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To facilitate data analysis, analgesic agents were converted into equianalgesic doses of morphine (e.
That is, the equianalgesic dose of the new opioid should be calculated via an equianalgesic table such as a mu-agonist dose chart, and, with a few exceptions, an automatic dose reduction of 25%50% should be made, except if the new drug is methadone or transdermal fentanyl.
Patients considered opioid tolerant are those who are taking at least 60 mg oral morphine per day, 25 mcg transdermal fentanyl/hour, 30 mg oral oxycodone/day, 8 mg oral hydromorphone/day, 25 mg oral oxymorphone/day or an equianalgesic dose of another opioid, for a week or longer.
Opioid rotation is undertaken by converting opioid doses using published equivalence tables and, in view of incomplete cross-tolerance, commencing with 30 to 50% of the calculated equianalgesic dose.