Drug Conversions
Opioid equivalents, steroid conversions, and medication transitions.
Clinical Overview
Transitioning patients between different medications within the same class requires careful calculation of equipotent doses to prevent withdrawal, under-dosing, or toxicity.
Common Use Cases
- •Converting between different opioids (MME)
- •IV to PO opioid conversions
- •Corticosteroid equivalencies
Clinical Pearls
Incomplete Cross-Tolerance
When converting between opioids, the calculated equipotent dose should typically be reduced by 25-50% due to incomplete cross-tolerance, except when converting to methadone which requires highly specific protocols.
Steroid Mineralocorticoid Activity
When converting steroids, remember that synthetic steroids like dexamethasone have zero mineralocorticoid activity, while hydrocortisone has significant mineralocorticoid effect.