Switching from one opioid to another — also called opioid rotation (or opioid conversion) — should always be done by a healthcare provider who has the right knowledge and experience. If you’re not sure about how to do it safely, it’s best to ask someone with more expertise.
You might consider opioid rotation if a patient is getting good pain relief but also having serious side effects. When using an opioid conversion calculator, remember that the recommended dose is based on how strong each opioid is and how it’s taken (oral, patch, injection, etc.). But these calculations are only rough estimates — everyone’s body reacts differently.
Because of this, it’s important to take a cautious and personal approach. Most of the time, the dose given by an opioid conversion calculator should be reduced by 25–50% to keep the patient safe. This is especially important if:
Also, keep in mind that each opioid works differently — some act fast, while others take longer. This timing matters, so the patient doesn’t go through withdrawal or get too much medication during the switch.
Once the new opioid is started, the dose should be adjusted slowly and carefully, based on how the patient feels. Watch closely for any side effects or signs of withdrawal, such as sweating, restlessness, stomach cramps, or anxiety.
In short, opioid rotation is a useful tool, but it should always be done thoughtfully. Use an opioid conversion calculator as a starting point, but never rely on it alone — monitor each patient closely and adjust as needed.
