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Equivalent Dose & Drug Conversions / Transfers / Switching

Welcome to the equivalent dose and drug conversions / transfers / switching section of the website for physicians and pharmacists. This section features links to a wide range of clinical resources on equivalent doses and conversions for opioids, benzodiazepines, antidepressants, antipsychotics, corticosteroids and more.

 

Thomas Jefferson University Hospital Therapeutic Interchange

Angiotensin Receptor Antagonist Therapeutic Interchange
Antihistamine. Non-Sedating Therapeutic Interchange
Beta Adrenergic Blocking Agents Therapeutic Interchange
Fibrate Derivatives Therapeutic Interchange
H-2 Antagonist Therapeutic Interchange
HMG-CoA Reductase Inhibitor Therapeutic Interchange
Inhaled Corticosteroid Therapeutic Interchange
Insulin Therapeutic Interchange
Proton Pump Inhibitor Therapeutic Interchange
Selective Serotonin Reuptake Inhibitor Therapeutic Interchange
Sulfonylurea Agents Therapeutic Interchange

Source: jefferson.edu
Clinical Resource: Tables
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Last Checked: 28/11/16 Link Error: Report It

 

Oral Proton Pump Inhibitors

Although studies exist comparing different PPIs, and some may suggest superiority of one agent over another, current NICE guidance does not recommend any particular PPI.

Of the five PPIs licensed for use in the UK (esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole), only lansoprazole and omeprazole are included on the NHSGGC Formulary. When choosing a PPI it should be noted that the licensed indications and the potential for interactions may differ between individual drugs.

Source: ggcprescribing.org.uk
Clinical Resource: Bulletin
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Last Checked: 28/11/16 Link Error: Report It

 

Antihypertensive Algorithm for Patients without Diabetes

Equivalency Chart for ACE-Inhibitors
Equivalency Chart for Angiotensin II Blockers
Equivalency Chart for β-Blockers

Source: med.unc.edu
Clinical Resource: Algorithm
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Last Checked: 28/11/16 Link Error: Report It

 

Are All Angiotensin Receptor Blockers Created Equal in the Management of Heart Failure?

This article will briefly review the classification of HF according to current guidelines, the role of ARBs in HF, review the recommended dosing for ARBs, and discuss the major ARB HF Trials.

Source: ufl.edu
Clinical Resource: Publication
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Last Checked: 28/11/16 Link Error: Report It

 

Appendix B Beta-Blockers (BB) > Page 2 - Beta-Blocker Equivalent Doses

Source: gov.bc.ca
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

How should conversion between doxazosin formulations be carried out in patients with hypertension?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Doxazosin is a long acting alpha-1 adrenergic blocker which is licensed for the treatment of hypertension. It is available as both immediate and modified release tablets.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

A Review of Critical Differences Among Loop, Thiazide, and Thiazide-Like Diuretics

This article reviews the general renal transport mechanisms of diuretics and compares and contrasts loop, thiazide, and thiazide-like diuretics.

Source: thomasland.com
Clinical Resource: Journal Article
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Last Checked: 28/11/16 Link Error: Report It

 

How is an intravenous aminophylline dose converted to an oral aminophylline or theophylline dose?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

When changing a patient’s therapy from IV aminophylline to oral therapy with either theophylline or aminophylline, the bioavailability and the salt equivalence should be considered.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Corticosteroid Conversion Table

Source: med.umkc.edu
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Corticosteroid Equivalent Dose Calculator

sterconv.html is a Javascript application which converts milligrams of various corticosteroids to the equivalent dose of Methylprednisolone. The conversion data is adapted from Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed.

Source: hedwig.mgh.harvard.edu
Clinical Resource: Calculator
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Last Checked: 28/11/16 Link Error: Report It

 

Corticosteroid converter

Corticosteroid Converter - based on anti-inflammatory potency

Source: globalrph.com
Clinical Resource: Calculator
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Last Checked: 28/11/16 Link Error: Report It

 

Dose Equivalence and Back Titration for Commonly Used Inhaled Corticosteroids

Dose equivalence for commonly used inhaled corticosteroid inhalers

Source: pharmac.govt.nz
Clinical Resource: Brochure
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Last Checked: 28/11/16 Link Error: Report It

 

What is the equivalent dose of oral prednisolone to intravenous (IV) hydrocortisone?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

From the literature, prednisolone 5mg is approximately equivalent to hydrocortisone 20mg in terms of equivalent anti-inflammatory dose.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Topical Corticosteroids
A Quick Guide to Potency, Structural Class and Cross-Reactivity

In 2005, the American Contact Dermatitis Society designated corticosteroids as allergen of the year. In response, the following classification chart has been constructed with the objective to allow for quick referencing and cross-referencing of the members of the corticosteroid family.

Source: the-dermatologist.com
Clinical Resource: Table
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Relative Potency of Selected Topical Corticosteroids

Topical corticosteroids range in potency from mild (class VII) to superpotent (class I— Relative Potency of Selected Topical Corticosteroids). Intrinsic differences in potency are attributable to fluorination or chlorination (halogenation) of the compound.

Source: merckmanuals.com
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Dose Equivalent and Changing Opioids

Considerations when switching opioids

Source: rcoa.ac.uk
Clinical Resource: Tables
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid Conversion Guidelines
Gippsland Region Palliative Care Consortium Clinical Practice Group

Opioid analgesics vary in potency, side effect and pharmacokinetic profile. Therefore the Opioid Conversion Guidelines has been developed to assist when changing opioid drug therapy.

Source: grpcc.com
Clinical Resource: Guideline
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid Conversion Ratios - Guide to Palliative Care Practice 2016
Eastern Metropolitan Region Palliative Care Consortium

Source: emrpcc.org.au
Clinical Resource: Guideline
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Last Checked: 28/11/16 Link Error: Report It

 

Opioids and Methadone Equivalents for Clinicians

We provide an opioid conversion table for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone.

Source: nih.gov
Clinical Resource: Journal Article
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Last Checked: 28/11/16 Link Error: Report It

 

A Guide to Equivalent Doses for Opioid Drugs

Source: southwest.devonformularyguidance.nhs.uk
Clinical Resource: Guide
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Approximate Equivalent Opioid Doses

Source: nhstaysideadtc.scot.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid Conversion Chart

The dosage of a new opioid is based on several factors including the available equi-analgesic dose data, the clinical condition of the patient, concurrent medications and patient safety. It is recommended that the new dose should be reduced by 30-50% to allow for incomplete cross-tolerance. The patient should be monitored closely until stable when switching opioid medications.

Source: olh.ie
Clinical Resource: Chart
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Last Checked: 28/11/16 Link Error: Report It

 

Opiate Conversion Doses

Note: these conversions are provided only as an approximate guide to equivalences and individual patient variability needs to be considered when switching from one opioid to another.

Source: wales.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Opioid dose conversion chart, syringe driver doses, rescue/PRN doses and opioid patches

Use the conversion chart to work out the equivalent doses of different opioid drugs by different routes

Source: yorkhospitals.nhs.uk
Clinical Resource: Chart
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Last Checked: 28/11/16 Link Error: Report It

 

Changing Routes of Administration of Opioids

Source: endoflife.northwestern.edu
Clinical Resource: Table
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What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Morphine is generally the strong opioid of choice and a common question is how to convert a dose of another opioid to morphine or vice versa.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

How should conversion from oral morphine to fentanyl patches be carried out?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Fentanyl patches are an effective alternative to oral morphine and a common question is how to change a patient from oral morphine to a fentanyl patch.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Conversion of Gabapentin to Pregabalin: Simple & easy

Dose equivalencies of Gabapentin & Pregabalin for the conversion protocol

Source: apsoc.org.au
Clinical Resource: Newsletter
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Last Checked: 28/11/16 Link Error: Report It

 

Is there any evidence to support the use of enteric coated (EC) over uncoated prednisolone tablets?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

As the debate continues about whether the EC formulation provides gastro-protection compared with the uncoated tablets, in addition to the cost differential of the two products (three-fold difference at time of writing based on Drug Tariff June 2013), a summary of the findings of the DTB and an update of the literature with a focus on the implications of switching formulations are presented

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

A Guide to Switching Antidepressants

Source: nes.scot.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Switching Antidepressants

The goal of this switching table is to offer a guide for physician and pharmacist in switching antidepressants. The table should be clear, easy to use and contains the most important information. Therefore, the table only contains the most commonly used antidepressants.

Source: wiki.psychiatrienet.nl
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Switching Antipsychotics

The goal of this switching table is to offer a guide for physician and pharmacist in switching antipsychotics. The table should be clear, easy to use and contain the most important information. Therefore, the table only contains the most common or special antipsychotics. There is also a group ‘rest AP’, containing antipsychotics with the same switching advice.

Source: wiki.psychiatrienet.nl
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Antipsychotic Switching: When, How, Why?

There are currently no definitive antipsychotic switching guidelines, however, certain strategies may be more appropriate in individual cases. This bulletin will review the reasons for switching, evaluate various switching methods and recommend switching strategies for individual antipsychotic agents.

Source: watag.org.au
Clinical Resource: Bulletin
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Q: Are there any general recommendations for switching from one antipsychotic agent to another?

A: It is frequently necessary to convert patients from one type of drug therapy to alternative agents within the same therapeutic category. This commonly occurs with drugs such as antidepressants, benzodiazepines, anticonvulsants, etc. In the case of antipsychotic medications, this issue must be carefully addressed. There are a number of reasons for switching patients from one antipsychotic compound to another.

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 28/11/16 Link Error: Report It

 

Haloperidol IM and oral equivalent doses

Source: hpft.nhs.uk
Clinical Resource: Table
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The Benzodiazepines > Potency

A large number of benzodiazepines are available. There are major differences in potency between different benzodiazepines, so that equivalent doses vary as much as 20-fold.

Source: benzo.org.uk
Clinical Resource: Manual
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Last Checked: 28/11/16 Link Error: Report It

 

Benzodiazepine equivalents

Source: sahealth.sa.gov.au
Clinical Resource: Conversion Chart
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Calculating equivalent doses of oral benzodiazepines

Benzodiazepines are the most commonly used anxiolytics and hypnotics. There are major differences in potency between different benzodiazepines and this difference in potency is important when switching from one benzodiazepine to another.

Source: sussexpartnership.nhs.uk
Clinical Resource: Document
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Last Checked: 28/11/16 Link Error: Report It

 

Australasian Menopause Society Guide to Equivalent HRT Doses

This Information Sheet has been developed as a guideline only to approximately equivalent doses of the different HRT/MHT products available Sept 2016. HRT is now referred to as Menopausal Hormone Therapy (MHT). The intention is to help physicians change their patients to higher or lower approximate doses of HRT/MHT if needing to tailor therapy, or remain within the same approximate dose if needing to change brands of HRT/MHT.

Source: menopause.org.au
Clinical Resource: Information Sheet
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Last Checked: 28/11/16 Link Error: Report It

 

How do you convert an oral pyridostigmine or neostigmine dose to a parenteral neostigmine dose?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

No formal guidelines for switching between oral pyridostigmine to parenteral neostigmine and no studies discussing the switch have been identified in the medical literature.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 28/11/16 Link Error: Report It

 

Intravenous-to-Oral Switch Therapy

Switching from intravenous (IV) to oral (PO) therapy as soon as patients are clinically stable can reduce the length of hospitalization and lower associated costs. While intravenous medications may be more bioavailable and have greater effects, some oral drugs produce serum levels comparable to those of the parenteral form. Medications involved in switch therapy include antibiotics, analgesics, antipsychotics, and antivirals.

Source: medscape.com
Clinical Resource: Article
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Criteria for Conversion of Medications From Intravenous to Oral/Enteral (IV/PO)
NewYork-Presbyterian Hospital

A number of commonly used medications are known to have virtually equivalent bioavailability when given by either the PO or IV routes.

Source: cumc.columbia.edu
Clinical Resource: Policy
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Last Checked: 28/11/16 Link Error: Report It

 

East Cheshire NHS Trust
Paracetamol IV to oral switch protocol

This document provides nursing, pharmacy and medical staff with a clear framework of how to switch from IV to oral paracetamol.

Source: eastcheshire.nhs.uk
Clinical Resource: Protocol
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Last Checked: 28/11/16 Link Error: Report It

 

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