Converting from other opioids in adults
- Discontinue all other around-the-clock opioid drugs when OxyContin therapy is initiated
- Initiate dosing using OxyContin 10 mg orally every 12 hours
- It is safer to underestimate a patient's 24-hour oral oxycodone requirements and provide rescue medication (e.g., IR opioid) than to overestimate the 24-hour oral oxycodone dosage and manage an adverse reaction due to an overdose. While useful tables of opioid equivalents are readily available, there is substantial inter-patient variability in the relative potency of different opioids
- There are no established conversion ratios for conversion from other opioids to OxyContin defined by clinical trials
- 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 and for signs of oversedation/toxicity after converting patients to OxyContin
Converting from methadone to OxyContin
Close monitoring is of particular importance when converting from methadone to other opioid agonists. The ratio between methadone and other opioid agonists may vary widely as a function of previous dose exposure. Methadone has a long half-life and can accumulate in the plasma.
Converting from transdermal fentanyl to OxyContin
Treatment with OxyContin can be initiated after the transdermal fentanyl patch has been removed for at least 18 hours. Although there has been no systematic assessment of such conversion, start with a conservative conversion: substitute 10 mg of OxyContin every 12 hours for each 25 mcg per hour fentanyl transdermal patch. Follow the patient closely during conversion from transdermal fentanyl to OxyContin, as there is limited documented experience with this conversion.
