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American Journal of Hospice and Palliative Medicine®
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The conversion challenge: From intrathecal to oral morphine

Robert K. Sylvester, PharmD

MeritCare Hospital, College of Pharmacy, North Dakota State University, Fargo, North Dakota

Stephanie M. Lindsay, PharmD

Pharmacy Resident, MeritCare Hospital, Fargo, North Dakota

Caroline Schauer, RN, BSN, CHPN

Hospice Liaison, Hospice of the Red River Valley Fargo, North Dakota

Numerous articles have described the methodologies used and outcomes achieved with the intrathecal (IT) administration of morphine for pain. However, only one case report has been published that describes converting a patient’s IT morphine to an oral regimen. This case report describes the experience of converting a patient’s IT morphine to oral morphine and discusses the scarcity of published data to validate suggested equianalgesic intraspinal morphine recommendations. The calculated equianalgesic oral to IT ratio in this case was 12:1. This is substantially lower than the 300:1 ratio published by Krames and the 90:1 ratio employed by a commercially available software program for calculating equianalgesic opioid doses. We recommend caution when applying existing guidelines for conversion of morphine from an IT to an oral regimen.

Key Words: intrathecal morphine • intraspinal morphine • equianalgesic doses • dosage conversion • equianalgesic conversion

American Journal of Hospice and Palliative Medicine®, Vol. 21, No. 2, 143-147 (2004)
DOI: 10.1177/104990910402100214
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This article has been cited by other articles:


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 The Annals of PharmacotherapyHome page
A. E Patanwala, J. Duby, D. Waters, and B. L Erstad
Opioid Conversions in Acute Care
Ann. Pharmacother., February 1, 2007; 41(2): 255 - 266.
[Abstract] [Full Text] [PDF]


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