Hydrocodone to Oxycodone: how to convert safely
Bottom line
1 mg oral hydrocodone ≈ 0.7 mg oral oxycodone (MME factors 1 → 1.5). After converting, reduce the calculated dose by 25–50% for incomplete cross-tolerance and re-titrate to effect.
Worked example
- Total the 24-hour hydrocodone dose — say 30 mg/day oral.
- Convert to morphine equivalents: 30 mg × 1 = 30 mg MME/day.
- Convert to oxycodone: 30 ÷ 1.5 = 20 mg/day.
- Apply a 25–50% cross-tolerance reduction: start near 15 mg/day or lower, divided by the dosing interval, with breakthrough doses available.
Try it with your patient's numbers
01 · From
Current regimen
Normalized: 30.0 MME/day
24-hour MME bridge30.0MME/day→↓
02 · To
Target regimen
Incomplete cross-tolerance reduction
03 · Estimated starting pointNo reduction applied
Oxycodone 20.0 mg PO/day
30.0 mg/dayHydrocodone (PO)× 130.0 MMEnormalized÷ 1.520.0 mg/dayequianalgesic− 0%20.0 mg/daystarting estimate
Show calculation detail
1) Start: Hydrocodone 30.0 mg PO/day
2) Convert to morphine equivalent: 30.0 mg × 1 → 30.0 mg MED/day
3) Convert to Oxycodone (PO): 30.0 ÷ 1.5 → 20.0 mg/day
4) Cross-tolerance: 0%
→ Final conversion= 20.0 mg/day
!
Starting estimate, not a prescription. Round conservatively and reassess pain, sedation, organ function, interactions, and clinical trajectory before ordering.
Cautions specific to this switch
- Most hydrocodone in practice is a combination product (Norco/Vicodin) — count the acetaminophen and keep the total below 3–4 g/day, lower with liver disease or alcohol use.
- CYP2D6 conversion to hydromorphone contributes to effect; 2D6 inhibitors (paroxetine, fluoxetine, bupropion) can blunt analgesia.
- Oxycodone is metabolized by CYP3A4 and CYP2D6 — strong CYP3A4 inhibitors (azoles, clarithromycin, some antivirals) can raise levels substantially.
- No parenteral form is available in the US; if the patient will lose enteral access, plan the rotation to an IV-capable agent before it happens.
- Equianalgesic tables are population averages. Re-assess pain, sedation (e.g. POSS), and respiratory status within hours of the first converted dose, not days.
Frequently asked questions
- How much oxycodone equals 30 mg of oral hydrocodone per day?
- 30 mg/day of oral hydrocodone is approximately 20 mg/day of oral oxycodone (30 mg × 1 MME factor ÷ 1.5 = 20 mg), before any cross-tolerance reduction. Most patients switching opioids should start 25–50% below the calculated equianalgesic dose.
- What is the conversion factor from hydrocodone to oxycodone?
- Oral hydrocodone has a morphine milligram equivalent (MME) factor of 1 and oral oxycodone a factor of 1.5, so 1 mg of hydrocodone ≈ 0.7 mg of oxycodone. Equianalgesic tables are population averages — individual response varies, so titrate to effect.
- Why reduce the dose for incomplete cross-tolerance?
- Tolerance to one opioid does not fully transfer to another. When rotating from hydrocodone to oxycodone, standard practice is to reduce the calculated equianalgesic dose by 25–50% and provide breakthrough doses while re-titrating. Frail or elderly patients warrant the larger reduction.
- Is this conversion exact?
- No. Published equianalgesic factors are averages with wide interpatient variability, and they differ slightly between references. Treat the calculated dose as a starting estimate, apply a cross-tolerance reduction, and reassess pain and sedation frequently after the switch.
Creado y mantenido por Yasmine Abbey, MD, MSc · Última revisión:
Apoyo educativo a la decisión para profesionales sanitarios. No es consejo médico — verifique los resultados frente a su juicio clínico, los protocolos de su institución y las guías vigentes.