id="genderError" data-bind="validationMessage: gender" style="display: none;"></div>
</div>
</div>
<dob-module id="age-module" params="property: age, twoCol: true, minAge: 12" class="hidden-print">
<module data-bind="style: { 'background-color': isValid ? '':'red' }">
<div class="form-group dob">
<fieldset>
<label for="dob" class="control-label col-xs-7 col-md-4" data-bind="css: { 'col-xs-7 col-md-4': twoCol, 'col-xs-3 col-md-2': !twoCol() }">Date of Birth:</label>
<legend class="sr-only">Date of Birth:</legend>
<div class="col-xs-5 col-md-8">
<div class="col-sm-4">
<label for="day" class="sr-only">Day of month:</label>
<select class="form-control" id="day" data-bind="value: day, options: days, optionsCaption: 'DD', optionsAfterRender: setLabelsToDayOptions">
<option value="" label="select day of month">DD</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><span class="validationMessage" style="display: none;"></span>
</div>
<div class="col-sm-4">
<label for="month" class="sr-only">Month:</label>
<select class="form-control" id="month" data-bind="value: month, options: months, optionsCaption: 'MM', optionsText: 'label', optionsValue: 'value', optionsAfterRender: setLabelsToMonthOptions">
<option value="" label="select month">MM</option>
<option value="1" label="January">Jan</option>
<option value="2" label="February">Feb</option>
<option value="3" label="March">Mar</option>
<option value="4" label="April">Apr</option>
<option value="5" label="May">May</option>
<option value="6" label="June">Jun</option>
<option value="7" label="July">Jul</option>
<option value="8" label="August">Aug</option>
<option value="9" label="September">Sep</option>
<option value="10" label="October">Oct</option>
<option value="11" label="November">Nov</option>
<option value="12" label="December">Dec</option>
</select><span class="validationMessage" style="display: none;"></span>
</div>
<div class="col-sm-4">
<label for="year" class="sr-only">Year:</label>
<select class="form-control" id="year" data-bind="value: year, options: years, optionsCaption: 'YYYY', optionsAfterRender: setLabelsToYearOptions">
<option value="" label="select year">YYYY</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
</select><span class="validationMessage" style="display: none;"></span>
</div>
</div>
</fieldset>
</div>
<div class="form-group dob">
<label for="dob" class="control-label col-xs-7 col-md-4" data-bind="css: { 'col-xs-7 col-md-4': twoCol, 'col-xs-3 col-md-2': !twoCol() }">OR</label>
</div>
<div class="form-group dob">
<label class="control-label col-xs-7 col-md-4 requiredIndicator required" for="age" data-bind="css: { 'col-xs-7 col-md-4': twoCol, 'col-xs-3 col-md-2': !twoCol() }">Age:</label>
<div class="col-xs-5 col-md-8" data-bind="validationElement: age, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title="This field is required." data-orig-title="">
<input type="text" id="age" placeholder="Age" class="form-control" data-bind="textInput: age, focusValidate: age" data-focus-validate="">
<div class="text-danger" role="alert" id="ageError" data-bind="validationMessage: age" style="display: none;"></div>
</div>
</div>
<h3 class="debug" data-bind="visible: isValid" style="display: none;">
<font color="green">VALID</font>
</h3>
<h3 class="debug" data-bind="visible: !isValid()">
<font color="red">INVALID</font>
</h3>
<!--<pre data-bind="text: ko.toJSON($data, null, 2)"></pre>-->
</module>
</dob-module>
<div class="panel panel-default result-summary visible-print" data-bind="visible: isValid" style="display: none;">
<div class="panel-body bg-success calculator-result">
<ul>
<li class="text-nowrap print-list-item" data-bind="if: patientName"></li>
<li class="text-nowrap print-list-item" data-bind="if: medicalRecordNumber"></li>
<li class="text-nowrap print-list-item" data-bind="if: gender"></li>
<li class="text-nowrap print-list-item">Age: <strong data-bind="text: (age() ? age().age : '')"></strong></li>
</ul>
</div>
</div>
<div class="panel panel-default regular-therapy hidden-print">
<div class="panel-heading">Step 1: Current REGULAR opioid therapy</div>
<div data-bind="template: { name: 'drug-list-template', data: { parent: $data, therapies: regularTherapies, drugs: regularOpioidDrugs, note: null } }">
<!--<pre class="debug" data-bind="text: ko.toJSON(drugs, null, 2)"></pre>-->
<div class="panel-body">
<table class="table table-bordered table-striped therapies">
<thead>
<tr>
<th width="30%">Opioid</th>
<th>Dosage</th>
<th class="hidden-print"></th>
</tr>
</thead>
<tbody data-bind="foreachTransition: therapies">
<tr data-bind="uniqueId: $data" id="unique1">
<td data-bind="validationElement: drug, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title="">
<div class="hidden-print">
<select class="form-control drug" data-bind="options: $parent.drugs, optionsText: 'title', value: drug, optionsCaption: 'Select...', focusValidate: drug" data-focus-validate="">
<option value="">Select...</option>
<option value="">Anamorph mg(PO)</option>
<option value="">Bupredermal microgram/hour(Transdermal)</option>
<option value="">Buprenorphine microgram/hour(Transdermal)</option>
<option value="">Codeine mg(PO)</option>
<option value="">Denpax microgram/hour(Transdermal)</option>
<option value="">dilaUDID mg(IM/IV/SC)</option>
<option value="">dilaUDID mg(PO)</option>
<option value="">Durogesic microgram/hour(Transdermal)</option>
<option value="">Endone mg(PO)</option>
<option value="">Fenpatch microgram/hour(Transdermal)</option>
<option value="">Fentanyl microgram/hour(Transdermal)</option>
<option value="">HYDROmorphone mg(IM/IV/SC)</option>
<option value="">HYDROmorphone mg(PO)</option>
<option value="">Kapanol mg(PO)</option>
<option value="">Morphine mg(IM/IV/SC)</option>
<option value="">Morphine mg(PO)</option>
<option value="">MS Contin mg(PO)</option>
<option value="">MS Mono mg(PO)</option>
<option value="">Norspan microgram/hour(Transdermal)</option>
<option value="">Ordine mg(PO)</option>
<option value="">Oxycodone mg(PO)</option>
<option value="">Oxycodone mg(SC/IV)</option>
<option value="">OxyCONTIN mg(PO)</option>
<option value="">OxyNORM mg(PO)</option>
<option value="">OxyNORM mg(SC/IV)</option>
<option value="">Palexia mg(PO)</option>
<option value="">Palexia SR mg(PO)</option>
<option value="">Sevredol mg(PO)</option>
<option value="">tAPENTadol mg(PO)</option>
<option value="">tAPENTadol SR mg(PO)</option>
<option value="">tRAMadol mg(IM/IV)</option>
<option value="">tRAMadol mg(PO)</option>
<option value="">tRAMadol SR mg(PO)</option>
<option value="">Tramal mg(PO)</option>
<option value="">Tramal SR mg(PO)</option>
<option value="">Tramedo mg(PO)</option>
<option value="">Tramedo SR mg(PO)</option>
<option value="">Zydol mg(PO)</option>
<option value="">Zydol SR mg(PO)</option>
</select>
<div class="text-danger" id="drugError" data-bind="validationMessage: drug" style="display: none;"></div>
</div>
<div class="visible-print-inline" data-bind="text: (drug() ? drug().drugName : '')"></div>
</td>
<td>
<div data-bind="if: drug(), validationElement: dose, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title=""></div>
</td>
<td class="hidden-print">
<button type="button" class="btn btn-primary btn-xs remove-drug" aria-label="Remove" data-bind="visible: ($parent.therapies().length > 1), click: $parent.parent.removeDrug.bind($data, $parent.therapies)"
title="Remove this drug" style="display: none;"><span aria-hidden="true">Remove</span></button>
</td>
</tr>
</tbody>
<tfoot>
<tr>
<td><!-- ko if: note --><!-- /ko --></td>
<td>
<ul class="small">
<li data-bind="html: cinsw.eviq.calculators.formulas.opioidConversion">Formula = (mg/day of current opioid) x (conversion factor) = oral Morphine Equivalent Daily Dose (oMEDD) (mg/day)</li>
</ul>
</td>
<td class="hidden-print"></td>
</tr>
</tfoot>
</table>
<div class="text-right hidden-print button-right">
<input type="button" class="btn btn-primary add-another-drug" data-bind="click: parent.addAnotherDrug.bind($data, therapies)" value="Add another drug">
</div>
</div>
</div>
</div>
<div class="panel panel-default breakthrough-therapy hidden-print">
<div class="panel-heading">Step 2: Current BREAKTHROUGH opioid therapy</div>
<div
data-bind="template: { name: 'drug-list-template', data: { parent: $data, therapies: breakthroughTherapies, drugs: breakthroughOpioidDrugs, note: 'Current breakthrough opioid entered to be what the patient is actually taking rather than what has been prescribed.' } }">
<!--<pre class="debug" data-bind="text: ko.toJSON(drugs, null, 2)"></pre>-->
<div class="panel-body">
<table class="table table-bordered table-striped therapies">
<thead>
<tr>
<th width="30%">Opioid</th>
<th>Dosage</th>
<th class="hidden-print"></th>
</tr>
</thead>
<tbody data-bind="foreachTransition: therapies">
<tr data-bind="uniqueId: $data" id="unique2">
<td data-bind="validationElement: drug, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title="">
<div class="hidden-print">
<select class="form-control drug" data-bind="options: $parent.drugs, optionsText: 'title', value: drug, optionsCaption: 'Select...', focusValidate: drug" data-focus-validate="">
<option value="">Select...</option>
<option value="">Anamorph mg(PO)</option>
<option value="">Codeine mg(PO)</option>
<option value="">dilaUDID mg(IM/IV/SC)</option>
<option value="">dilaUDID mg(PO)</option>
<option value="">Endone mg(PO)</option>
<option value="">HYDROmorphone mg(IM/IV/SC)</option>
<option value="">HYDROmorphone mg(PO)</option>
<option value="">Morphine mg(IM/IV/SC)</option>
<option value="">Morphine mg(PO)</option>
<option value="">Ordine mg(PO)</option>
<option value="">Oxycodone mg(PO)</option>
<option value="">Oxycodone mg(SC/IV)</option>
<option value="">OxyNORM mg(PO)</option>
<option value="">OxyNORM mg(SC/IV)</option>
<option value="">Palexia mg(PO)</option>
<option value="">Sevredol mg(PO)</option>
<option value="">tAPENTadol mg(PO)</option>
<option value="">tRAMadol mg(IM/IV)</option>
<option value="">tRAMadol mg(PO)</option>
<option value="">Tramal mg(PO)</option>
<option value="">Tramedo mg(PO)</option>
<option value="">Zydol mg(PO)</option>
</select>
<div class="text-danger" id="drugError" data-bind="validationMessage: drug" style="display: none;"></div>
</div>
<div class="visible-print-inline" data-bind="text: (drug() ? drug().drugName : '')"></div>
</td>
<td>
<div data-bind="if: drug(), validationElement: dose, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title=""></div>
</td>
<td class="hidden-print">
<button type="button" class="btn btn-primary btn-xs remove-drug" aria-label="Remove" data-bind="visible: ($parent.therapies().length > 1), click: $parent.parent.removeDrug.bind($data, $parent.therapies)"
title="Remove this drug" style="display: none;"><span aria-hidden="true">Remove</span></button>
</td>
</tr>
</tbody>
<tfoot>
<tr>
<td><!-- ko if: note -->
<ul class="small">
<li data-bind="html: 'Note: ' + note">Note: Current breakthrough opioid entered to be what the patient is actually taking rather than what has been prescribed.</li>
</ul><!-- /ko -->
</td>
<td>
<ul class="small">
<li data-bind="html: cinsw.eviq.calculators.formulas.opioidConversion">Formula = (mg/day of current opioid) x (conversion factor) = oral Morphine Equivalent Daily Dose (oMEDD) (mg/day)</li>
</ul>
</td>
<td class="hidden-print"></td>
</tr>
</tfoot>
</table>
<div class="text-right hidden-print button-right">
<input type="button" class="btn btn-primary add-another-drug" data-bind="click: parent.addAnotherDrug.bind($data, therapies)" value="Add another drug">
</div>
</div>
</div>
</div>
<div class="panel panel-default final-drug hidden-print">
<div class="panel-heading">Step 3: Convert to final opioid</div>
<div class="panel-body">
<table class="table table-bordered table-striped final-opioid">
<thead>
<tr>
<th width="30%">Opioid</th>
<th>
<p>Dose reduction for incomplete cross-tolerance</p>
<p class="small">Cross-tolerance is the development of tolerance to the effects of one opioid due to previous exposure to another. Since cross-tolerance is not always complete, switching to another opioid with same
equianalgesic dose can lead to greater than anticipated potency. Dosing adjustment is recommended to accommodate for unknown cross-tolerance. It is recommended that dosing adjustments for cross-tolerance, unsatisfactory
efficacy despite dose titration or unaccepted toxicity are made in consultation with a palliative care or pain specialist.</p><!--SCTASK3303550 Dom C-->
</th>
</tr>
</thead>
<tbody>
<tr>
<td data-bind="validationElement: finalDrug, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}" title="This field is required." data-orig-title="">
<div class="hidden-print">
<select class="form-control drug" data-bind="uniqueId: finalDrug, options: finalDrugs, optionsText: 'title', value: finalDrug, optionsCaption: 'Select...', focusValidate: finalDrug" id="unique3" data-focus-validate="">
<option value="">Select...</option>
<option value="">Anamorph mg(PO)</option>
<option value="">Denpax microgram/hour(Transdermal)</option>
<option value="">dilaUDID mg(IM/IV/SC)</option>
<option value="">dilaUDID mg(PO)</option>
<option value="">Durogesic microgram/hour(Transdermal)</option>
<option value="">Endone mg(PO)</option>
<option value="">Fenpatch microgram/hour(Transdermal)</option>
<option value="">Fentanyl microgram/hour(Transdermal)</option>
<option value="">HYDROmorphone mg(IM/IV/SC)</option>
<option value="">HYDROmorphone mg(PO)</option>
<option value="">Kapanol mg(PO)</option>
<option value="">Morphine mg(IM/IV/SC)</option>
<option value="">Morphine mg(PO)</option>
<option value="">MS Contin mg(PO)</option>
<option value="">MS Mono mg(PO)</option>
<option value="">Ordine mg(PO)</option>
<option value="">Oxycodone mg(PO)</option>
<option value="">Oxycodone mg(SC/IV)</option>
<option value="">OxyCONTIN mg(PO)</option>
<option value="">OxyNORM mg(PO)</option>
<option value="">OxyNORM mg(SC/IV)</option>
<option value="">Sevredol mg(PO)</option>
</select>
<div class="text-danger" id="finalDrugError" data-bind="validationMessage: finalDrug" style="display: none;"></div>
</div>
<div class="visible-print-inline" data-bind="text: (finalDrug() ? finalDrug().drugName : '')"></div>
</td>
<td>
<select class="form-control drug-reduction hidden-print" data-bind="options: finalDrugReductions, optionsText: 'text', value: finalDrugReduction">
<option value="">None</option>
<option value="">-25%</option>
<option value="">-50%</option>
<option value="">-75%</option>
</select><span class="validationMessage" style="display: none;"></span>
<div class="visible-print" data-bind="text: (finalDrugReduction() ? finalDrugReduction().text : '')">None</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
<div class="panel panel-default results eviq-oc-calculator" data-bind="if: isValid"></div>
</fieldset>
<div class="button-right">
<input type="button" class="btn btn-default reset" data-bind="click: reset" value="Reset">
</div>
<h3 class="debug" data-bind="visible: isValid" style="display: none;">
<font color="green">VALID</font>
</h3>
<h3 class="debug" data-bind="visible: !isValid()">
<font color="red">INVALID</font>
</h3>
<!--<pre class="debug" data-bind="text: ko.toJSON($data.regularTherapies, null, 2)"></pre>
<pre class="debug" data-bind="text: ko.toJSON($data.breakthroughTherapies, null, 2)"></pre>-->
<div data-bind="modal: modal" class="modal fade terms-conditions-modal in" template-id="termsConditionsModal" tabindex="-1" role="dialog" aria-labelledby="termsConditionsModalLabel" data-keyboard="true" data-backdrop="static"
aria-hidden="true" style="display: block; padding-left: 0px;">
<div class="modal-dialog">
<div class="modal-content oc-calculator-modal">
<div class="modal-header">
<h4 data-bind="html: header" class="modal-title" id="termsConditionsModalLabel">Terms & Conditions</h4>
</div>
<div class="modal-body">
<p>The Cancer Institute NSW does not warrant or represent that the information is free from errors or omission.</p>
<p>Furthermore, changes in circumstances after the time of publication of the information may impact on the accuracy of the information.</p>
<p>The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from the opioid
calculator.</p>
<p>The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution.</p>
<p>Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user.</p>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-primary" data-bind="click:action, html:primaryLabel" id="save-changes">Accept</button>
</div>
</div>
</div>
</div>
<script type="text/html" id="drug-list-template">
<!--<pre class="debug" data-bind="text: ko.toJSON(drugs, null, 2)"></pre>-->
<div class="panel-body">
<table class="table table-bordered table-striped therapies">
<thead>
<tr>
<th width="30%">Opioid</th>
<th>Dosage</th>
<th class="hidden-print"></th>
</tr>
</thead>
<tbody data-bind="foreachTransition: therapies">
<tr data-bind="uniqueId: $data">
<td data-bind="validationElement: drug, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}">
<div class="hidden-print">
<select class="form-control drug" data-bind="options: $parent.drugs, optionsText: 'title', value: drug, optionsCaption: 'Select...', focusValidate: drug"></select>
<div class="text-danger" id="drugError" data-bind="validationMessage: drug"></div>
</div>
<div class="visible-print-inline" data-bind="text: (drug() ? drug().drugName : '')"></div>
</td>
<td>
<div data-bind="if: drug(), validationElement: dose, validationOptions: { insertMessages: false, errorElementClass: 'has-error'}">
<label data-bind="uniqueFor: dose" class="dose">
<!-- ko if: drug().presetDoses().length -->
<select class="form-control dose" data-bind="uniqueId: dose, options: drug().presetDoses, value: dose, optionsCaption: 'None'"></select>
<!-- /ko -->
<!-- ko ifnot: drug().presetDoses().length -->
<input type="text" class="form-control form-control-inline dose" data-bind="uniqueId: dose, textInput: dose" />
<!-- /ko -->
<span class="unit" data-bind="text: drug().unit"></span> in 24 hours </label>
<span class="calculated-dose" data-bind="if: calculatedDose()"> x <span data-bind="text: drug().toOralMorphineConversionFactorLow"></span> = <span data-bind="text: calculatedDose()"></span> mg of Morphine (PO) </span>
<div class="text-danger" id="doseError" data-bind="validationMessage: dose"></div>
</div>
</td>
<td class="hidden-print">
<button type="button" class="btn btn-primary btn-xs remove-drug" aria-label="Remove" data-bind="visible: ($parent.therapies().length > 1), click: $parent.parent.removeDrug.bind($data, $parent.therapies)"
title="Remove this drug"><span aria-hidden="true">Remove</span></button>
</td>
</tr>
</tbody>
<tfoot>
<tr>
<td><!-- ko if: note -->
<ul class="small">
<li data-bind="html: 'Note: ' + note"></li>
</ul><!-- /ko -->
</td>
<td>
<ul class="small">
<li data-bind="html: cinsw.eviq.calculators.formulas.opioidConversion"></li>
</ul>
</td>
<td class="hidden-print"></td>
</tr>
</tfoot>
</table>
<div class="text-right hidden-print button-right">
<input type="button" class="btn btn-primary add-another-drug" data-bind="click: parent.addAnotherDrug.bind($data, therapies)" value="Add another drug" />
</div>
</div>
</script>
<!-- Terms & conditions modal -->
<script id="termsConditionsModal" class="modal-dialog" type="text/html">
<div class="modal-dialog">
<div class="modal-content oc-calculator-modal">
<div class="modal-header">
<h4 data-bind="html: header" class="modal-title" id="termsConditionsModalLabel"></h4>
</div>
<div class="modal-body">
<p>The Cancer Institute NSW does not warrant or represent that the information is free from errors or omission.</p>
<p>Furthermore, changes in circumstances after the time of publication of the information may impact on the accuracy of the information.</p>
<p>The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from the opioid
calculator.</p>
<p>The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution.</p>
<p>Clinical application of any information obtained from the opioid calculator is the sole responsibility of the user.</p>
</div>
<div class="modal-footer">
<button type="button" class="btn btn-primary" data-bind="click:action, html:primaryLabel" id="save-changes"></button>
</div>
</div>
</div>
</script>
</oc-calculator>
</div>
<div class="panel-group accordion" id="protocol" role="tablist" aria-multiselectable="true">
<div class="panel panel-default printAvoidPageBreakInside ">
<div class="panel-heading" role="tab" id="147319" data-name="practice-points" tabindex="0">
<h2 class="panel-title">
<a class="" role="button" data-toggle="collapse" href="#collapse147319" aria-expanded="true" aria-controls="collapse147319">
Practice points
</a>
</h2>
</div>
<div id="collapse147319" data-section="approval" data-section-name="Practice points" data-node-id="147319" data-node-guid="ffb82416-d7f5-48f1-b500-0bdec147921e"
data-node-alias-path="/Clinical-resources/eviQ-calculators/3201-Opioid-Conversion-Calculator/Practice-points" data-doc-guid="5506bd34-e64d-43d5-92a5-d9c37b66ec76" class="panel-collapse collapse in" role="tabpanel"
aria-labelledby="147319" aria-expanded="true" style="">
<div class="panel-body">
<ul>
<li>All calculations must be confirmed before use. Significant inter/intra patient variability exists in the response to different opioid drugs and the dose of these agents. After changing an opioid drug or its dose, patients
should be closely assessed and the dose or drug altered as necessary.</li>
<li>Calculations used for opioid switching should be documented in the patients record.</li>
<li>All conversions are made by first calculating the oral morphine equivalent daily dose (oMEDD) of the opioid being converted from, and then calculating the specific dose of the opioid being converted to. For conversion
factors used in the calculator select <a href="https://www.eviq.org.au/additional-clinical-information/3344-conversion-factors-used-in-eviq-opioid-conver" target="_blank" rel="noopener noreferrer">here</a>.</li>
<li>It is the responsibility of the user to round up or down calculated results if required, to align with preparations available at individual workplaces.</li>
<li>The eviQ opioid conversion calculator is only to be used for patients greater than 12 years old. For this reason the Date of Birth field is mandatory. For patients under this age consult with a pain or palliative care
specialist</li>
</ul>
<table class="table table-responsive">
<tbody>
</tbody>
</table>
</div>
</div>
</div>
<div class="panel panel-default printAvoidPageBreakInside ">
<div class="panel-heading" role="tab" id="147320" data-name="opioids-not-included-in-the-eviq-calculator" tabindex="0">
<h2 class="panel-title">
<a class="collapsed" role="button" data-toggle="collapse" href="#collapse147320" aria-expanded="false" aria-controls="collapse147320">
Opioids not included in the eviQ calculator
</a>
</h2>
</div>
<div id="collapse147320" data-section="approval" data-section-name="Opioids not included in the eviQ calculator" data-node-id="147320" data-node-guid="d1dcd4e9-f743-4f64-aaf9-1d03b6c75661"
data-node-alias-path="/Clinical-resources/eviQ-calculators/3201-Opioid-Conversion-Calculator/Opioids-not-included-in-the-eviQ-calculator" data-doc-guid="e871b785-0b84-45e6-9444-3b9e2f4fab0d" class="panel-collapse collapse"
role="tabpanel" aria-labelledby="147320">
<div class="panel-body">
<p>Dose conversion of the following opioids is complex and should only be made in consultation with pain or palliative care specialists who are experienced in the management of opioid therapy:</p>
<ul>
<li>Buprenorphine transdermal (TD): due to the limited evidence on dose conversions and practical experience of its use compared to other opioids, the calculator only allows conversion from buprenorphine TD to other opioids.</li>
<li>Fentanyl parenteral: Due to pharmacokinetic properties of parenteral fentanyl, dose conversion to/from other opioids and fentanyl parenteral is complex.</li>
<li>Fentanyl transmucosal: There is no dose equivalence between transmucosal fentanyl and other opioid formulations. All available formulations are not bio-equivalent and not directly interchangeable. Careful patient selection,
training, titration and monitoring are required to ensure optimum use.</li>
<li>Methadone: Dose conversion to/from other opioids and methadone is complex; consultation with pain or palliative care specialists familiar with methadone use is recommended.</li>
</ul>
<p>Evidence is limited to support the use of the following opioids for cancer pain:</p>
<ul>
<li>Buprenorphine parenteral and sublingual: both formulations are only indicated for the short-term (not more than one week) management of severe pain for which other treatment options are inappropriate.</li>
<li>Combination analgesics: <ul>
<li>Low dose codeine products (e.g. aspirin/codeine, ibuprofen/codeine and paracetamol/codeine): there is no conclusive evidence that products containing codeine have any benefits over the single non-opioid agent alone.</li>
<li>Tramadol and paracetamol combinations: there is no evidence that the combination is more effective, safer or better tolerated than paracetamol 500 mg and codeine 30 mg (both as individual drugs or in combination as 30/500
mg). In addition, the combination has sub-therapeutic doses of both active ingredients i.e. tramadol 37.5 mg/paracetamol 325 mg.</li>
</ul>
</li>
<li>Oxycodone rectal: Given the unpredicted pharmacokinetics of rectal administration, relative paucity of pharmacologic data, and the availability of multiple other routes, rectal dosing is not commonly used.</li>
<li>Oxycodone and naloxone (Targin<sup>®</sup>): The maximum dose of naloxone in the combination product Targin<sup>®</sup> can limit its practical use in palliative care.</li>
<li>Tramadol and tapentadol: Due to limited evidence on the efficacy of tramadol and tapentadol from clinically useful trials (particularly in primary care, chronic pain and cancer pain), the calculator only allows conversion from
tramadol and tapentadol to other opioids. For cancer pain in particular, they are neither more effective nor better tolerated than other less expensive analgesics and, in severe pain, strong opioids are likely to be more
effective.</li>
</ul>
<table class="table table-responsive">
<tbody>
</tbody>
</table>
</div>
</div>
</div>
<div class="panel panel-default ">
<div class="panel-heading" role="tab" id="126511" data-name="history" tabindex="0">
<h2 class="panel-title">
<a class="collapsed" role="button" data-toggle="collapse" href="#collapse126511" aria-expanded="false" aria-controls="collapse126511">
History
</a>
</h2>
</div>
<div id="collapse126511" data-section="approval" data-section-name="History" data-node-id="126511" data-node-guid="67eaad33-6e66-4b90-8ce9-2ca0b405df74"
data-node-alias-path="/Clinical-resources/eviQ-calculators/3201-Opioid-Conversion-Calculator/History" data-doc-guid="cc3c9f11-ed43-443b-8116-990bfd635192" class="panel-collapse collapse" role="tabpanel" aria-labelledby="126511">
<div class="panel-body">
<h4 class="histoty-title">Version 3</h4>
<table class="table-fullwidth">
<thead>
<tr>
<th scope="row">Date</th>
<th scope="col">Summary of changes</th>
</tr>
</thead>
<tbody>
<tr>
<th scope="row">08/12/2023</th>
<td>
<p>Calculator reviewed by expert palliative care reference committee. Approved for publication with the following changes made:</p>
<ul>
<li>Information relating to the calculator intention and limitations of use added.</li>
<li>Incomplete cross-tolerance disclaimer updated.</li>
<li>The term "Oral Morphine (PO) Equivalent mg/day" updated to "oral Morphine Equivalent Daily Dose (oMEDD) (mg/day)”.</li>
<li>Dosing frequency for breakthrough opioids updated to “not more frequently than every hour”.</li>
<li>Consensus was to significantly decrease the daily threshold for the oral morphine equivalent daily dose (oMEDD), which, when attained, prompts a safety warning on the screen. The safety warning thresholds for oMEDD
have been adjusted to >50 mg, as opposed to the previous 600 mg, and >100 mg, as opposed to the previous 1000 mg. This modification ensures safety, accommodates a broader spectrum of clinicians, and aligns with The
Royal Australian College of General Practitioners (RACGP) and the Faculty of Pain Medicine ANZCA opioid calculator. Acknowledging both are for chronic non-cancer pain.</li>
<li>Tapentadol PO (IR and SR) and tramadol PO (SR) have been added to step 1 and step 2 of the calculator.</li>
<li>Fentanyl parenteral removed from the calculator.</li>
<li>Opioids not included in the calculator and practice points sections updated.</li>
<li>Additional notes for morphine parenteral updated to include referral to other resources for end-of-life patients.</li>
<li>Conversion factors updates: buprenorphine transdermal has been adjusted to x 2 (previously x 2.5), the conversion factor for hydromorphone oral has been modified to x 5 (previously x 6), and the conversion factor for
morphine parenteral has been changed to x 3 (previously x 2.5) to bring it in line with established guidelines.</li>
</ul>
<p>Version number increased to V.3. Next review in 2 years.</p>
</td>
</tr>
</tbody>
</table>
<h4 class="histoty-title">Version 2</h4>
<table class="table-fullwidth">
<thead>
<tr>
<th scope="row" style="width: 10%;">Date</th>
<th scope="col">Summary of changes</th>
</tr>
</thead>
<tbody>
<tr>
<th scope="row" style="width: 10%;">31/05/2017</th>
<td>
<p>Transferred to new eviQ website.</p>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div id="protocol-references" class="panel panel-default " style="display: block;">
<div class="panel-heading" role="tab" id="170904" data-name="references" tabindex="0">
<h2 class="panel-title">
<span id="prhShowAccordion" class="accordion-show">
<a class="collapsed" role="button" data-toggle="collapse" href="#collapse170904" aria-expanded="false" aria-controls="collapse170904">
References
</a>
</span>
<span id="prhHideAccordion" class="accordion-hide"> References </span>
</h2>
</div>
<div id="collapse170904" class="panel-collapse collapse" role="tabpanel" aria-labelledby="heading170904">
<div class="panel-body">
<dl id="outDL" class="dl-horizontal dl-narrow m-b-0">
<dt id="reference-[%nodeguid%]" class="dtref" style="display: none;">[%id%]</dt>
<dd class="ddref" style="display: none;">
<div class="condition-bold"> [%title%] </div>
<div class="never-print hidden-print " [%visiblity%]="">
<div>
<div class="small text-muted accordion-show">
<div tabindex="0">
<a class="collapsed" role="link" data-toggle="collapse" href="#abstract-[%id%]" aria-expanded="false" aria-controls="abstract-[%id%]" data-reference="[%id%]">Read abstract</a>
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</div>
</div>
</dd>
<h3>Bibliography</h3>
<dt id="reference-169654" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Palliative Care Expert Group. Therapeutic Guidelines: Palliative Care. Therapeutic Guidelines Limited: Melbourne. 2021. </div>
<div class="never-print hidden-print " style="display: none">
<div>
<div class="small text-muted accordion-show">
<div tabindex="0">
<a class="collapsed" role="link" data-toggle="collapse" href="#abstract-169654" aria-expanded="false" aria-controls="abstract-169654" data-reference="169654">Read abstract</a>
<span class="fa fa-angle-down" aria-hidden="true"></span>
</div>
</div>
<div id="abstract-169654" class="collapse m-t-1" data-reference-toggle="169654" aria-expanded="false" style="display: none;"></div>
</div>
</div>
</dd>
<dt id="reference-169655" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Faculty of Pain Medicine, ANZCA. Opioid-Dose Equivalence. 2021.
https://www.anzca.edu.au/getattachment/6892fb13-47fc-446b-a7a2-11cdfe1c9902/PM01-(Appendix-2)-Opioid-Dose-Equivalence-Calculation-of-Oral-Morphine-Equivalent-Daily-Dose-(oMEDD).aspx </div>
<div class="never-print hidden-print " style="display: none">
<div>
<div class="small text-muted accordion-show">
<div tabindex="0">
<a class="collapsed" role="link" data-toggle="collapse" href="#abstract-169655" aria-expanded="false" aria-controls="abstract-169655" data-reference="169655">Read abstract</a>
<span class="fa fa-angle-down" aria-hidden="true"></span>
</div>
</div>
<div id="abstract-169655" class="collapse m-t-1" data-reference-toggle="169655" aria-expanded="false" style="display: none;"></div>
</div>
</div>
</dd>
<dt id="reference-169657" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> The Royal Australian College of General Practitioners. Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain management. East Melbourne, VIC: RACGP. 2022. </div>
<div class="never-print hidden-print " style="display: none">
<div>
<div class="small text-muted accordion-show">
<div tabindex="0">
<a class="collapsed" role="link" data-toggle="collapse" href="#abstract-169657" aria-expanded="false" aria-controls="abstract-169657" data-reference="169657">Read abstract</a>
<span class="fa fa-angle-down" aria-hidden="true"></span>
</div>
</div>
<div id="abstract-169657" class="collapse m-t-1" data-reference-toggle="169657" aria-expanded="false" style="display: none;"></div>
</div>
</div>
</dd>
<dt id="reference-169658" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Therapeutic Goods Administration, Department of Health, Commonwealth of Australia. </div>
<div class="never-print hidden-print " style="display: none">
<div>
<div class="small text-muted accordion-show">
<div tabindex="0">
<a class="collapsed" role="link" data-toggle="collapse" href="#abstract-169658" aria-expanded="false" aria-controls="abstract-169658" data-reference="169658">Read abstract</a>
<span class="fa fa-angle-down" aria-hidden="true"></span>
</div>
</div>
<div id="abstract-169658" class="collapse m-t-1" data-reference-toggle="169658" aria-expanded="false" style="display: none;"></div>
</div>
</div>
</dd>
<dt id="reference-169659" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Queensland Health, Centre for Palliative Care Research and Education Guidelines for Subcutaneous Infusion Device Management in Palliative Care and other settings – 3rd Edition. 2021. </div>
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</div>
</dd>
<dt id="reference-169834" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Statement regarding the use of opioid analgesics in patients with chronic non-cancer pain. Faculty of Pain Medicine, ANZCA. Available at:
https://www.anzca.edu.au/getattachment/7d7d2619-6736-4d8e-876e-6f9b2b45c435/PS01(PM)-Statement-regarding-the-use-of-opioid-analgesics-in-patients-with-chronic-non-cancer-pain [Accessed 19 May 2021]. </div>
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</div>
</div>
</dd>
<dt id="reference-169837" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> The Safer Care Victoria Opioid Conversion Ratios Guidance document. Available at: https://www.bettersafercare.vic.gov.au/sites/default/files/2021-02/GUIDANCE_Opioid%20Conversion%20FINAL_0.pdf </div>
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</dd>
<dt id="reference-169836" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Wiffen, P.J., S. Derry, K. Naessens, et al. 2015. “Oral tapentadol for cancer pain.” Cochrane Database Syst Rev:2015(9). </div>
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<p id="CD011460-sec-0001title">BACKGROUND: A large proportion of people with advanced cancer will experience moderate to severe pain. Tapentadol is a novel, centrally acting analgesic medicine acting at the μ‐opioid
receptor and inhibiting noradrenaline reuptake. The efficacy of tapentadol is stated to be comparable to morphine and oxycodone. OBJECTIVES: To assess the analgesic efficacy of tapentadol for the relief of cancer
pain in adults, and the adverse events associated with its use in clinical trials. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from January 2005 to July
2015, together with reference lists of retrieved papers and review articles, and two clinical trial registries. Searches started from 2005 because this covered the period during which clinical trials were conducted. We
contacted the manufacturer of tapentadol in the UK to find additional trials not identified by electronic searches. We did not restrict searches by language. SELECTION CRITERIA: We included randomised controlled trials
(RCTs) of tapentadol compared with placebo or active controls in adults with moderate to severe cancer pain. Pain had to be measured using a validated assessment tool, and studies had to include at least 10 participants
per treatment arm. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data using a standard form and assessed risk of bias. We extracted available data on study design, participant details,
interventions, and outcomes, including analgesic outcome measures, withdrawals, and adverse events. MAIN RESULTS: We included four studies with 1029 participants. All the studies used a parallel‐group design, and
included an initial titration phase to determine the maximum effective and tolerated dose, followed by a maintenance phase. Tapentadol medication was taken twice daily and doses ranged from 50 to 500 mg per day. Rescue
medication (morphine or oxycodone immediate‐release) was available to participants in all studies. Overall, 440 participants were randomised in classically designed RCTs, and 589 participants were enrolled in
enriched‐enrolment, randomised‐withdrawal (EERW) trials. A total of 476 participants were randomised to titration with tapentadol and 338 participants took tapentadol throughout the maintenance phase of their trial. All
studies used numerical rating scores, Patient Global Impression of Change scores, and use of rescue medication as measures of efficacy, and all reported on adverse events and withdrawals. All studies enrolled fewer than
200 participants per treatment arm and were therefore at risk of overestimating efficacy. One study was terminated early due to problems with supply of rescue medication, with fewer than 20 participants enrolled per
treatment arm in the maintenance phase of the trial. We judged another study at high risk of bias due to an open‐label design. There were insufficient data for pooling and statistical analysis. Response rates for pain
intensity were comparable across treatment groups in each study. In one EERW study, response rates were high across both treatment and placebo arms during the maintenance phase (62% tapentadol, 69% morphine, 50%
placebo). For pain relief, tapentadol is no more and no less effective than oxycodone or morphine (low quality evidence). Treatment emergent adverse event rates were high, approximately 50% to 90%. The most common
adverse events were gastrointestinal (nausea, vomiting, constipation) (low quality evidence). There was no advantage of tapentadol over morphine or oxycodone in terms of serious adverse events. The number of people
experiencing effects on consciousness, appetite, or thirst was low. AUTHORS' CONCLUSION: Information from RCTs on the effectiveness and tolerability of tapentadol was limited. The available studies were of moderate or
small size and used different designs, which prevented pooling of data. Pain relief and adverse events were comparable between the tapentadol and morphine and oxycodone groups.</p>
</div>
</div>
</div>
</dd>
<dt id="reference-169835" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Wiffen, P.J., S. Derry, R.A. Moore. 2017. “Tramadol with or without paracetamol (acetaminophen) for cancer pain.” Cochrane Database Syst Rev:5(5). </div>
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<p>BACKGROUND:<strong> </strong>Tramadol is an opioid analgesic licensed for use in moderate to severe pain. It is considered as a low risk for abuse, so control regulations are not as stringent as for 'strong'
opioids such as morphine. It has a potential role as a step 2 option of the World Health Organization (WHO) analgesic ladder. OBJECTIVES:<strong> </strong>To assess the benefits and adverse effects of tramadol
with or without paracetamol (acetaminophen) for cancer-related pain. SEARCH METHODS: We searched the following databases using a wide range of search terms: the Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, Embase, and LILACS. We also searched three clinical trials registry databases. The date of the last search was 2 November 2016. SELECTION CRITERIA:<strong> </strong>We selected studies that were
randomised, with placebo or active controls, or both, and included a minimum of 10 participants per treatment arm. We were interested particularly in blinded studies, but also included open studies.We excluded
non-randomised studies, studies of experimental pain, case reports, and clinical observations. DATA COLLECTION AND ANALYSIS:<strong> </strong>Two review authors independently extracted data using a standard form and
checked for agreement before entry into Review Manager 5. We included information about the number of participants treated and demographic details, type of cancer, drug and dosing regimen, study design (placebo or active
control) and methods, study duration and follow-up, analgesic outcome measures and results, withdrawals, and adverse events. We collated multiple reports of the same study, so that each study, rather than each report,
was the unit of interest in the review. We assessed the evidence using GRADE and created a 'Summary of findings' table.The main outcomes of interest for benefit were pain reduction of 30% or greater and 50% or greater
from baseline, participants with pain no worse than mild, and participants feeling much improved or very much improved. MAIN RESULTS:<strong> </strong>We included 10 studies (12 reports) with 958 adult
participants. All the studies enrolled participants with chronic malignant tumour-related pain who were experiencing pain intensities described as moderate to severe, with most experiencing at least 4/10 with current
treatment. The mean ages were 59 to 70 years, with participants aged between 24 and 87 years. Study length ranged from one day to six months. Five studies used a cross-over design. Tramadol doses ranged from 50 mg as
single dose to 600 mg per day; doses of 300 mg per day to 400 mg per day were most common.Nine studies were at high risk of bias for one to four criteria (only one high risk of bias for size). We judged all the results
to be very low quality evidence because of widespread lack of blinding of outcome assessment, inadequately described sequence generation, allocation concealment, and small numbers of participants and events. Important
outcomes were poorly reported. There were eight different active comparators and one comparison with placebo. There was little information available for any comparison and no firm conclusions could be drawn for any
outcome.Single comparisons of oral tramadol with codeine plus paracetamol, of dihydrocodeine, and of rectal versus oral tramadol provided no data for key outcomes. One study used tramadol combined with paracetamol; four
participants received this intervention. One study compared tramadol with flupirtine - a drug that is no longer available. One study compared tramadol with placebo and a combination of cobrotoxin, tramadol, and
ibuprofen, but the dosing schedule poorly explained.Two studies (191 participants) compared tramadol with buprenorphine. One study (131 participants) reported a similar proportion of no or mild pain at 14 days.Three
studies (300 participants) compared tramadol with morphine. Only one study, combining tramadol, tramadol plus paracetamol, and paracetamol plus codeine as a single weak-opioid group reported results. Weak opioid produced
reduction in pain of at least 30% from baseline in 55/117 (47%) participants, compared with 91/110 (82%) participants with morphine. Weak opioid produced reduction in pain of at least 50% in 49/117 (42%) participants,
compared with 83/110 (75%) participants with morphine.There was no useful information for any other outcome of benefit or harm. AUTHORS' CONCLUSION:<strong> </strong>There is limited, very low quality, evidence from
randomised controlled trials that tramadol produced pain relief in some adults with pain due to cancer and no evidence at all for children. There is very low quality evidence that it is not as effective as morphine. This
review does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different is very high. The place of tramadol in managing cancer pain and its role as step 2 of the
WHO analgesic ladder is unclear.</p>
</div>
</div>
</div>
</dd>
<dt id="reference-170068" class="dtref"></dt>
<dd class="ddref">
<div class="condition-bold"> Janssen-Cilag Pty Ltd. DUROGESIC product information. 2023. </div>
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the accuracy of the information. The user agrees not to hold the Cancer Institute NSW or any of its officers, employees or contractors liable in any way for use and/or outcomes brought about through the use of any information obtained from
the opioid calculator. The doses are calculated as a guideline only, based on currently published conversion factors and may differ from those used in your institution. Clinical application of any information obtained from the opioid
calculator is the sole responsibility of the user.</p>
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1. Home
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OPIOID CONVERSION CALCULATOR
* ID: 3201 v.3
* Endorsed
* Opioid Conversion Calculator
* View history
* Print this page
*
Opioid Conversion Calculator:
Version 3 has undergone significant updates. Consult the history section for
comprehensive details.
Related eLearning: - Principles of opioid conversion opens in a new tab or
window
INTENTION OF USE
* Familiarity is important for safe prescribing of opioids and clinicians need
to have a good understanding of pain management and equianalgesic conversions
before using this calculator. Its use should not replace the need for
education in the area of equianalgesic dosing.
* The calculator provides conversions from one opioid to another and/or from
one route of administration to another, to be used as a guide only. It is not
tailored to any specific pain syndrome or for utilisation by specific
healthcare professionals.
* The calculator does not provide clinical guidance on therapeutic use of
opioids e.g. initiating, tapering or stopping opioids; drug-drug
interactions, side effects or dosing in renal/hepatic impairment or any other
special populations. Long-term opioid therapy for chronic non-cancer pain
remains controversial. Refer to guidance for opioid use in chronic non-cancer
pain.
* Clinical judgement should always be used while switching opioids. Medical and
psychosocial factors and clinical care environment need to be assessed prior
to opioid rotation.
Related pages:
* Conversion factors used in eviQ opioid conversion calculator
On this page
* Practice points
* Opioids not included in the eviQ calculator
* History
* References
Expand all Collapse all Back to top
OPIOID CONVERSION
Patient Name:
Medical Record Number:
Gender:
Male Female
Date of Birth: Date of Birth:
Day of month: DD12345678910111213141516171819202122232425262728293031
Month: MMJanFebMarAprMayJunJulAugSepOctNovDec
Year:
YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923
OR
Age:
VALID
INVALID
*
*
*
* Age:
Step 1: Current REGULAR opioid therapy
Opioid Dosage
Select...Anamorph mg(PO)Bupredermal microgram/hour(Transdermal)Buprenorphine
microgram/hour(Transdermal)Codeine mg(PO)Denpax
microgram/hour(Transdermal)dilaUDID mg(IM/IV/SC)dilaUDID mg(PO)Durogesic
microgram/hour(Transdermal)Endone mg(PO)Fenpatch
microgram/hour(Transdermal)Fentanyl microgram/hour(Transdermal)HYDROmorphone
mg(IM/IV/SC)HYDROmorphone mg(PO)Kapanol mg(PO)Morphine mg(IM/IV/SC)Morphine
mg(PO)MS Contin mg(PO)MS Mono mg(PO)Norspan microgram/hour(Transdermal)Ordine
mg(PO)Oxycodone mg(PO)Oxycodone mg(SC/IV)OxyCONTIN mg(PO)OxyNORM mg(PO)OxyNORM
mg(SC/IV)Palexia mg(PO)Palexia SR mg(PO)Sevredol mg(PO)tAPENTadol
mg(PO)tAPENTadol SR mg(PO)tRAMadol mg(IM/IV)tRAMadol mg(PO)tRAMadol SR
mg(PO)Tramal mg(PO)Tramal SR mg(PO)Tramedo mg(PO)Tramedo SR mg(PO)Zydol
mg(PO)Zydol SR mg(PO)
Remove
* Formula = (mg/day of current opioid) x (conversion factor) = oral Morphine
Equivalent Daily Dose (oMEDD) (mg/day)
Step 2: Current BREAKTHROUGH opioid therapy
Opioid Dosage
Select...Anamorph mg(PO)Codeine mg(PO)dilaUDID mg(IM/IV/SC)dilaUDID mg(PO)Endone
mg(PO)HYDROmorphone mg(IM/IV/SC)HYDROmorphone mg(PO)Morphine
mg(IM/IV/SC)Morphine mg(PO)Ordine mg(PO)Oxycodone mg(PO)Oxycodone
mg(SC/IV)OxyNORM mg(PO)OxyNORM mg(SC/IV)Palexia mg(PO)Sevredol mg(PO)tAPENTadol
mg(PO)tRAMadol mg(IM/IV)tRAMadol mg(PO)Tramal mg(PO)Tramedo mg(PO)Zydol mg(PO)
Remove
* Note: Current breakthrough opioid entered to be what the patient is actually
taking rather than what has been prescribed.
* Formula = (mg/day of current opioid) x (conversion factor) = oral Morphine
Equivalent Daily Dose (oMEDD) (mg/day)
Step 3: Convert to final opioid
Opioid
Dose reduction for incomplete cross-tolerance
Cross-tolerance is the development of tolerance to the effects of one opioid due
to previous exposure to another. Since cross-tolerance is not always complete,
switching to another opioid with same equianalgesic dose can lead to greater
than anticipated potency. Dosing adjustment is recommended to accommodate for
unknown cross-tolerance. It is recommended that dosing adjustments for
cross-tolerance, unsatisfactory efficacy despite dose titration or unaccepted
toxicity are made in consultation with a palliative care or pain specialist.
Select...Anamorph mg(PO)Denpax microgram/hour(Transdermal)dilaUDID
mg(IM/IV/SC)dilaUDID mg(PO)Durogesic microgram/hour(Transdermal)Endone
mg(PO)Fenpatch microgram/hour(Transdermal)Fentanyl
microgram/hour(Transdermal)HYDROmorphone mg(IM/IV/SC)HYDROmorphone mg(PO)Kapanol
mg(PO)Morphine mg(IM/IV/SC)Morphine mg(PO)MS Contin mg(PO)MS Mono mg(PO)Ordine
mg(PO)Oxycodone mg(PO)Oxycodone mg(SC/IV)OxyCONTIN mg(PO)OxyNORM mg(PO)OxyNORM
mg(SC/IV)Sevredol mg(PO)
None-25%-50%-75%
None
VALID
INVALID
TERMS & CONDITIONS
The Cancer Institute NSW does not warrant or represent that the information is
free from errors or omission.
Furthermore, changes in circumstances after the time of publication of the
information may impact on the accuracy of the information.
The user agrees not to hold the Cancer Institute NSW or any of its officers,
employees or contractors liable in any way for use and/or outcomes brought about
through the use of any information obtained from the opioid calculator.
The doses are calculated as a guideline only, based on currently published
conversion factors and may differ from those used in your institution.
Clinical application of any information obtained from the opioid calculator is
the sole responsibility of the user.
Accept
PRACTICE POINTS
* All calculations must be confirmed before use. Significant inter/intra
patient variability exists in the response to different opioid drugs and the
dose of these agents. After changing an opioid drug or its dose, patients
should be closely assessed and the dose or drug altered as necessary.
* Calculations used for opioid switching should be documented in the patients
record.
* All conversions are made by first calculating the oral morphine equivalent
daily dose (oMEDD) of the opioid being converted from, and then calculating
the specific dose of the opioid being converted to. For conversion
factors used in the calculator select here.
* It is the responsibility of the user to round up or down calculated results
if required, to align with preparations available at individual workplaces.
* The eviQ opioid conversion calculator is only to be used for patients greater
than 12 years old. For this reason the Date of Birth field is mandatory. For
patients under this age consult with a pain or palliative care specialist
OPIOIDS NOT INCLUDED IN THE EVIQ CALCULATOR
Dose conversion of the following opioids is complex and should only be made in
consultation with pain or palliative care specialists who are experienced in the
management of opioid therapy:
* Buprenorphine transdermal (TD): due to the limited evidence on dose
conversions and practical experience of its use compared to other opioids,
the calculator only allows conversion from buprenorphine TD to other opioids.
* Fentanyl parenteral: Due to pharmacokinetic properties of parenteral
fentanyl, dose conversion to/from other opioids and fentanyl parenteral is
complex.
* Fentanyl transmucosal: There is no dose equivalence between transmucosal
fentanyl and other opioid formulations. All available formulations are not
bio-equivalent and not directly interchangeable. Careful patient selection,
training, titration and monitoring are required to ensure optimum use.
* Methadone: Dose conversion to/from other opioids and methadone is complex;
consultation with pain or palliative care specialists familiar with methadone
use is recommended.
Evidence is limited to support the use of the following opioids for cancer pain:
* Buprenorphine parenteral and sublingual: both formulations are only indicated
for the short-term (not more than one week) management of severe pain for
which other treatment options are inappropriate.
* Combination analgesics:
* Low dose codeine products (e.g. aspirin/codeine, ibuprofen/codeine and
paracetamol/codeine): there is no conclusive evidence that products
containing codeine have any benefits over the single non-opioid agent
alone.
* Tramadol and paracetamol combinations: there is no evidence that the
combination is more effective, safer or better tolerated than paracetamol
500 mg and codeine 30 mg (both as individual drugs or in combination as
30/500 mg). In addition, the combination has sub-therapeutic doses of both
active ingredients i.e. tramadol 37.5 mg/paracetamol 325 mg.
* Oxycodone rectal: Given the unpredicted pharmacokinetics of rectal
administration, relative paucity of pharmacologic data, and the availability
of multiple other routes, rectal dosing is not commonly used.
* Oxycodone and naloxone (Targin®): The maximum dose of naloxone in the
combination product Targin® can limit its practical use in palliative care.
* Tramadol and tapentadol: Due to limited evidence on the efficacy of tramadol
and tapentadol from clinically useful trials (particularly in primary care,
chronic pain and cancer pain), the calculator only allows conversion from
tramadol and tapentadol to other opioids. For cancer pain in particular, they
are neither more effective nor better tolerated than other less expensive
analgesics and, in severe pain, strong opioids are likely to be more
effective.
HISTORY
VERSION 3
Date Summary of changes 08/12/2023
Calculator reviewed by expert palliative care reference committee. Approved for
publication with the following changes made:
* Information relating to the calculator intention and limitations of use
added.
* Incomplete cross-tolerance disclaimer updated.
* The term "Oral Morphine (PO) Equivalent mg/day" updated to "oral Morphine
Equivalent Daily Dose (oMEDD) (mg/day)”.
* Dosing frequency for breakthrough opioids updated to “not more frequently
than every hour”.
* Consensus was to significantly decrease the daily threshold for the oral
morphine equivalent daily dose (oMEDD), which, when attained, prompts a
safety warning on the screen. The safety warning thresholds for oMEDD have
been adjusted to >50 mg, as opposed to the previous 600 mg, and >100 mg, as
opposed to the previous 1000 mg. This modification ensures safety,
accommodates a broader spectrum of clinicians, and aligns with The Royal
Australian College of General Practitioners (RACGP) and the Faculty of Pain
Medicine ANZCA opioid calculator. Acknowledging both are for chronic
non-cancer pain.
* Tapentadol PO (IR and SR) and tramadol PO (SR) have been added to step 1 and
step 2 of the calculator.
* Fentanyl parenteral removed from the calculator.
* Opioids not included in the calculator and practice points sections updated.
* Additional notes for morphine parenteral updated to include referral to other
resources for end-of-life patients.
* Conversion factors updates: buprenorphine transdermal has been adjusted to x
2 (previously x 2.5), the conversion factor for hydromorphone oral has been
modified to x 5 (previously x 6), and the conversion factor for morphine
parenteral has been changed to x 3 (previously x 2.5) to bring it in line
with established guidelines.
Version number increased to V.3. Next review in 2 years.
VERSION 2
Date Summary of changes 31/05/2017
Transferred to new eviQ website.
REFERENCES REFERENCES
[%id%]
[%title%]
Read abstract
[%abstract%]
BIBLIOGRAPHY
Palliative Care Expert Group. Therapeutic Guidelines: Palliative Care.
Therapeutic Guidelines Limited: Melbourne. 2021.
Read abstract
Faculty of Pain Medicine, ANZCA. Opioid-Dose Equivalence. 2021.
https://www.anzca.edu.au/getattachment/6892fb13-47fc-446b-a7a2-11cdfe1c9902/PM01-(Appendix-2)-Opioid-Dose-Equivalence-Calculation-of-Oral-Morphine-Equivalent-Daily-Dose-(oMEDD).aspx
Read abstract
The Royal Australian College of General Practitioners. Prescribing drugs of
dependence in general practice, Part C2: The role of opioids in pain management.
East Melbourne, VIC: RACGP. 2022.
Read abstract
Therapeutic Goods Administration, Department of Health, Commonwealth of
Australia.
Read abstract
Queensland Health, Centre for Palliative Care Research and Education Guidelines
for Subcutaneous Infusion Device Management in Palliative Care and other
settings – 3rd Edition. 2021.
Read abstract
Statement regarding the use of opioid analgesics in patients with chronic
non-cancer pain. Faculty of Pain Medicine, ANZCA. Available at:
https://www.anzca.edu.au/getattachment/7d7d2619-6736-4d8e-876e-6f9b2b45c435/PS01(PM)-Statement-regarding-the-use-of-opioid-analgesics-in-patients-with-chronic-non-cancer-pain
[Accessed 19 May 2021].
Read abstract
The Safer Care Victoria Opioid Conversion Ratios Guidance document. Available
at:
https://www.bettersafercare.vic.gov.au/sites/default/files/2021-02/GUIDANCE_Opioid%20Conversion%20FINAL_0.pdf
Read abstract
Wiffen, P.J., S. Derry, K. Naessens, et al. 2015. “Oral tapentadol for cancer
pain.” Cochrane Database Syst Rev:2015(9).
Read abstract
BACKGROUND: A large proportion of people with advanced cancer will experience
moderate to severe pain. Tapentadol is a novel, centrally acting analgesic
medicine acting at the μ‐opioid receptor and inhibiting noradrenaline reuptake.
The efficacy of tapentadol is stated to be comparable to morphine and oxycodone.
OBJECTIVES: To assess the analgesic efficacy of tapentadol for the relief of
cancer pain in adults, and the adverse events associated with its use in
clinical trials. SEARCH METHODS: We searched the Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE, and EMBASE from January 2005 to July 2015,
together with reference lists of retrieved papers and review articles, and two
clinical trial registries. Searches started from 2005 because this covered the
period during which clinical trials were conducted. We contacted the
manufacturer of tapentadol in the UK to find additional trials not identified by
electronic searches. We did not restrict searches by language. SELECTION
CRITERIA: We included randomised controlled trials (RCTs) of tapentadol compared
with placebo or active controls in adults with moderate to severe cancer pain.
Pain had to be measured using a validated assessment tool, and studies had to
include at least 10 participants per treatment arm. DATA COLLECTION AND
ANALYSIS: Two review authors independently extracted data using a standard form
and assessed risk of bias. We extracted available data on study design,
participant details, interventions, and outcomes, including analgesic outcome
measures, withdrawals, and adverse events. MAIN RESULTS: We included four
studies with 1029 participants. All the studies used a parallel‐group design,
and included an initial titration phase to determine the maximum effective and
tolerated dose, followed by a maintenance phase. Tapentadol medication was taken
twice daily and doses ranged from 50 to 500 mg per day. Rescue medication
(morphine or oxycodone immediate‐release) was available to participants in all
studies. Overall, 440 participants were randomised in classically designed RCTs,
and 589 participants were enrolled in enriched‐enrolment, randomised‐withdrawal
(EERW) trials. A total of 476 participants were randomised to titration with
tapentadol and 338 participants took tapentadol throughout the maintenance phase
of their trial. All studies used numerical rating scores, Patient Global
Impression of Change scores, and use of rescue medication as measures of
efficacy, and all reported on adverse events and withdrawals. All studies
enrolled fewer than 200 participants per treatment arm and were therefore at
risk of overestimating efficacy. One study was terminated early due to problems
with supply of rescue medication, with fewer than 20 participants enrolled per
treatment arm in the maintenance phase of the trial. We judged another study at
high risk of bias due to an open‐label design. There were insufficient data for
pooling and statistical analysis. Response rates for pain intensity were
comparable across treatment groups in each study. In one EERW study, response
rates were high across both treatment and placebo arms during the maintenance
phase (62% tapentadol, 69% morphine, 50% placebo). For pain relief, tapentadol
is no more and no less effective than oxycodone or morphine (low quality
evidence). Treatment emergent adverse event rates were high, approximately 50%
to 90%. The most common adverse events were gastrointestinal (nausea, vomiting,
constipation) (low quality evidence). There was no advantage of tapentadol over
morphine or oxycodone in terms of serious adverse events. The number of people
experiencing effects on consciousness, appetite, or thirst was low. AUTHORS'
CONCLUSION: Information from RCTs on the effectiveness and tolerability of
tapentadol was limited. The available studies were of moderate or small size and
used different designs, which prevented pooling of data. Pain relief and adverse
events were comparable between the tapentadol and morphine and oxycodone groups.
Wiffen, P.J., S. Derry, R.A. Moore. 2017. “Tramadol with or without paracetamol
(acetaminophen) for cancer pain.” Cochrane Database Syst Rev:5(5).
Read abstract
BACKGROUND: Tramadol is an opioid analgesic licensed for use in moderate to
severe pain. It is considered as a low risk for abuse, so control regulations
are not as stringent as for 'strong' opioids such as morphine. It has a
potential role as a step 2 option of the World Health Organization (WHO)
analgesic ladder. OBJECTIVES: To assess the benefits and adverse effects of
tramadol with or without paracetamol (acetaminophen) for cancer-related
pain. SEARCH METHODS: We searched the following databases using a wide range of
search terms: the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, Embase, and LILACS. We also searched three clinical trials registry
databases. The date of the last search was 2 November 2016. SELECTION
CRITERIA: We selected studies that were randomised, with placebo or active
controls, or both, and included a minimum of 10 participants per treatment arm.
We were interested particularly in blinded studies, but also included open
studies.We excluded non-randomised studies, studies of experimental pain, case
reports, and clinical observations. DATA COLLECTION AND ANALYSIS: Two review
authors independently extracted data using a standard form and checked for
agreement before entry into Review Manager 5. We included information about the
number of participants treated and demographic details, type of cancer, drug and
dosing regimen, study design (placebo or active control) and methods, study
duration and follow-up, analgesic outcome measures and results, withdrawals, and
adverse events. We collated multiple reports of the same study, so that each
study, rather than each report, was the unit of interest in the review. We
assessed the evidence using GRADE and created a 'Summary of findings' table.The
main outcomes of interest for benefit were pain reduction of 30% or greater and
50% or greater from baseline, participants with pain no worse than mild, and
participants feeling much improved or very much improved. MAIN RESULTS: We
included 10 studies (12 reports) with 958 adult participants. All the studies
enrolled participants with chronic malignant tumour-related pain who were
experiencing pain intensities described as moderate to severe, with most
experiencing at least 4/10 with current treatment. The mean ages were 59 to 70
years, with participants aged between 24 and 87 years. Study length ranged from
one day to six months. Five studies used a cross-over design. Tramadol doses
ranged from 50 mg as single dose to 600 mg per day; doses of 300 mg per day to
400 mg per day were most common.Nine studies were at high risk of bias for one
to four criteria (only one high risk of bias for size). We judged all the
results to be very low quality evidence because of widespread lack of blinding
of outcome assessment, inadequately described sequence generation, allocation
concealment, and small numbers of participants and events. Important outcomes
were poorly reported. There were eight different active comparators and one
comparison with placebo. There was little information available for any
comparison and no firm conclusions could be drawn for any outcome.Single
comparisons of oral tramadol with codeine plus paracetamol, of dihydrocodeine,
and of rectal versus oral tramadol provided no data for key outcomes. One study
used tramadol combined with paracetamol; four participants received this
intervention. One study compared tramadol with flupirtine - a drug that is no
longer available. One study compared tramadol with placebo and a combination of
cobrotoxin, tramadol, and ibuprofen, but the dosing schedule poorly
explained.Two studies (191 participants) compared tramadol with buprenorphine.
One study (131 participants) reported a similar proportion of no or mild pain at
14 days.Three studies (300 participants) compared tramadol with morphine. Only
one study, combining tramadol, tramadol plus paracetamol, and paracetamol plus
codeine as a single weak-opioid group reported results. Weak opioid produced
reduction in pain of at least 30% from baseline in 55/117 (47%) participants,
compared with 91/110 (82%) participants with morphine. Weak opioid produced
reduction in pain of at least 50% in 49/117 (42%) participants, compared with
83/110 (75%) participants with morphine.There was no useful information for any
other outcome of benefit or harm. AUTHORS' CONCLUSION: There is limited, very
low quality, evidence from randomised controlled trials that tramadol produced
pain relief in some adults with pain due to cancer and no evidence at all for
children. There is very low quality evidence that it is not as effective as
morphine. This review does not provide a reliable indication of the likely
effect. The likelihood that the effect will be substantially different is very
high. The place of tramadol in managing cancer pain and its role as step 2 of
the WHO analgesic ladder is unclear.
Janssen-Cilag Pty Ltd. DUROGESIC product information. 2023.
Read abstract
Disclaimer: The Cancer Institute NSW does not warrant or represent that the
information is free from errors or omission. Furthermore, changes in
circumstances after the time of publication of the information may impact on the
accuracy of the information. The user agrees not to hold the Cancer Institute
NSW or any of its officers, employees or contractors liable in any way for use
and/or outcomes brought about through the use of any information obtained from
the opioid calculator. The doses are calculated as a guideline only, based on
currently published conversion factors and may differ from those used in your
institution. Clinical application of any information obtained from the opioid
calculator is the sole responsibility of the user.
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