Dose conversion from other oral opioids to once-daily Hysingla ER
Conversion recommendations for managing your patient's transition to Hysingla ER from a non-hydrocodone oral opioid or a transdermal opioid medication
Conversion from other oral opioids to Hysingla ER chronic pain therapy
- Discontinue all other around-the-clock opioid drugs when Hysingla ER therapy is initiated
- There is inter-patient variability in the relative potency of opioid drugs and formulations. Therefore, a conservative approach is advised when determining the total daily dosage of Hysingla ER
- It is safer to underestimate a patient's 24-hour oral hydrocodone dosage and provide rescue medication (e.g., immediate-release opioid) than to overestimate the 24-hour oral hydrocodone dosage and manage an adverse reaction due to an overdose
- In a Hysingla ER clinical trial with an open-label titration period, patients were converted from their prior opioid to Hysingla ER using the conversion factors in the table below as a guide for the initial Hysingla ER dose.
Determining the starting dose of Hysingla ER
- First use the table to convert the prior oral opioids to a total hydrocodone daily dose
- Then reduce the calculated daily hydrocodone dose by 25% to account for inter-patient variability in relative potency of different opioids
- Always round the dose down, if necessary, to the nearest Hysingla ER tablet strength available and initiate therapy with that dose. If the converted Hysingla ER dose using the conversion factors table is less than 20 mg, initiate therapy with Hysingla ER 20 mg
- This is NOT a table of equianalgesic doses. Conversion factors in this table are ONLY for the conversion from one of the listed oral opioid analgesics to Hysingla ER
- The table CANNOT be used to convert from Hysingla ER to another opioid. Doing so will result in an overestimation of the dose of the new opioid and may result in fatal overdose
| Opioids | Oral Dose (mg) | Approximate Oral Conversion Factor |
|---|---|---|
| Codeine | 133 | 0.15 |
| Hydromorphone | 5 | 4 |
| Morphine | 40 | 0.5 |
| Oxycodone | 20 | 1 |
| Oxymorphone | 10 | 2 |
| Tramadol | 200 | 0.1 |
Conversion from transdermal fentanyl to Hysingla ER
Eighteen hours following the removal of the transdermal fentanyl patch, Hysingla ER treatment can be initiated. For each 25 mcg/hr fentanyl transdermal patch, a dose of Hysingla ER 20 mg every 24 hours represents a conservative initial dose. Follow the patient closely during conversion from transdermal fentanyl to Hysingla ER, as there is limited experience with this conversion.
Conversion from transdermal buprenorphine to Hysingla ER
All patients receiving transdermal buprenorphine (≤20 mcg/hr) should initiate therapy with Hysingla ER 20 mg every 24 hours. Follow the patient closely during conversion from transdermal buprenorphine to Hysingla ER, as there is limited experience with this conversion.
Close observation and frequent titration are warranted until pain management is stable on the new opioid. Monitor patients for signs and symptoms of opioid withdrawal or for signs of over-sedation/toxicity after converting patients to Hysingla ER.
