Sedation/Analgesia, PICU, Mechanically Ventilated Patient — Converting IV to Enteral Sedation - Calculating the Dose for Opioids — Clinical Pathway: ICU

Sedation/Analgesia, Mechanically Ventilated Patient Clinical Pathway — PICU

Converting IV to Enteral Opioids – Calculating the Enteral Dose

Please note: When considering enteral conversion for patient > 50 kg wean continuous infusion until
threshold for maximum enteral dose is reached.

Continuous Medication Infusion Enteral Agent Typical Maximum Dose
Fentanyl 2.5 mcg/kg/hr
  • Morphine
  • Hydromorphone
  • Oxycodone
  • 0.45 mg/kg/DOSE every 4 hours
  • 0.07 mg/kg/DOSE every 4 hours
  • 0.3 mg/kg/DOSE every 4 hours
  • 15 mg/DOSE
  • 5 mg/DOSE
  • 10 mg/DOSE
Fentanyl < 2.5 mcg/kg/hr
  • Step 1: Calculate enteral morphine equivalent
    • Fentanyl ___ mcg/kg/hr x ___ kg x 0.18 = ___ mg enteral morphine/dose
    • Calculated dose should be given every 4 hours
  • Step 2 : Convert to desired enteral agent if not enteral morphine
    • Enteral morphine to enteral hydromorphone
      • ___ mg enteral morphine/dose x 0.15 = ___ mg enteral hydromorphone/dose
      • Calculated dose should be given every 4 hours
    • Enteral morphine to enteral oxycodone
      • ___ mg enteral morphine/dose x 0.67 = ___ mg enteral oxycodone/dose
      • Calculated dose should be given every 4 hours
Morphine 0.1 mg/kg/hr
  • Morphine
  • Hydromorphone
  • Oxycodone
  • 1.2 mg/kg/DOSE every 4 hours
  • 0.18 mg/kg/DOSE every 4 hours
  • 0.8 mg/kg/DOSE every 4 hours
  • 15 mg/DOSE
  • 5 mg/DOSE
  • 10 mg/DOSE
Morphine < 0.1 mg/kg/hr
  • Step 1: Calculate enteral morphine equivalent
    • Morphine ___ mg/kg/hr x ___ kg x 12 = ___ mg enteral morphine/dose
    • Calculated dose should be given every 4 hours
  • Step 2 : Convert to desired enteral agent if not enteral morphine
    • Enteral morphine to enteral hydromorphone
      • ___ mg enteral morphine/dose x 0.15 = ___ mg enteral hydromorphone/dose
      • Calculated dose should be given every 4 hours
    • Enteral morphine to enteral oxycodone
      • ___ mg enteral morphine/dose x 0.67 = ___ mg enteral oxycodone/dose
      • Calculated dose should be given every 4 hours
Hydromorphone 0.015 mg/kg/hr
  • Morphine
  • Hydromorphone
  • Oxycodone
  • 1.2 mg/kg/DOSE every 4 hours
  • 0.18 mg/kg/DOSE every 4 hours
  • 0.8 mg/kg/DOSE every 4 hours
  • 15 mg/DOSE
  • 5 mg/DOSE
  • 10 mg/DOSE
Hydromorphone < 0.015 mg/kg/hr
  • Step 1: Calculate enteral morphine equivalent
    • Hydromorphone ___ mg/kg/hr x ___ kg x 80 = ___ mg enteral morphine/dose
    • Calculated dose should be given every 4 hours
  • Step 2 : Convert to desired enteral agent if not enteral morphine
    • Enteral morphine to enteral hydromorphone
      • ___ mg enteral morphine/dose x 0.15 = ___ mg enteral hydromorphone/dose
      • Calculated dose should be given every 4 hours
    • Enteral morphine to enteral oxycodone
      • ___ mg enteral morphine/dose x 0.67 = ___ mg enteral oxycodone/dose
      • Calculated dose should be given every 4 hours