Converting between equianalgesic opioid dosing isn’t exactly a hard science. Given the lack of blinded trials, bidirectional conversions, dose-dependent conversions, incomplete cross-tolerance, equianalgesic discrepancies in the literature, and patient-specific factors (specifically metabolism and absorption), a “simple” equianalgesic conversion table often doesn’t do the process justice.
In addition to the issues with conversion tables, the human component can be even more problematic. While conversion tables are straightforward, there is a huge potential for lethal dosing errors. These tables deemphasize the importance of reasonable clinical judgment, which is pivotally important given the narrow therapeutic window of opioids.
A new opioid equianalgesic conversion calculator is now available on ClinCalc. I feel confident that this calculator is one of, if not the most, advanced equianalgesic calculator on the internet. Here are a few unique features that the calculator uses:
- Important safety features, such as TALLman lettering for similar opioid names as well as clinical warnings and information to alert the user of important clinical considerations
- Because some opioid conversions are not well agreed upon in the literature, dose ranges are provided to emphasize that opioid conversions are not a black/white decision process
- Advanced conversion features, like bidirectional conversions, dose-dependent conversions, and three different methods of transdermal fentanyl calculations
Given the importance of clinical judgment, creating an electronic conversion utility is no easy task. Opioid conversions are more of an art than a science. The use of both an electronic converter in conjunction with clinical judgment, however, is a very powerful combination to provide confidence and an element of evidence-based medicine into the conversion recommendation process.