Equivalent Dosing

DOSE TRIAL for Heart Failure Exacerbation: "Among patients with acute decompensated HF, high-dose loop diuretics are associated with better symptom improvement than low-dose loop diuretics at the cost of some renal impairment, while continuous diuretic infusions are no better than intermittent diuretic boluses." - Wiki Journal Club

High Dose Loop Diuretics - Take the patient's home daily oral diuretics, convert to PO furosemide if not already taking furosemide. Then convert to IV furosemide, then multiply by 2.5x to get their inpatient total daily IV dose of furosemide. Original trial had administration twice daily.

MDCalc: Steroid Equivalencies. https://www.mdcalc.com/steroid-conversion-calculator

Uptodate:

Important notes:

The doses included here provide a starting point for the purpose of comparing and switching different opioids during maintenance therapy; these are not recommended doses for the initiation of opioid therapy.

Equianalgesic conversions serve only as a general guide to estimate opioid dose equivalents. When switching to a new opioid, the initial daily dose for the new opioid determined by using the conversions in the first part of this table should be further reduced by 25 to 50% to adjust for lack of complete mu receptor cross-tolerance (except when switching to methadone, which requires a 75 to >90% reduction; refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia). In contrast, when switching between intravenous and oral administration of the same opioid, an empiric reduction of the equianalgesic dose estimate shown above is generally not necessary.

The calculated starting dose of the new opioid or new route of administration will require monitoring and further titration after making the conversion. For a review of multiple factors that must be considered for safely individualizing conversion of opioid analgesia in patients with cancer, refer to UpToDate topics on cancer pain management with opioids, optimizing analgesia.

The approximate equivalences have been rounded. Further rounding may be necessary for available tablet strengths.

The second part of this table provides conversion factors to assess the total daily oral morphine milligram equivalent (MME) dose. Total daily oral MME dose >50 mg is one factor among several that can help identify patients who may be at higher risk for overdose and may benefit from closer monitoring and coprescription of naloxone. A high daily MME dose may also be useful for identifying tolerance, and can suggest that a patient may benefit from opioid rotation. For further information refer to UpToDate content on chronic pain management.